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Let’s Consider Two New Emerging Medical Delivery Models

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Entrepreneurial, New-Wave and Outside-the-Box Competitive Models

Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.com

[Publisher-in-Chief]

I travel quite a bit in my professional and personal life. And, have been told possess an above-average curiosity in all things medical management. I look – see and report. So, what have I noted recently?

There are a number of new-wave health care delivery models now being explored to improve the manner in which medical care can be delivered. Let’s take a quick look at two emerging options at both the individual and institutional levels.

1. The Micro Medical Practice [MMP]

A micro medical practice [MMP] is a low overhead, high-tech, labor reduced and often mobile office model that allows more physician control and patient face-time [i.e., Dr. Ramona Seidel, Annapolis, Maryland]. This concept can be extended to those patients who want or need to pay cash for their health care; high deductible health insurance, health insurance with high co pays and residuals, etc.

Or, the concept may include that seen with the practice of physician-assistant Cheryl DeMonner PA-C at the Micro Medical Practice of Santa Cruz County. William Morris MD is her supervising physician.

Source: www.micromedsc.com

2. Satisfaction Guaranteed Medical Care

At the Detroit Medical Center, patient focused medical care is taken to a competitive extreme with this promise:

“If our patients are not absolutely satisfied with any aspect of their inpatient service or overnight stay in a DMC hospital, we will credit their patient pay balance up to $100.”

Guarantee applies to all inpatient (or overnight) stays and all surgery services provided at a DMC hospital. Adjustment/Refund is dependent upon the nature of dissatisfaction as follows:

  • Tier 1 ($25) Problems with physical facilities
  • Tier 2 ($50) Inadequate communication
  • Tier 3 ($75) Excessive wait issues
  • Tier 4 ($100) Poor service from employees

And, they have the twenty-nine minute emergency room guarantee.

Source: http://doctorandpatient.blogspot.com/2007/01/29-minute-er-guarantee.html

Assessment

If you were to take a good guess as to what sort of new healthcare delivery business model will spring up next, you would be well served by looking at smaller private and more entrepreneurial entities [personal and primary care], rather than behemoth organizations [secondary or tertiary care].

Conclusion

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Implementation of the Healthcare Deficit Reduction Act

Signed by President Bush in 2006

By Gregory O. Ginn; PhD, MBA, CPA, MEd

By Hope Rachel Hetico; RN, MHA, CMP™

The Deficit Reduction Act (DRA), S. 1932, was signed by President Bush on February 8, 2006, and became Public Law No. 109-171.  Implementation of the act includes these provisions:

www.CertifiedMedicalPlanner.com

Subtitle A – Provisions Relating to Medicare Part A

  • hospital quality improvement (section 5001);
  • improvements to Medicare-dependent hospital (MDH) programs (section 5003);
  • reduction in payments to skilled nursing facilities (SNFs; section 5004);
  • phase-in of inpatient rehabilitation facility classification criteria (section 5005);
  • development of a strategic plan regarding investment in specialty hospitals (section 5006);
  • demonstration projects to permit gain-sharing arrangements (section 5007); and
  • post-acute care payment reform demonstration programs (section 5008).

Subtitle B  Provisions Relating to Medicare Part B

  • title transfer of certain durable medical equipment (DME) to patients after 13-month rental (section 5101);
  • adjustments in payment for imaging services (section 5102);
  • limitations on payments for procedures in ambulatory surgical centers (ASCs; section 5103);
  • minimum updates for physician services (section 5104);
  • three-year extension of hold-harmless provisions for small rural hospitals and sole community hospitals (section 5105);
  • updates on composite rate components of basic care-mix adjusted prospective payment systems (PPS) for dialysis services (section 5106);
  • accelerated implementation of income-related reductions in Part B premium subsidy (section 5111);
  • Medicare coverage of ultrasound screening for abdominal aortic aneurysms; National Educational And Information Campaign (section 5112);
  • improvements to patient access and utilization of colorectal cancer screening under Medicare (section 5113);
  • delivery of services at federally qualified health centers (FQHC) (section 5114); and
  • waiver of Part B Late Enrollment Penalty for certain international volunteers (section 5115).

Subtitle C – Provisions Relating To Parts A and B

  • home health payments (section 5201);
  • revision of period for providing payment for claims that are not submitted electronically (section 5202);
  • timeframe for Part A and B payments (section 5203); and
  • Medicare Integrity Program (MIP) funding (section 5204).

Subtitle D – Provisions Relating To Part C

  • phase-out of risk adjustment budget neutrality in determining payments to Medicare Advantage organizations (section 5301); and
  • Rural PACE Provider Grant Programs (section 5302).[1]

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The goal of the act is to save nearly $40 billion over five years from mandatory spending programs through slowing the growth in spending for Medicare and Medicaid. Has it been successful to-date?

Assessment

We know from personal experience that the DRA can be implemented by all healthcare stakeholders to the benefits of the industry sector in the aggregate. But, has it been?

Conclusion

And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

Editors Note: Gregory Ginn has been a professor in the Department of Health Care Administration at the University of Nevada, Las Vegas, since 2000. He received his doctorate, MBA, M.Ed., and undergraduate degree from the University of Texas at Austin, and is an inactive Certified Public Accountant registrant in the States of Nebraska and Texas. Before his current position at UNLV, he spent time teaching at Clarkson College, College of Saint Mary, University of Findlay, University of Central Texas, Stephen F. Austin State University, State University of New York at Buffalo, University of Houston at Victoria, University of Texas at Austin, and the Southwest Texas State University. Prior to his academic roles, he was an accountant for Touche Ross & Co., and an Internal Revenue Service Tax Auditor. Dr. Ginn has also been a reviewer for organizations such as: Health Care Management Review and the Health Care Administration Division of the Academy of Management. He is Treasurer for the Nevada Executive Health Care Forum and was a member of the Southern Nevada Wellness Council. His graduate teaching experience in healthcare administration is abundant, having taught courses in: Management of Health Services Organizations, Quantitative Methods, The U.S. Health Care System, Health Care Systems and Policy, Health Care Finance, Group Practice Management, Long-term Care, and Health Care Law.  He has been published in numerous journals, including Journal of Healthcare Management, Hospital Topics, Nursing Homes, Journal of Nursing Administration, International Electronic Journal of Health Education, and Hospital and Health Services Administration. His current and former professional memberships include: American College of Healthcare Executives, Nevada Executive Healthcare Forum, Academy of Management, Association of University Programs in Health Administration, Certified Medial Planner (Hon.) and Heartland Health Care Executives.

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On Hospital Revenue Cycles Management

Operational Considerations for Improvement

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

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

One of us has been an acute general care hospital administrator while the other vice-president of a clinical and medical staff.

Throughout our respective tenures, providing high quality care with improved health outcomes was our primary concern – and actually is that of most hospitals of any size, geography, or demographic. Conflicts of interest were inevitable of course, and occasionally the interest of stakeholders collided, or was ignored. And, continually we realized – and were reminded – that money matters and the maxim “no margin, no mission” applies.

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Strong Management Required for Success

Nevertheless, the foundation of strong financial health ultimately lies in effective management of the hospital revenue cycle. And, strong internal management and leadership is the basis of an enhanced revenue cycle. In practical terms, effective management means understanding the process and targeting the core of the revenue cycle in order to fine-tune and support fiscal health and business growth.

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A Triad of Processes Groupers

For us, the processes of hospital revenue cycles were grouped in three areas corresponding to the journey of a patient through the system: the front door, the middle, and the back door; to the extent possible.

1. Front-door processes are termed patient access functions and revolve around scheduling, registration, pre-admission, and admissions. When these processes are streamlined and swift; the value is most evident to a hospitals’ customers, the patients, but it is also vital to the revenue maintenance (and enhancement) of the facility. The most effective and efficient time to accomplish patient access activities is when patients and their caregivers are together. Patient access needs to be handled by highly skilled and motivated employees who can accomplish a hospital’s goals for information capture while carrying out customer service objectives. This is also the optimal stage for achieving denial management.

2. Middle processes include case management (CM) and health information management (HIM).  Those involved in the CM function act as gatekeepers to review the appropriateness of clinic referrals and ensure financial clearance is established.  CM also involves developing a plan for discharge and monitoring to ensure it is timely and appropriate to the level of care.  Another important focus of CM is the freeing up of acute care beds.

The HIM functions revolve around document management, coding, transcription, and charge capture. Financial performance can be significantly improved when case management and HIM activities are optimized by using information technologies that are integrated with process and workflow. The end result can be an increase in revenue and reduction in regulatory risk.

3. Finally, back-door processes are termed patient financial services (PFS) functions and revolve around billing, collections, follow-up, and resolution. These are the business office billing and administrative functions that support the front-line caregivers and that interface with external payers and patients to resolve outstanding accounts receivable. Back-door processes bring significant value to hospitals by reducing administrative costs, increasing collections levels, and dramatically lowering the percentage of aged accounts receivables [ARs].

Assessment

Modern hospitals today that are seeking to improve their bottom lines through better-managed and enhanced revenue cycle operations in these three areas front, middle, and back usually encounter challenges with people, processes, and technology. These challenges may be addressed by incorporating following:

  • optimizing organizational structure;
  • raising the bar through benchmarking; and
  • adopting appropriate technology.

Editors: We appreciate the ME-P input of Karen White PhD and Ross Fidler. 

www.HealthcareFinancials.com

Conclusion

Now, please tell us your hospital revenue cycles story and how these challenges were executed; successfully or not!  What benchmarks did you use for them, and were any others required. Do these operational activities conflict or compliment each other; how and why or why not?

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Understanding Patient-Focused Healthcare

Emerging Trend Focuses on the Patient

By Gregory O. Ginn; PhD, MBA, CPA, MEd

By Hope Rachel Hetico; RN, MHA, CMP™

One swelling competitive medical administration and clinical trend is patient-focused and holistic healthcare, which centers on patient needs and attempts to humanize patient care.

Definition

www.HealthDictionarySeries.com

Patient-focused healthcare therefore incorporates the following concepts, among others:

  • patient education;
  • active participation of the patient;
  • involvement of the family;
  • nutrition;
  • art; and
  • music.

These are thought to improve patient outcomes. Further, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes.

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An example of this would be classes to prepare couples for childbirth. These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.

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Assessment

We know from personal experience that this type of education is enormously beneficial in reducing stress and improving the decision-making ability of patients who are involved in healthcare processes.

www.HealthcareFinancials.com

Conclusion

And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

Editors Note: Gregory Ginn has been a professor in the Department of Health Care Administration at the University of Nevada, Las Vegas, since 2000. He received his doctorate, MBA, M.Ed., and undergraduate degree from the University of Texas at Austin, and is an inactive Certified Public Accountant registrant in the States of Nebraska and Texas. Before his current position at UNLV, he spent time teaching at Clarkson College, College of Saint Mary, University of Findlay, University of Central Texas, Stephen F. Austin State University, State University of New York at Buffalo, University of Houston at Victoria, University of Texas at Austin, and the Southwest Texas State University. Prior to his academic roles, he was an accountant for Touche Ross & Co., and an Internal Revenue Service Tax Auditor. Dr. Ginn has also been a reviewer for organizations such as: Health Care Management Review and the Health Care Administration Division of the Academy of Management. He is Treasurer for the Nevada Executive Health Care Forum and was a member of the Southern Nevada Wellness Council. His graduate teaching experience in healthcare administration is abundant, having taught courses in: Management of Health Services Organizations, Quantitative Methods, The U.S. Health Care System, Health Care Systems and Policy, Health Care Finance, Group Practice Management, Long-term Care, and Health Care Law.  He has been published in numerous journals, including Journal of Healthcare Management, Hospital Topics, Nursing Homes, Journal of Nursing Administration, International Electronic Journal of Health Education, and Hospital and Health Services Administration. His current and former professional memberships include: American College of Healthcare Executives, Nevada Executive Healthcare Forum, Academy of Management, Association of University Programs in Health Administration, Certified Medial Planner (Hon.) and Heartland Health Care Executives.

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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On Hospital CPOE Systems [Part Two]

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Computerized Physician Order Entry Systems

By Brent Metfessel; MD, MIS

A significant initial cost outlay for an organization-wide CPOE system is necessary, which for a large hospital may run into the tens of millions of dollars.  Understandably, the majority of the hospitals that have installed a CPOE system are large urban hospitals.  The up-front cost outlay may be prohibitive for smaller or rural hospitals unless there is an increase in outside revenue or third-party subsidies.

However, although it may take a few years before a positive ROI becomes manifest, there can be a significant financial return from such systems.

www.CPOE.org

Potential Benefits

The potential benefits of a CPOE system go beyond quality. Significant decreases in resource utilization can occur. In one study, inpatient costs were 12% lower and average Length of Stay (LOS) was 0.89 day shorter for patients residing on general medicine wards that used a CPOE system with decision support. Rather simple decision support tools can reap cost benefits as well. When a computerized antibiotic advisor was integrated with the ordering process, one institution realized a reduction in costs per patient ($26,325 vs. $35,283) and average LOS (10.0 days vs. 12.9 days), with all differences statistically significant.

Studies have shown that CPOE systems can significantly reduce medication error rates, including rates of serious errors.

For example, one large east coast hospital saw a 55% reduction in serious adverse medication errors after the system was installed. However, on occasion errors can actually be introduced due to the computing process; in particular, errors can be introduced if the provider accidentally selects the wrong medication from the list or drop-down menu.

Accordingly, a CPOE system should not be viewed as a replacement for the pharmacist in terms of checking for medication errors. In addition, proper user interface design such as highlighting every other line on the medication screen for better visibility and having the provider give a final check to the orders before sending are some ways of reducing this kind of error. Overall, error rates from incorrect order entry on the computer are much smaller than other medication errors prior to introduction of the system.

Appropriate use of a CPOE system helps prevent errors and quality of care deficiencies due to problems with the initiation of orders.  However, errors can also occur in the execution of orders, particularly with the administration of medications to patients.  Bar coding of medications, discussed previously, is a simple way to close the loop in medication error prevention as well as further increase the efficiency of workflow.

Despite its advantages, a CPOE system has been implemented on an organization-wide basis in only about 45% of all US hospitals and growth in implementations has been relatively slow, although about 67% plan to add a CPOE system in the next few years.  Implementing a CPOE system is not an easy task, and there is a significant risk of failure.  Most hospitals utilize vendors for implementation rather than attempting to develop the system in-house given the difficulty of hiring full-time IT talent that specializes in CPOE systems.

One critical feature of any CPOE system is to obtain physician buy-in to the technology, since they will be doing most of the ordering.  Actually, unless the system is of the highest sophistication, physicians may claim it takes more time to write orders using a CPOE system than using the paper chart, as there may be a number of drop-down menus to negotiate prior to arriving at the appropriate drug.  Real-time retrieval of information and electronic documentation, provision of on-line alerts, and the ability to use standard order sets (prepackaged sets of orders pertaining to a particular clinical condition or time period in an episode of care), when relevant, can make the net time spent on writing orders similar to using paper charts.

Doctor Acceptance

It is also important, for physician acceptance, to not overwhelm them with on-line alerts.  Clearly, the system needs to point out the more serious errors, but if the physician’s process is frequently interrupted by alerts, they may increasingly resist the system.

For example, medication allergy alerts may warn physicians not only of potential problems with medications that have an exact match to the allergen, but also, as a defensive maneuver (“better safe than sorry”), to other medications that have a related molecular structure,, even though the patient may already be taking such medication and tolerating it well.  Furthermore, allergies to medications that may result in life-threatening anaphylactic shock may not be distinguished from “sensitivities” that consist of side effects that are not true allergies and are usually much less serious.

Thus, the potential exists for frequent alert generation that would interrupt the work flow and require time spent to override the alerts, making the system difficult to use and leading to user resistance.  One suggested solution is to have a hierarchy of importance, with alerts for potentially life-threatening situations being allowed to interrupt the work flow and requiring specific override or acknowledgment, and alerts for less serious problems being “noninterruptive,” allowing easy visibility of the alert without requiring stoppage of the work flow.

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CPOE Pitfalls

Other pitfalls with respect to CPOE systems include the following:

  • crowded menus making it easy to select the wrong patient or wrong drug with the mouse;
  • fragmented information necessitating navigation through numerous screens to find the relevant information;
  • computer downtime (scheduled or unscheduled); and
  • location of terminals in busy places, which can lead to distractions and resulting incomplete or incorrect entries.

Intelligent, well-thought-out system designs can serve to mitigate many of these problems.  It is important that such difficulties appear on the systems designers’ “radar screen” and are explicitly considered in the implementation.

Pharmacists

As for pharmacists, a CPOE system will not take them out of the process. Although a CPOE system has the capability to capture many drug errors and remove the need for manual order entry, there will always be a need for pharmacists to not only give a second look at possible errors, but to take a more active role in patient care, including going on ward rounds for complex cases, defining optimal treatment, and giving consultative advice.

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Assessment

A CPOE system has the potential to give physicians ready access to patient data anywhere in the hospital as well as at home or on the road, especially with Internet-based connections. This is significant given the difficulty in obtaining patient charts for mobile providers.

In today’s environment of high expectations for care quality and pay-for-performance initiatives, enhanced quality of care can translate into financial gain. Although there is a significant up-front allocation of funds for CPOE systems, given present trends the time may arrive where there is no longer a choice but to implement such a system.

Conclusion

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On Hospital CPOE Systems [Part One]

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Computerized Physician Order Entry Systems

[By Brent Metfessel MD, MIS]

Since the late 1990s, there has been increasing pressure for hospitals to develop processes to ensure quality of care. The Institute of Medicine (IOM) has estimated the number of annual deaths from medical error to be 44,000 to 98,000.  Manual entry of orders, use of non-standard abbreviations, and poor legibility of orders and chart notes contribute to medical errors.  They also concluded that most errors are the result of system failures, not people failures.

www.CPOE.org

Other studies suggest that between 6.5% and 20% of hospitalized patients will experience an adverse drug event (ADE) during their stay. Both quality and cost of care suffer.  The cost for each ADE is estimated to be about $2,000 to $2,500, mainly resulting from longer lengths of stay. The National Committee on Vital and Health Statistics reported that about 23,000 hospital patients die annually from injuries linked specifically to the use of medications.

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The Joint Commission and the Leapfrog Group

In addition, the Joint Commission and the Leapfrog Group, a consortium of large employers, have pushed patient safety as a high priority and hospitals are following suit. The Leapfrog Group in particular highlighted CPOE systems as one of the changes that would most improve patient safety.  These patient safety initiatives have further advanced CPOE systems, since these systems have the reduction of medical errors as a prime function.  State and federal legislatures have also stepped up activity in this regard.

For example, back in July 2004, the federal government strongly advocated for electronic medical records, including the creation of the Office of the National Coordinator for Health Information Technology to develop a National Health Information Network. Consequently, regional health information organizations have been established in many states, and these are used for the purpose of expediting the sharing and exchange of healthcare data and information, although there still remain issues in terms of providing adequate funding to these programs.

In addition, consideration was given to the allocation of grants and low-interest loans to aid hospitals in implementing healthcare technology solutions.  In 2000, California first enacted legislation (Senate Bill 1875) stating that as a condition of licensure, acute care hospitals, with the exception of small and rural hospitals, submit plans to implement technological solutions (such as CPOE systems) to substantially reduce medication-related errors by January 1, 2002. Hospitals in California had until January 1, 2005, to actually implement their medication error-reduction plans and make them operational. Unfortunately, many are still not in compliance today.

Health plans also entered the patient safety stage. In 2002, one large health plan in the northeast provided a 4% bonus to hospitals implementing a CPOE system and staffing intensive care units (ICUs) with “intensivists.” Today, this goal is almost the norm, but not yet reality for all.

More than Data Retrieval 

Many hospitals have “data retrieval” systems where a provider on the wards can obtain lab results and other information. A CPOE system, however, allows entry of data from the wards and is usually coupled with a “decision support” module that does just that — supports the provider in making decisions that maximize care quality and/or cost effectiveness.

In this application of HIT, physicians and possibly other providers enter hospital orders directly into the computer. Many vendors of such systems make special efforts to create an intuitive and user-friendly interface, with a variable range of customization possibilities. The physicians can enter orders either on a workstation on the ward or in some cases at the bedside.

Features of a True CPOE System

Basic features of CPOE should include the following:

  • Medication analysis system — A medication analysis program usually accompanies the order entry system. In such cases, either after order entry or interactively, the system checks for potential problems such as drug-drug interactions, duplicate orders, drug allergies and hypersensitivities, and dosage miscalculations. More sophisticated systems may also check for drug interactions with co-morbidities (e.g., psychiatric drugs that may increase blood pressure in a depressed patient with hypertension), drug-lab interactions (e.g., labs pointing to renal impairment that may adversely affect drug levels), and suggestions to use drugs with the same therapeutic effect but lower cost. Naturally, physicians have the option to decline the alerts and continue with the order. In fact, if there are alerts that providers are frequently overriding, providers will often provide feedback that can lead to modification of the alert paradigms. Encouraging feedback increases the robustness of the CPOE system and facilitates continuous quality improvement.
  • Order clarity — Reading the handwriting of providers is a legendary problem. Although many providers do perfectly well with legibility, other providers have difficulty due to being rushed, stressed, or due to trait factors. Since the orders are accessible directly on the workstation screen or from the printer, time is saved on callbacks to decipher illegible orders as well as preventing possible errors in order translation. A study in 1986 by Georgetown University Hospital (Washington, D.C.) noted that 16% of all manual medical records are illegible. Clarifying these orders takes professional time, and resources are spent duplicating the data; thus, real cost savings can be realized through the elimination of these processes.
  • Increased work efficiency — Instantaneous electronic transmittal of orders to radiology, laboratory, pharmacy, consulting services, or other departments replaces corresponding manual tasks. This increase in efficiency from a CPOE system has significant returns. In one hospital in the southeast, the time taken between drug order submission and receipt by the pharmacy was shortened from 96 minutes (using paper) to 3 minutes. Such an increase in efficiency can save labor costs and lead to earlier discharge of patients. The same hospital noted a 72% reduction in medication error rates during a three-month period after the system was implemented. Alerting providers to duplicate lab orders further saves costs from more efficient work processes. And, in another instance, the time from writing admission orders to execution of the orders decreased from about six hours to 30 minutes, underscoring CPOE system utility in making work processes more efficient; thus positively affecting the bottom line.

Assessment

In today’s environment of high expectations for care quality and pay-for-performance initiatives, enhanced quality of care can translate into financial gain. Although there is a significant up-front allocation of funds for CPOE systems, given present trends the time may arrive where there is no longer a choice but to implement such a system.

Conclusion

Although a Computerized Physician Order Entry system alone will reap significant benefits if intelligently implemented, in order to realize the greatest benefit a CPOE system should be rolled up into a fully functioning EMR system where feasible.

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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Our New Face – Same ME-P

We Got Visual “Fly”

By Ann Miller RN, MHA

[Executive Director]

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As you may have noticed, we have a brand new look; very visual and very photographic. ME-P got fly.

But, underneath it all, we’re the same ME-P you’ve come to count on for daily essays, updates, investigative reportage, comments, gossips, breaking news, expert advice and op-ed pieces, the classifieds, and much more!

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As always, thank you for reading the ME-P, and purchasing our products and/or related consulting services. We appreciate the opportunity to serve you. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

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By Ann Miller RN, MHA

[Executive-Director]

If you want the opportunity to reach a personalized weekly audience of the financial services sector, and health care industry insiders, innovators and watchers, the Medical Executive-Post and its educational forums may be right for you?

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We are discussed, read and viewed by financial advisors, accountants, medical students, physicians, dentists, podiatrists, optometrists and industry analysts; as well as healthcare administrators, office managers, CXOs, doctor-investors, insurance agents, Wall Street insiders and nurse-executives from many hospitals, clinics and health systems in the country.

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Advertise with us and you’ll put your brand, ad, classified or promo in front of a smart & tightly focused demographic; one at the forefront of our financial services and medical marketplace of collaboratively informed, growing and professional “movers and shakers of the Health 2.0 space.”

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The DDS / Doctor [Salesman] will See [Up-Sell] you Now

Blurring the Line between Medical Professionalism … and Mercantilism

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Concerns and complaints about pushy dentists are apparently becoming more numerous among consumers, as elective cosmetic treatments and marginally effective tests and modalities are increasingly available from the same providers that patients formerly turned to for unbiased dental advice and oral healthcare. All for a price!

http://www.msnbc.msn.com/id/37198272/ns/health-oral_health

So, enter the cosmetic [rank-and-file] dentists and the elective renaissance of the profession – at least economically. An entire industry has even sprung up teaching dentists how to sell various products, and up-sell related services and procedures.

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Root-Cause [pun intended]  

Why is this happening? Economics of course! Dental profession success in eradicating cavities, caries and other common mouth disorders – which used to comprise 80% of dental procedures and income – is now a two-edge sword working against their financial self interests … damn!

In fact, I recall about three decades ago when the situation first became acute, as more than a few of our nation’s dental schools closed for lack of interest in matriculation. Right here in Atlanta, the prestigious Emory University School of Dentistry closed its doors while I myself was a patient there; and employed as a surgical resident at a nearby acute care hospital. Contemporaneous cocktail party talk and medical gossip centered on the “death of dentistry” as I exhaled a sigh of relief at my career choice.

Going forward, years later, far too many managed care contracts reimbursed so poorly that they became a loss-leader [access portal to a patient population] for dental practitioners. In other worlds, lose money or break-even on the covered services contract, but profit handsomely by offering [pushing] non-covered services to cohort contract members … and their sphere of influence.

One Word from Mrs. Robinson – Plastics

Plastic surgeons, of course, are still the doctors most commonly associated with non-covered and purely cosmetic and elective treatments such as Botox injections, facelifts and tummy tucks. But, similar elective procedures — which generally aren’t covered by insurance — are being offered by a wide variety of medical specialists.

For example, many dermatologists, who treat patients for skin cancer and other diseases, also promote treatments to smooth wrinkles, lighten age spots and remove hair. Otolarnygologists, who care for patients with conditions of the ear, nose and throat, commonly perform nose jobs, brow lifts and eyelid surgery. And, podiatrists, who are often experts at foot reconstructive, diabetic and ankle surgery, sell shoes, shoe-inserts, laser beam treatments for fungus toenails and various cosmetic and prosthetic devices for deformed toenails and crooked digits.

Medicare Limits – Privates Don’t

At least Medicare requires an ABN [advanced beneficiary notice] for non-covered medical services, and limits non-participating doctors to 115% of the Medicare fee schedule for all providers. Increasingly, some private health plans are doing and proposing, same.  

Practice Management Guru

Now, I have no issue with efficient medical practice management operations, for any specialty. In this era of managed care and health 2.0, governmental intervention is onerous, competition is fierce and patient empowerment is reversing the aging command-control medical establishment. Nor, do I have a problem with offering the entire range of therapeutic and/or elective options to any patient. This is a “good – better – best” elective marketing concept.

In fact, the third edition of our best-selling book, the Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] will soon be released this autumn www.BusinessofMedicalPractice.com. In it, we seek to educate doctors about modern business, management and economics practices; as well as the emerging participatory health 2.0 philosophy and information technology skills. Our goal is enhancing the survival potential of the independent practicing medical professional.

But, the ever expanding menu of treatment options – promoted by a trusted medical professional – should include procedural risks and complications, period of recovery and alternatives, including benign neglect [watchful waiting], marginal benefit and marginal utility, as well as price transparency.

Call this new-wave litany, a type of “informed patient business consent”.

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Aphorisms of the Past

Over the years, we have heard phrases like the following from all sorts of independent specialists. I know I have, and so have you. Many are the butt of “insider” jokes:

MD: I’m sure that appendix is hot – I have a car payment to make

DPM: Even the normal foot can be surgically improved

DO: Now, I can bill like a real MD

DDS: We can straighten out – the straightest teeth

DC: I’ll crack your back in only forty sessions … and I finance

But, these are aphorisms of the last-generation. Today we are responsible adults. Let’s grow up and become medical professionals and “DOCTORS” again … not healthcare merchants, sales sharks or equipment shills that offer strategic competitive advantages; but not real patient benefits.  

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Assessment

The old practice management business adage of yesteryear – to work longer hours, see more patients quicker, up-sell marginally effective procedures, or do more treatments in order to realize more income – will not necessarily hold true in the modern era.

http://www.washingtonpost.com/wp-dyn/content/article/2010/05/17/AR2010051703034.html

According to colleague, financial advisor and ME-P thought leader Brian J. Knabe MD – a primary care physician and current www.CertifiedMedicalPlanner.com matriculant – and textbook chapter 27 co-author on physician compensation and salary:

In the environment of Healthcare 2.0, those doctors who embrace efficiency, innovation and appropriate business models will be better positioned to optimize their incomes. 

http://businessofmedicalpractice.com/chapter-27-salary-compensation-2/

Conclusion

Comments from our dental – and other – physician readers are requested. And, so are your general or specific thoughts on this ME-P. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

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How to Post on the ME-P

A Post is not a Comment

By Ann Miller; RN, MHA

[Executive Director]

The number of comments to our ME-P posts has increased of late, and we are grateful.

Now, an increasing number of subscribers, readers and visitors are asking how they might contribute an original or modified post [not comment to a post] for our target MEP audience. And so, we offer the following guidelines.

Essay Format

Essays should be original and may not be submitted to other publications, blogs or listservs without permission. Essays must target our audience and be in the following format:

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Please be concise and limit your essay to 300-500 words or less. Use spell and grammar checker. A digital photo in JPEG format is optional.

Assessment

You must be a subscriber to post an essay or article. Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, company or service. So, be sure to subscribe to the ME-P. It is fast, free and secure.

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ME-P Security Status Update

On Posts, Comments, e-Mails and Viruses – Oh My!

By Hope Rachel Hetico; RN, MHA, CMP™

[Managing Editor]

D-oh!  If you’re having trouble posting to the ME-P, or receiving annoying and non-sense spam, you’re not alone.

Over the last 96 hours, we’ve received numerous emails from members letting us know that they’re having problems leaving comments, or receiving blast emails from the site [Several even darkly accused us of censorship and other crimes against democracy]. No; not us, for we believe that sunlight is the best disinfectant.

Based on the reports we’re getting from around the web, the problem appears to be an issue with marketing messages not intentionally sent by us and caused by a pervasive, but not malicious, nasty little computer virus. Fortunately, we believe the situation has been completely rectified, and are working on even stronger preventative firewalls. So, please accept our apologies.

And so, for the time being, if you’d like to comment on a post, you can also do so privately at: www.BusinessofMedicalPractice.com or mail us at: MarcinkoAdvisors@msn.com

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Letter from the Editor-in-Chief

Help Support the ME-P

You were among of the first; the early adopters if you will. You saw the troubling state of healthcare, medical economics, private practice and the financial services community in our country.

And, you believed in the ME-P and our “new-wave” brand of informed and collaborative investigative journalism to do something about it.

Our History

For the last three years, the ME-P has played the role of educator, watchdog and advocate for medical practice management and financial planning transparency, scrutinizing powerful people, systems and institutions that would prefer to stay out of the spotlight, highlighting the fine print that might otherwise slip past cash-strapped physicians and their consulting advisors.

As newsrooms across the country contract, in-depth investigations are viewed as a luxury that many print publications can’t afford. Journalists are getting kicked off their beats. And, when they do, we are there to help pick up the virtual baton.

The Pioneers

We’re pioneering a new, no-profit e-model, helping spearhead a movement to reinvigorate investigative and non-clinical healthcare administrative and business journalism in this country.

But, we need the support of our most loyal readers – concerned members of the healthcare industrial complex, like you – to spread the word about our mission. If you value our investigations and essays, you will tell five colleagues about the ME-P, today.

Participatory Power

You’ll see our stories in your inbox every day, so you know the types of issues we’re tackling. Our reporting speaks for itself – but we need your help to get the word out about where it’s coming from. We need your participation and collaboration to tell your colleagues.

Our Request

I’ll bet you believe in the power of investigative journalism just as much as I do. So, please tell five [5] of your colleagues that they can stay on the leading edge of the groundbreaking stories that shine a light on the unbiased nexus of medical practice and financial planning, in plain English.

Assessment

In the modern Health 2.0 era, our goal is to “bridge the gap between medical mission and profit margin.”     

Join the ME-P Nation today … and tell us what you think!   Thank you for standing up for investigative healthcare journalism. Thank you for supporting the Medical Executive-Post. Now go; please tell five [5 … or more] colleagues to subscribe. It’s fast, free and secure.

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Conclusion

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Seeking Patient 2.0 and Health 2.0 Definitional Stability

What is it – How does it work?

By Hope Rachel Hetico; RN, MHA

[Managing Editor]

The Internet is a constantly evolving service that continues to grow at an exponential rate, despite late adoption by some physician practices. 

History

Since 1995, the primary use of the internet 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 insurance benefits coverage.

More recently, physicians are finding other beneficial avenues to expand their utilization of the Internet:     

  • Direct e-mail inquiries from patients.
  • Patient educational newsletters and links to other educational sites.
  • Continuing medical education (CME).
  • Chat room, consultations, conferences or professional presentations.
  • 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.
  • Appointment scheduling patient reminders.
  • HIPAA compliant Application Service Providers (ASP) for dictation, recording, routing and speech recognition and transcription services.
  • eMR (Electronic Medical Records) and clinical medical group ware, etc.

Health 2.0, Web 2.0 and Patient 2.0

But, ever since the term “web 2.0″ was first used in 2004, there has been an inordinate amount of chatter about what web 2.0 really is and its true impact in medicine. No one’s defined it clearly, but we think the web evolution relative to healthcare essentially falls into 3 generations, as outlined in the new re-source: Dictionary of Health Information Technology www.HealthDictionarySeries.com and our related websites, wikis and professional blogs www.BusinessofMedicalPractice.com

Health 2.0 Journalists

According to healthcare visionary and uber-blogger Matthew Holt, http://www.health2advisors.com and similar other sources, Healthcare 2.0 may be defined as:

“A rapidly developing and powerful new business approach in the health care industry that uses the Web to collect, refine and share information. It is transforming how patients, professionals, and organizations interact with each other and the larger health system. The foundation of healthcare 2.0 is information exchange plus technology. It employs user-generated content, social networks and decision support tools to address the problems of inaccessible, fragmentary or unusable health care information. Healthcare 2.0 connects users to new kinds of information, fundamentally changing the consumer experience (e.g., buying insurance or deciding on/managing treatment), clinical decision-making (e.g., risk identification or use of best practices) and business processes (e.g., supply-chain management or business analytics)”.

And so, if Health 1.0 was a book, Health 2.0 is a live discussion.

Furthermore, Scott Shreeve, MD – http://blog.crossoverhealth.com [personal communication] of Cross-Over Health defines health 2.0 as:

 “A New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”

Assessment

By now, you probably realize that Health 2.0 empowers patients and worries doctors.

Writing for Time magazine recently, journalist Bonnie Rochman explored the ramifications of patients sharing information and tips online, an “empowerment movement” that she calls “Patient 2.0.”

In her piece, she profiled the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as  www.PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.

Source: http://www.healthjournalism.org/blog/2010/02/patient-20-empowers-patients-worries-doctors

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Conclusion

And so, your comments on this ME-P are appreciated. Do doctors really fear Health 2.0? What do Health 2.0 and Patient 2.0 mean to you? How would you define the terms formally, and how do you use Web 2.0 in your medical practice? Or, are you a late-adopter still waiting for governmental or CCHIT definitional clarity?

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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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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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

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.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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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Healthcare Organizations [A Journal on CD-ROM]

Journal of Financial Management Strategies

By Ann Miller; RN, MHA

[Executive-Director]

ADVERTISEMENT

www.HealthcareFinancials.com

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                                               

So, feel free to give em’ a click and be sure to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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

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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

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.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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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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

Join Our Mailing List

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. 

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

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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. 

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

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 

Get our Widget: Get this widget!

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

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.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.

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

Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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.

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

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

Get our Widget: Get this widget!

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

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

List of Healthcare IT Trade Associations

Advancing Medical Practice Success with Strategic Relationships

By Staff ReportersHDS

To be efficient in healthcare delivery today, doctors must partner and understand the resources and affiliations that are available to them. Here is a brief list of several healthcare trade associations and leading industry vendors submitted for your review.

AHIMA
The American Health Information Management Association (AHIMA) is the premier association of health information management professionals. AHIMA’s 51,000 members are dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. Founded in 1928 to improve the quality of medical records, AHIMA is committed to advancing the health information management profession in an increasingly electronic and global environment through leadership in advocacy, education, certification, and lifelong learning.

EHRA
HIMSS EHRA is a trade association of Electronic Health Record (EHR) vendors that addresses national efforts to create interoperable EHRs in hospital and ambulatory care settings. HIMSS EHRA operates on the premise that the rapid, widespread adoption of EHRs will help improve the quality of patient care and the productivity of the healthcare system. The primary mission of the association is to provide a forum for the EHR vendor community relative to standards development, the EHR certification process, interoperability, performance and quality measures, and other EHR issues that may become the subject of increasing government, insurance and physician association initiatives and requests.

HIMSS
HIMSS (Healthcare Information and Management Systems Society) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology and management systems for the betterment of human health. Founded in 1961 with offices in Chicago, Washington D.C., and other locations across the country, HIMSS represents approximately 17,000 individual members and some 275 member corporations that employ more than 1 million people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.

HITSP
The Healthcare Information Technology Standards Panel serves as a cooperative partnership between the public and private sectors for achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States. Comprised of a wide range of stakeholders, the Panel will assist in the development of the U.S. Nationwide Health Information Network (NHIN) by addressing issues such as privacy and security within a shared healthcare information system. The Panel is sponsored by the American National Standards Institute (ANSI) in cooperation with strategic partners such as the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI), and Booz Allen Hamilton. Funding for the Panel is being provided via the ONCHIT contract award from the U.S. Department of Health and Human Services.

HL7
Health Level Seven is an American National Standards Institute (ANSI)-accredited Standards Developing Organization (SDO) operating in the healthcare clinical and administrative data arena. It is a not-for-profit volunteer organization made up of providers, vendors, payers, consultants, government groups, and others who develop clinical and administrative data standards for healthcare. Health Level Seven develops specifications; the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.

MSHUG
Microsoft Healthcare Users Group (MS-HUG) unified with the Healthcare Information and Management Systems Society (HIMSS) as part of the HIMSS Users Group Alliance Program in October 2003. The unification strengthens the commitment of HIMSS and MS-HUG to better serve their members and the industry through a shared strategic vision to provide leadership and healthcare information technology solutions that improve the delivery of patient care.

WEDI
The Workgroup for Electronic Data Interchange [WEDI’s] goal is to improve the quality of healthcare through effective and efficient information exchange and management. They aim to provide leadership and guidance to the healthcare industry on how to use and leverage the industry’s collective knowledge, expertise, and information resources to improve the quality, affordability, and availability of healthcare.

Assessment

As the health information technology industry evolves, we will continue to contribute our expertise to foster ideas that shape the future of healthcare by offering more examples similar to the above.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Who did we miss? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

How Proprietary HIT Vendors May Demolish Health Reform

Top Five Issues from the Longman Report

By Staff ReportersNetwork

Here are the top five quotes from the Longman Report. The author, Phillip Longman, is a senior fellow at the New America Foundation and the author of: “Best Care Anywhere: Why VA Health Care Is Better than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.

http://www.newamerica.net/people/phillip_longman

The List 

1. Twenty years after the digital revolution, only an astonishing 1.5 percent of hospitals have integrated information technology systems. Almost all experts agree that in order to begin to deal with the problems of the health care system, this has to change. 

2. Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation. 

3. Thanks to the stimulus bill, $20 billion is about to be poured into buggy, expensive, proprietary software that will not bring the benefits the Obama administration hopes for. Rather, it will amount to a giant bailout of a health IT industry whose business model has never really worked. 

4. The VA’s open-source software allowed a nurse in Topeka, Kansas, to adapt for her own work a bar-code scanner she saw used at a rental-car agency. Her innovation cut the number of medication-dispensing errors in half at some facilities, and saved thousands of lives. 

5. While a few large institutions have managed to make meaningful use of proprietary health IT, these systems have just as often been expensive failures. In 2003, Cedars-Sinai Medical Center in Los Angeles tore out a “state-of-the-art” $34 million proprietary system after doctors rebelled and refused to use it.

Assessment 

http://www.newamerica.net/publications/articles/2004/the_best_care_anywhere 

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.

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

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

Get our Widget: Get this widget!

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

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

On PHI Security Breaches

Join Our Mailing List

New HHS Regulations

[By Staff Reporters]

Effective September 23, 2009, new regulations issued by the U.S. Department of Health and Human Services (“HHS”) will require covered entities to notify affected individuals and HHS following the discovery of a breach of patient information. These regulations are more expansive than other notification laws that may already exist. Under these new regulations, covered entities must analyze every privacy and/or security incident to determine whether a notification requirement exists and then satisfy detailed notice requirements.

Breach Defined 

According to Garfunkel, Wild and Travis PC, a “breach” may be defined as the unauthorized acquisition, access, use or disclosure of unsecured Protected Health Information (“PHI”) which compromises the security or privacy of the PHI. It is important to note that this definition of breach is broader than most state notification laws under which most covered entities have already been operating for a number of years. While state notification laws may only require notification when there is an unauthorized disclosure of social security numbers or other specific kinds of personal information, under these new Federal regulations, unauthorized access, acquisition, use or disclosure of any PHI, not just social security number, is a potential breach. Furthermore; unauthorized uses of PHI, not just access or disclosure, requires notification.

Assessment

For more info: http://www.gwtlaw.com

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Product DetailsProduct DetailsProduct Details

Evaluating a Sample Physician Financial Plan II

Stress Testing Results a Decade Later

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

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™dave-and-hope4

We are often asked by physicians and colleagues; medical, nursing and graduate students, and/or prospective clients to see an actual “comprehensive” financial plan. This is a reasonable request. And, although most doctors who are regular readers of this Medical Executive-Post have a general idea of what’s included, many have never seen a professionally crafted financial plan. This not only includes the outcomes, but the actual input data and economic assumptions, as well.

The ME-P Difference

And so, in a departure from our pithy and typically brief journalistic style, we thought it novel to present such a plan for hindsight review. But; we present same in a very unusual manner befitting our iconoclastic and skeptical next-generation Health 2.0 philosophy. And, we challenge all financial advisors to do same and compare results with us.

How so?

By using a real life plan constructed a decade ago and letting ME-P reader’s review, evaluate and critique same.

  • Part I is for a drug-rep, then married medical school student [51 pages] with no children.
  • Part II is for the same mid-career practicing physician [28 pages] with 2 children.
  • Part III is for the same experienced practitioner at his professional zenith [56 pages].   

Part II: Sample Financial Plan II

Fiduciary Advisorsfp-book2

As former financial advisors and licensed insurance agents – and a reformed certified financial planner – it is our duty to act as economic fiduciaries for clients. In other words; to put client interests above our own. This culture was incumbent in our participatory online www.CertifiedMedicalPlanner.com educational program in health economics and medical practice management; since inception in 2000.

Assessment

And so, as Edward I. Koch famously asked as Mayor of New York City from 1978-1989: “how am I doing”; we sought to ask and answer same. What did we do right or wrong; and how were our assumptions correct or erroneous?  As Certified Professionals in Healthcare Quality this is the question we continually seek to answer in medicine. And, as health economists, this is the financial advisory equivalent of Evidence Based Medicine [EBM] or Evidence Based Dentistry [EBD] etc. It is a query that all curious FAs should ask.

Note: Sample plan III to follow; so keep visiting the ME-P. Be sure to review sample plan I, right here:

Link: Sample Financial Plan I

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. As a financial advisor, accountant, financial planner, etc., we challenge you to lay bare your results as we have done. And, be sure to “rant and rave” – and – “teach and preach” about this post in the style of Socrates, with Candor, Intelligence and Goodwill, to all. Doctors – chime in – too.

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.

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

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

Get our Widget: Get this widget!

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

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.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.

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

Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

 

ASSUMPTIONS

Sample Mega Plan for a New Physician 

Joe Good, a 30-year-old pharmaceutical sales representative, and his pregnant wife Susie Good, a 30-year-old accountant, sought the services of a certified financial planner because of a $150,000 inheritance from Joe’s grandfather. The insecurity about what to do with the funds was complicated by their insecurity over future employment prospects, along with Joe’s frustrated boyhood dream of becoming a physician, along with only a fuzzy concept of their financial future. 

After several information-gathering meetings with the CFP, concrete goals and objectives were clarified, and a plan was instituted that would assist in financing Joe’s medical education without sacrificing his entire inheritance and current lifestyle. They desired at least one more child, so insurance and other supportive needs would increase and were considered, as well. Their prioritized concerns included the following:

1. What is the proper investment management and asset allocation of the $150,000?

2. Is there enough to pay for medical school and support their lifestyle?

3. Can they indemnify insurance concerns through this transitional phase of life,  including the survivorship concerns of premature death or disability?

4. Can they afford for Susie to be the primary bread winner through Joe’s medical school,   internship, and residency years?

5. Can they afford another child?

Current income was not high, and current assets were below the unified estate tax-credit. Therefore, income and estate-planning concerns were not significant at that time.

After thoroughly discussing the gathered financial data, and determining their risk profile, the CMP™ made the following suggestions: 

1. Reallocate the inheritance based on their risk tolerance, from conservative to long-term growth.

2. Maximize group health, life, and disability insurance benefits.

3. Supplement small quantities of whole life insurance with larger amounts of term insurance.

4. Create simple wills, for now. 

Sample Mega Plan for a Mid-Life Physician 

A second plan was drawn up 10 years later, when Joe Good was 40 years old and a practicing internist. Susan, age 40, had been working as a consultant for the same company for the past decade. She was allowed to telecommunicate between home and office. Daughter Cee is nine years old, and her brother Douglas is seven years old. 

The preceding suggestions had been implemented. The family maintained their modest lifestyle, and their investment portfolio grew to $392,220, despite the withdrawal of $10,000 per year for medical school tuition. The financial planning aspects of the family’s life went unaddressed. Educational funding needs for Cee and Douglas prompted another frank dialogue with their CMP. Their prioritized concerns at this point were as follows:

1. Reallocation of the investment portfolio

2. Educational funding for both children

3. Tax reduction strategies

4. Medical partnership buy-in concerns

5. Maximization of their investment portfolio

6. Review of risk management needs and long-term care insurance

7. Retirement considerations

The following suggestions were made:

1. Grow the $392,220 nest egg indefinitely.

2. Project future educational needs with current investment vehicles.

3. Maximize qualified retirement plans with tax efficient investments.

4. Update wills to include bypass marital trust creation, and complete proper testamentary planning, including guardians for Cee and Douglas.

5. Retain a professional medical practice valuation firm for the practice buy-in.

Sample Mega Plan for a Mature Physician 

At age 55, Dr. Joseph B. Good was a board-certified and practicing internist and partner of his group. Susan, age 55, was the office manager for Dr. Good’s practice, allowing her to provide professional accounting services to her husband’s office and thereby maximizing benefits to the couple from the practice. Daughter Cee was 24 years old, and her brother Douglas was 22 years old. The preceding suggestions had been implemented.  They upgraded their home and modest lifestyle within the confines of their current earnings. They did not invade their grandfather’s original inheritance, which grew to $1,834,045. Reallocation was needed. The other financial planning aspects of their lives had gone unaddressed. Retirement and estate planning issues prompted another revisit with their original CMP’s junior partner.

Their prioritized concerns at this point were as follows:

1. Long-term care issues

2. Retirement implementation

3. Estate planning

4. Business continuity concerns

The following suggestions were made:

1. Analyze the cost and benefits of long-term case insurance, funded with current income until retirement.

2. Reallocate portfolio assets and  plan for estate tax reduction, with offspring and charitable planning consideration..

3. Retain a professional practice management firm for practice sale, with proceeds to maintain current lifestyle until age 70.

If you want the opportunity to reach a personalized weekly audience of health care industry insiders, innovators and watchers, the Medical Executive-Post and its educational forums may be right for you?

Advertise with us:

https://healthcarefinancials.wordpress.com/2007/11/11/advertise/

Ann Miller; RN, MHA

[Executive Director]

Medical Executive-Post

Dictionary of Health Insurance and Managed Care

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Whither the Dictionary of Health Insurance and Managed Care?

HDS

A simple query that demands a cogent answer!

Why do we need the Dictionary of Health Insurance and Managed Care, and, why do payers, providers, benefits managers, consultants, and consumers need a credible and unbiased source of explanations for their health insurance needs and managed care products?

The Answer is Clear!

Health care is the most rapidly changing domestic industry. The revolution occurring in health insurance and managed care delivery is particularly fast. Some might even suggest these machinations were malignant, as many industry segments, professionals, and patients suffer because of them. And so, because knowledge is power in times of great flux, codified information protects all people from physical, as well as economic harm.

We appreciate the support of our sponsors. So, click-on on the links and review all dictionary products.

Link: http://healthdictionaryseries.com/TechnologySecurity.aspx

Link: http://www.findbookprices.com/author/Hope_Hetico

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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

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How to Become a ME-P Thought-Leader

Answering a Growing Chorus of Inquiries

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

[Managing Editor]hetico

The Medical Executive-Post is the complimentary companion blog to the premium peer-reviewed quarterly subscription journal: Healthcare Organizations [Financial Management Strategies]. While the perspective of our blog is private medical practitioners, the focus of our e-journal on CD-ROM is large medical groups, healthcare organizations, hospitals, healthcare-systems, ASCs, emerging healthcare institutions and medical business entities  TABLE OF CONTENTS

HOFMS

The ME-P is for Doctors

 

Currently, the ME-P is being developed as a common venue for medical professionals to share their insights on how to best manage a private medical practice. A well-established practice will have a solid financial and executive-management foundation, and will have protocols, procedures and contingency plans in place before they are ever needed in an emergency. And so, we seek new-wave and next-generation input from physicians, osteopaths, podiatrists, dentist, nurses, PAs, CRNAs and optometrists who have experience starting and running medical practices in the Health 2.0 modern era. The goal is better patient care as doctors avoid costly or tragic management mistakes.

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The ME-P is for Financial Advisors and Management Consultants

Physician advisors like attorneys, accountants, practice managers, medical billing experts, insurance agents, commercial realtors, healthcare IT experts and others are invited to display their expertise, too. You may not become rich here, but you may become famous, or at least develop an excellent client base from the doctors and practitioners reading your articles, posts and comments! Financial advisors, CMAs, CFAs, MBAs, PhDs, CFP® and Certified Medical Planners [CMP™] are also invited to strut “cognitive-stuff”, as free-labor publishing entrepreneurs! Then, we aim to unite both sectors for success.  

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Steps to Becoming a Thought-Leader

1. Send us an email with your bio and contact info.

2. Tell us why you want to write for the ME-P.

3. Send in an original writing sample.

We may follow-up and discuss your credentials and the topics you’re interested in writing about.

Assessment  

Speaking engagements, travel to exotic locales, and print or e-book chapter contributions may all be in your future because of your career launching contributions to the ME-P. Everyone has something to share and teach, and we look forward to learning from everyone joining us here. And, please feel free to contact us for deeper involvement in all www.MedicalBusinessAdvisors.com, www.HealthDictionarySeries.com or www.CertifiedMedicalPlanner.com activities. Take your career to the next level with the ME-P.

HDS

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. 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.

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

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Financial Ratio Liquidity Analysis for Medical Accounts Receivable

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Understanding Vital Balance Sheet and Income Statement Components

By Dr. David Edward Marcinko; MBA, CMP™

By Dr. Gary L. Bode; MSA, CPA, CMP™ [Hon]

Dr. Gary L. Bode CPA MSAFinancial ratios are derived from components of the balance sheet and income statement. These short and long-term financial ratio values are “benchmarked” to values obtained in medical practice management surveys that become industry standards. Often they become de facto economic indicators of entity viability, and should be monitored by all financial executives regularly.

Defining Terms

One of the most useful liquidity ratiosrelated to ARs is the current ratio. It is mathematically defined as: current assets/current liabilities. The current ratio is important since it measures short-term solvency, or the daily bill-paying ability of a medical practice, clinic  or hospital; etc.  Current assets include cash on hand (COH), and cash in checking accounts, money market accounts, money market deposit accounts, US Treasury bills, inventory, pre-paid expenses, and the percentage of ARs that can be reasonably expected to be collected. Current liabilitiesare notes payable within one year. This ratio should be at least 1, or preferably in the range of about 1.2 to 1.8 for medical practices.

Other Ratios

The quick ratiois similar to the current ratio. However, unlike the current ratio, the quick ratio does not include money tied up in inventory, since rapid conversion to cash might not be possible in an economic emergency. A reasonable quick ratio would be 1.0 – 1.3 for a hospital, since this ratio is a more stringent indicator of liquidity than the current ratio.

Assessment

A point of emphasis in the case of both the current ratio and the quick ratio is that higher is not necessarily better. Higher ratios denote a greater capacity to pay bills as they come due, but they also indicate that the entity has more cash tied up in assets that have a relatively low rate of earnings. Hence, there is an optimum range for both ratios: they should be neither too low nor too high.

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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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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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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Proactive Medical Accounts Receivable Monitoring

Forewarned is Forearmed

Dr. David E. Marcinko MBA CMP™

By Dr. Gary L. Bode; MSA, CPA, CMP™

http://www.CertifiedMedicalPlanner.org

All hospitals, medical clinics, healthcare entities, and doctors are aware that accounts receivable (ARs) represent money that is owed to them, usually by a patient, insurance company, health maintenance organization (HMO), Medicare, Medicaid, or other third party payor. In the reimbursement climate that exists today, it is not unusual for ARs to represent 75% of a hospital’s investments in current assets. And, a medical practice may have ARs in the range of several hundred thousand dollars. ARs are a major source of cash flow, and cash flow is the life-blood of any healthcare entity. It pays bills, meets office payroll, and satisfies operational obligations.

Avoidance Management

The best way to manage AR problems is to avoid them in the first place by implementing a good system of AR control. Answering the following questions may help upgrade a system of AR control:

  • Is an AR policy in place for the collection of self-pay accounts (de minimus and maximus amounts, annual percentage rate (APR), terms, penalties, etc.)?
  • Do employees receive proper AR, bad debt, and follow-up training within legal guidelines?
  • Are AR exceptions approved by the doctor, office manager, or accounting department, or require individual scrutiny?
  • Are AR policies in place for dealing with hardship cases, pro bono work, co-pay waivers, discounts, or no-charges?
  • Are collection procedures within legal guidelines?
  • Are AR policies in place for dealing with past due notices, telephone calls, dunning messages, collection agencies, small claims court, and other collection methods?
  • Are guidelines in place for handling hospital, clinic, or medical practice consultations, unpaid claims, refilling of claims, and appealing claims?
  • Are office AR policies periodically revised and reviewed, with employee input?
  • Does the doctor, hospital, or clinic agree with and support the guidelines?

Assessment

It is  typical that poor control occurs because the doctor and/or hospital is too busy treating patients, or the front office or administrative staff does not have, or follow a good system of AR control.

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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.

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 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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Understanding the PHI “Minimum Necessary” Rule

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Protected Health Information and HIPAA

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

Dr. Mata

One important concept of the Health Insurance Portability and Accountability Act [HIPAA] is the “minimum necessary” rule, which states the minimum use of Protected Health Information [PHI] to identify a person, such as a social security number, home address, or phone number.

Only the essential elements are to be used in transferring information from the patient record to anyone else that needs this information.

Financial Information Included

This is especially important when financial information is being addressed. Only the minimum codes necessary to determine the cost should be provided to the financial department. No other information should be accessed by that department. Many institutions have systems where a registration or accounting clerk can pull up as much information as a doctor or nurse, but this is now against HIPAA policy and subject to penalties. The “minimum necessary” rule is also changing the way software is set up and vendor access is provided.

Human Resources

Another challenging task is keeping up with the number of people who access PHI, because the privacy regulations allow a patient to receive an accounting of anyone who has accessed their information, both internally (within your hospital, Emerging Healthcare Organization, or medical entity) and externally (such as through your business associates).  The patient has the right to know who in the lengthy data chain has seen their PHI.  This sets up an audit challenge for the medical organization, especially if the accountability is programmed internally.  When other business associates use this PHI without documenting access to a specific patient’s PHI, no one would be accountable for a breach in privacy.

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One way to track access is through a designated record set, which contains medical or mixed billing records, and any other information that a physician and/or medical practice utilizes for making decisions about a patient.  It is up to the hospital, EHO, or healthcare organization to define which set of information comprises “protected health information” and which does not, though logically this should not differ from locale to locale.

Assessment

Overlaps from the privacy regulations that are also addressed in the security regulations are access controls, audit trails, policies on e-mail and fax transmissions, contingency planning, configuration management, entity and personal authentication, and network controls. For more information about the Security Standards final rule; reference the Federal Register.

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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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
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FINANCE: Financial Planning for Physicians and Advisors
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Appraising a Medical Practice

The “Art of the Deal” for Buyers and Sellers

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chiefdem2

Are you considering selling your practice — or merging it with another? Thinking of buying? If you are, you’re hardly alone. Despite the decline of the big physician practice management companies [PPMCs] of the 1990s, the merger-and-acquisition market remains robust for small, private practices, as they respond to the continuing financial squeeze being placed on them, in 2009.

 

Read: http://www.humana.com/providers/NewsLetters/HumanaWeb1stQ07/articles/CoverStoryOne.html

Assessment

Humana’s YourPractice is a quarterly publication for office staff, physicians and other health care providers within the Humana network, and is produced by Corporate Communications in conjunction with “Physicians Practice”.

biz-book

Note: David Marcinko is also a writer for Physicians Practice 

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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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  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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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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Sponsors Welcomed

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Dictionary of Health Economics and Finance

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Whither the Dictionary of Health Economics and Finance?

DHEF

A simple query that demands a cogent answer!

Medical professionals are struggling to maintain adequate income levels. While some specialties are flourishing, others like primary care barely moved forward, not even incrementally keeping up with inflation. In the words of Atul Gawande, MD, a former surgical resident at Brigham and Women’s Hospital in Boston, and one of the best young medical writers in America,

“Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of their practice”.

Therefore, the ability to decipher the alphabet soup of medical economics (i.e., OPHCOO, ALOS, DRG, RBRVS, behavioral health, acuity, etc), and understand those financial terms coming from clinical medicine (i.e., call premium, cost benefit ratios, IGARCH, AACPD, IBNR ABCM, internal rate of return, accounts receivable days outstanding, etc.) is vital for survival. Until we have a common language however, medical professionals cannot possess a shared vision, nor can we communicate successfully to create healthcare entities that provide quality care to patients and reasonable profits to medical practitioners.

We appreciate the support of our sponsors. So, click-on on the links below to review all dictionary products.

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Essential Insights on Successful Physician Budgeting

fp-book5Special Report for all Medical Professionals

By Dr. David Edward Marcinko; MBA

By Hope Rachel Hetico; RN, MHA

What: A Special Report Prepared upon the Request of “Podiatry Today”

Who: Dr. David E Marcinko and Hope Rachel Hetico; MHA

 

Topic: Essential Insights on Successful Budgeting

Reporter: Jeffrey Hall [Editor “Podiatry Today” Magazine]

Where: Internet Ether

Although some doctors might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a medical practice. These authors emphasize keys to smart budgeting and how to track spending and savings in these tough economic times. The universal applicability to all doctors is obvious.

Read the Report Here

Link: http://www.podiatrytoday.com/essential-insights-on-successful-budgeting

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Dictionary of Health Information Technology and Security

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Whither the “Dictionary of Health Information Technology and Security?”

DHITS

A simple query that demands a cogent answer!

There is a myth that all stakeholders in the healthcare space understand the meaning of basic information technology jargon. In truth, the vernacular of contemporary medical information systems is unique, and often misused or misunderstood. It is sometimes altogether confounding.

Terms such as, “RSS”, “eHRs”, “DRAM”, “ROM”, “USB”, “PDA”, “NPI”, “CCHIT”, and “DNS” are common acronyms, but is their meaning AND functionality truly understood?

We appreciate the support of our sponsors. So, click-on on the links below and review all dictionary products.

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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

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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

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Health Information Technology Security and Encryption

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Understanding the Risks of eMRs and Internet Connectivity

[By Carol S. Miller; RN, MBA]Sun Micro

E-mails, PDA data, and Internet connectivity, unless encrypted, can be read by anyone.  Therefore, if these items are not encrypted, physicians should be careful of what they say and how they say it, especially when discussing any patient information with other providers, vendors, or managed care organizations. In addition, just because you deleted e-mail from the system does not mean that you have deleted it from the server or from the computers that maintain copies of your server’s data.  HIPAA regulations set forth the criteria in electronically transferring patient related data via the Internet.

Secure and Encrypt Messages and Health Information

If you want secure messages, an encryption program should be used. If the message is intercepted the text will be scrambled to anyone other than your intended recipient.  Most physicians feel encryption is too time consuming; however, programs such as Pretty Good Privacy at www.pgp.com provides an easy and nearly seamless integration into e-mail and operating systems, encrypting the sensitive files but still allowing ease of communication.  PCP software developed by MIT and endorsed by HIPAA, uses privacy and strong authentication.  Only the intended recipient can read the data.  If files were intercepted, they would be completely unreadable.  Other software programs are available in the marketplace that will work using a private key – similar to a password.  Tell the program the name of the file you want to encrypt and the private key, and the program uses a mathematical algorithm to encrypt the file.  For reference material on various encryption and security software programs, search the web under “encryption” or go to one of the following sites:  www.zixit.com, www.cisco.com, www.aspencrypt.com, or www.verisgn.com.  

Assessment

In addition to encryption, the office needs a good anti-virus program that is designed to detect and prevent viruses, such as Norton Anti Virus at www.symantec.com and McAfee VirusScan at www.mcafee.com 

Conclusion

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The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition

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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Product Details

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

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Physician Property, Casualty and Liability Protection

Essentials of Risk Management

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

Medical professionals may not be familiar with the unique differences between the terms – property, casualty and liability.  Property insurance is coverage for the loss of, or damage to, real and personal property caused by fire, theft, explosion, riot, vandalism and a host of other risks.  Casualty and liability are generally interchangeable terms for the coverage of legal liability due to injury to others or damage to their property.

dhimc-book1

Personal Liability Coverage

One of the most common of all personal liability coverages is the Homeowner’s policy. This is not one policy, but several policy declarations (what is insured – the location), forms, endorsements, and “floaters,” which protect the structure of the home against loss, as well as the personal property (contents) to various degrees. Risks for homeowners need not be consistent across the country and the rates generally reflect the differences. For example, homes in the Midwest need protection from tornados, while homes along the East, West and Southern coasts need coverage for hurricanes and flood risks. 

Policy Form

The Home Owners Policy Form contains five categories of coverage for property:

  • The dwelling
  • Other structures
  • Personal property
  • Loss of use
  • Additional coverages, such as debris removal, trees, shrubs, and plants, or now, electronic theft (credit card, checking account theft).

The Contract

The contract contains three areas of Liability Coverage:

  • Personal liability
  • Medical payments to others
  • Miscellaneous liability benefits.

The Endorsements

Endorsements are an important aspect of the Homeowners coverage because they permit the customization of the coverage to the unique requirements of the individual. Two examples:

We noted that the West coast does not have tornados, however, they do have earthquakes and therefore, an endorsement can be added which will transfer the risk for earthquakes – or even volcanic eruptions. If the individual doctor has a home business, the business property can be protected against such perils as loss of business records due to fire or water damage. There is, however, no coverage for liability for providing poor professional services.

The Floaters

Finally, the Homeowners policy may contain “floaters” (named because the articles covered are moveable, thus “float around.”). The use of floaters can be very beneficial for coverage of unique or expensive electronic equipment and most commonly, jewelry. The other common personal coverage is Automobile Insurance. Forty-two states have compulsory insurance laws that require insurance on automobiles before it is registered. Various states have unique laws pertaining to:

  • Financial Responsibility, or proof of responsibility, by carrying insurance, a cash deposit, bond or security for future liability effective after an accident, which is the major criticism of these laws. 
  • Unsatisfied Judgment Funds that compensate individuals who are unable to collect from a judgment resulting from an automobile accident.
  • Uninsured Motorist Coverage is required in most states as mandated by state insurance regulators.  In essence, the insured’s own insurance company acts as the insurance company for the uninsured motorist.
  • No-fault Automobile Insurance stems from the problems associated with today’s tort law.  These policy forms, however, vary dramatically by state and a full discussion is not possible here.  Information and advice from a professional insurance agent is always recommended.

Conclusion

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Product Details

Networks Basics for Medical Professionals

Defining WANs and LANs

By Carol S. Miller; RN, MBAbiz-book13

Depending on whether the practice is housed in one or multiple-office locations and there is a need to connect multiple computers, either a local area network (LAN) or wide are network (WAN) should be part of the package consideration.

The LAN

The LAN is a computer network that covers only a small area (often a single office or building).  The advantage of a LAN (besides connecting several computers to a network system) is the ability to configure one printer for multiple stations.  The same may be said for sharing administrative, clinical, financial and operational data in real-time manner to support smooth office function.

The WAN

The WAN provides the ability to link data on one network for multiple office site locations.

www.HealthDictionarySeries.comdhimc-book25

Conclusion

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

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

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Paradigm Shift to “Defined Health Contributions” from “Defined Health Benefits” Plans

What it is – How it Works

By Staff Reporters

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In the past, according to Robert James Cimasi MHA AVA CMP™ of Health Capital Consultants LLC in St. Louis MO, many employers had defined retirement benefits for employees. Today, most retirement benefits are in the form of 401K plans where companies make defined contributions, effectively shifting the financial risk of paying for retirement to employees.

Defined Health Contributions

Defined health contributions are similar to employer-funded defined retirement contributions like 401K plans. Currently, employers pay for some portion of about half of Americans’ health insurance. Traditional employer-funded plans are those for which the employee simply fills out a form; that is, an employer will offer one or possibly two health insurance plans, and the employee fills out application paperwork. The employer administers the plan and may charge the employee a portion of the monthly premium or pay the entire premium themselves. A defined contribution plan allows companies to shift the financial risk of paying for rising health insurance costs.

Defined Health Benefits

Although part of the “benefit” of a health benefit plan is that the employer also takes care of all the administrative paperwork related to the insurance, companies are increasingly uninvolved in the administration process, opting instead to let the employee decide which plan out of many choices suits them best. For example, if an employer typically spends about $5,000 per employee per year on health benefits, the employer would use that money as a “defined contribution.” The employee then has $5,000 to spend per year on benefits, but instead of using the employer-defined health plan, the employee may choose from a variety of HMOs, preferred provider organizations PPOs, or other health plans. If the insurance premiums rise above this amount, the employee must make up the difference.

dhimc-book24Defined Contribution Package

Many employers are currently offering a defined contribution package to their employees. The definition of “defined contributions,” however, can range from one in which employers are completely uninvolved in the administration of benefits and simply give their employees cash or vouchers for the amount contributed that they can use to buy coverage, to a more “defined choice model” where employers offer a variety of health options at differing price levels along with a premium dollar contribution, and a variety of other options in between.

Risk Shifting

Thus, defined contributions shift the financial risk from the employer to the employee. Defined care is not a replacement for managed care, but will probably cause managed care to adapt under these new systems. That is, HMOs, PPOs and other managed care plans still appear to be the main choices in a defined care environment, so they are in fact a part of the system.

Assessment

Another challenge with a defined health benefit program is that the concept of risk-pooling becomes more difficult. In traditional employer-sponsored plans, rates are usually based on the pool of employees; a chronically ill employee who tries to find insurance independently may face rates drastically higher than if they had participated in an employer-sponsored plan.

MORE: www.CertifiedMedicalPlanner.org

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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