Medical Executive-Post @ Healthcare Financials.com

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Publisher-in-Chief, on September 28th, 2007 at 12:01 AM Said:

WHY YOU CAN EXPECT MORE FROM THE MEDICAL EXECUTIVE-POST?
[The Online Community of Physicians, Health Executives and Their Advisors]

Enhanced Forums: Peer-to-peer discussion forums and professional network fosters the exchange of ideas and information by section editors and industry experts.

Content Calendar: Complete list of posts and topics itemized by year, month and date; augmented with “search” functionality to quickly locate desired topics-of-choice.

Classified Ads: Uniting buyers with sellers, employers with employees, and physician-executives with personal advisors and consultants.

Ask-a-Consultant: Providing health economics solutions for the modern fiduciary era.

Shared Understanding: Creating a knowledge repository that is dynamically constructed by viewers, rather than information that has been codified and published.

Socratic Dialog: Pursuing candor, intelligence and goodwill in all things.

RSS Feeds: Get regular updates, directed to your secure email box, as new Executive-Post material is published.

To encourage Executive Post visitors to subscribe; post, comment and participate in ongoing community discussions, we’ve left commenting enabled, so feel free to speak your mind and leave all the comments you like!

SAVE & SHARE:

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Fraternally,
Dr. David Edward Marcinko; FACFAS MBA CPHQ
Certified Medical Planner™
Publisher-in-Chief
Atlanta, Georgia USA
http://www.HealthcareFinancials.com
http://www.HealthDictionarySeries.com
http://www.CertifiedMedicalPlanner.com
MarcinkoAdvisors@msn.com
Ann, on September 28th, 2007 at 11:58 AM Said:

FOR OCTOBER – NOVEMBER 2009
ME-Pr PHOTO SHARING
OUR NEWEST FEATURE*

With Apologies to Flickr

We are proud to introduce an exciting new Medical Executive-Post feature called the ME-Pr. Our goal is to aggregate and help subscribers make their related photographs available to those in our ecosystem who appreciate them; comical machinations or sad twists, interesting or ironic, shockingly complex or banal; or just plain iconoclastic. We hope the ME-Pr will make these things possible … and more!

To do this, we want you to send us photos and videos so we can post, redact and make them searchable.

Learn more: http://healthcarefinancials.wordpress.com/2009/10/01/me-pr-photo-sharing-examples-2009/

*Now in Beta
Ann, on September 28th, 2007 at 11:59 AM Said:

FOR SEPTEMBER 2009
INTRODUCING PRIVATE CHANNELS*

A private online ME-P blog channel that allows you to express yourself in a completely safe, protected, and secure environment.

Enjoy the public benefits of the ME-P, as well as the private experience of publishing your daily thoughts and ideas on your own channel; just like Pruitt’s Platform.

Learn more: http://healthcarefinancials.wordpress.com/private-channels/

Get your free private channel today!
Ann Miller; RN, MHA
[Executive Director]
MarcinkoAdvisors@msn.com
* For a limited time only!
Ann, on September 29th, 2007 at 12:01 AM Said:

FOR AUGUST 2009
ME-P PUBLISHER INTERVIEWED

What: Personal Telephonic Interview
Who: Dr. David E. Marcinko; MBA [Publisher-in-Chief], and others
By: Michael Gibbons [reporter]
For: ADVANCE Newsmagazines
Topic: The Physician Financial “Credit Crunch”
Where: Internet Ether

Maybe you’re a young dermatologist, plastic surgeon or other physician who dreams of starting your own practice. Or; maybe you’re an established professional but want to expand your palette of medical service offerings. Either way, you’ve probably made an unpleasant discovery: Banks are leery about lending today. Global recessions with seemingly no end in sight tend to give loan officers sticky fingers.

Report: “Financial Experts Share Tips on Obtaining Loans to Start or Expand a Medical Practice.”

Link: http://healthcarefinancials.wordpress.com/2009/08/02/dr-marcinko-interviewed-on-the-physician-credit-crunch/

Please send us your comments in the usual fashion. And, be sure to subscribe to the ME-P. Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Fraternally,
Ann Miller; RN, MHA
Executive Director
Ann Miller, on September 29th, 2007 at 12:04 AM Said:

FOR JULY 2009
What: Five articles for HCP [live] and the Healthcare Professionals Network
Who: Dr. David Edward Marcinko; MBA
Topic: Various
Where: Internet Ether

We are pleased to report on the response to many of our featured posts and informative articles; some positive, others not so. Of course, many of the most positive “kudos” go out to our Publisher-in-Chief, Dr. David Edward Marcinko; MBA. Most folks simply love his musings. This is appropriate since our complimentary ME-P personal blog, and its’ companion premium-institutional subscription guide: Healthcare Organizations [Journal of Financial Management Strategies] on CD-ROM, was his brain-child. He has quite the national, and international, reputation ya know.
Link: http://www.HealthcareFinancials.com

Reputation Augmentation or Decimation

Of course, for good or for bad, Dave’s reputation is sure to be augmented [cough-cough] as he begins his most recent public [private] speaking and book signing tour in the Upper Peninsula, of Michigan. As usual, he will be “teaching and preaching”, and “signing and opining.” So, contact me daily for his travel itinerary this month, and I’ll let you know his exact venue. Perhaps you’ll have time to catch-up with him. If not, just give him an electronic “shout–out” on this ME-P platform.
Link: http://healthcarefinancials.wordpress.com/dr-david-marcinko%e2%80%99s-bookings/

Book Signing and Speaking Tour

Nevertheless, Dave sure does seem to invite controversy wherever he goes. His polemics are just that note-able, and dare I say, controversial. And so, here are five more articles written by Dave and posted on the HCP Live [beta] website and Healthcare Professionals Network. The Editor, Peter Kelly, is a colleague and Dave was pleased to write for him. We all are firm believers in the motto: “Give Blog – Get Blog.” If the postings are new to you – please enjoy them all with our compliments. If not; re-read and relish them again. SEARCH word: Marcinko
Link: http://www.hcplive.com/hcplive/search

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. I’ll try to hold down the e-publishing-fort, until Dave returns in mid-July. Until then, please 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

Fraternally,
Ann Miller; RN, MHA
Executive Director
Ann Miller; RN, MHA, on September 29th, 2007 at 1:04 AM Said:

FOR JUNE 2009

What: An Interview and Special Report Exclusively Prepared for the ME-P
Who: Mr. Jack Levy, CISSP [President – Securebill, Inc]
Topic: Physician Selection of eHRs
Reporter: Amaury Cifuentes; CFP®
Where: Internet Ether

Although skeptics of eHRs abound, President Barack H. Obama’s signing of the American Recovery and Reinvestment Act [ARRA] of 2009 has created a massive push for their implementation. The Act provides $19.2 billion, including $17.2 billion for financial incentives to be administered by Medicare and Medicaid. This assistance – of up to $40 to $65 thousand per eligible physician – and up to $11 million per hospitals – begins in 2011.

Read the Report Here
Link: http://healthcarefinancials.files.wordpress.com/2009/05/jack-levy-interview.pdf

And so, please send us your thoughts and comments in the usual fashion.

Fraternally,
Ann Miller; RN, MHA
Executive Director
Editorial Staff, on September 29th, 2007 at 1:05 AM Said:

FOR MAY 2009

What: A Special Report Especially Prepared upon the Request of Podiatry Today
Who: Dr. David E Marcinko and Hope Rachel Hetico; RN, MHA
Topic: Essential Insights on Successful Budgeting
Reporter: Jeffrey Hall [Editor Podiatry Today]
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. Universal applicability is obvious.

Read the Report Here
Link: http://www.podiatrytoday.com/essential-insights-on-successful-budgeting

And so, please send us your thoughts and comments in the usual fashion.

Fraternally,
Ann Miller; RN, MHA
Executive Director
Editorial staff, on September 29th, 2007 at 1:06 AM Said:

FOR APRIL 2009

What: An exclusive telephonic and email interview.
Who: Dr. David Edward Marcinko; MBA [Editor, administrator and health economist]
Topic: The recession, economy, hospital operations, and Obama administration
Where: The telephone and internet virtual ME-P ether
Why: Providing opinions and pontifications on the healthcare industrial complex.

By: Steve Brawner
Sponsor: Medical Business News, Inc., publisher of Medical News of Arkansas

Currently, among the many dilemmas in healthcare, we seek to answer queries like:

• When will the recession end and how will it affect hospitals and physician practitioners?
• What operations and organizational policies can hospitals pursue to survive, going forward?
• How will the Obama stimulus plan affect hospitals and healthcare organizations?

Now, in as much as this controversy affects patients, administrators, politicians, Wall Street, nurse-executives and physicians alike, we went right to the source for up-to-date information regarding this current topic. Get ready for a controversial interview, and Question-Answer session, with Dr. David Edward Marcinko; Publisher-in-Chief, of this ME-P.

Link: http://healthcarefinancials.wordpress.com/2009/04/01/medical-news-of-arkansas-interviews-dr-marcinko/?preview=true&preview_id=9094&preview_nonce=d9039cf076

Link: [edited] http://www.arkansasmedicalnews.com/news.php?viewStory=738

And so, please send us your thoughts and comments in the usual fashion.

Fraternally,
Ann Miller; RN, MHA
Executive Director
Dr. Marcinko, on September 29th, 2007 at 2:00 AM Said:

FOR MARCH 2009
An exclusive email interview:

Who: Bennett Aikin; AIF®
Where: The internet virtual ether
Topic: Financial fiduciary accountability
Why: To explain a growing controversy in the financial services industry

By Hope Rachel Hetico; RN, MHA, CMP™
By Ann Miller; RN, MHA

Currently, there is a growing dilemma in the financial sales and services industry. It goes something like this:

• What is a financial fiduciary?
• Who is a financial fiduciary?
• How can I tell if my financial advisor is a fiduciary?

Now, in as much as this controversy affects laymen and physician-investors alike, we went right to the source for up-to-date information regarding this often contentious topic. Get ready for a controversial e-mail interview, and Question-Answer session, with Bennett [Ben] Aikin; AIF®; the Communications Coordinator for http://www.fi360.com

Link:
http://healthcarefinancials.wordpress.com/2009/03/01/an-interview-with-bennett-aikin-aif%c2%ae/

And so, please send us your thoughts and comments in the usual fashion.

Fraternally,
Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
Ann Miller, on September 29th, 2007 at 2:53 AM Said:

FOR FEBRUARY 2009
Audio-Video Presentations

Beginning this month, the Medical Executive-Post will begin placing your professional videos and vlogs; online. This decision was made after listening to our subscribers. Hopefully, our growing status in the new-wave electronic video medium will be elevated, too.

Our first contributions were sent in by Jeremy Engdahl-Johnson, with our thanks! Sample topics include the following:

• Will e-HRs be governed by some industry standard? Who will provide them?
• How do we achieve standardization of electronic health records?
• How has the Veterans Health Administration used electronic health records?
• Transcript: Who owns electronic health information?
• What are the benefits of electronic health records?
• How do we make an investment in healthcare during a recession?
• and more!

Link: http://www.HealthcareTownHall.com
And so, please continue to send in your informed posts and expert commentary in the usual fashion.

Fraternally,
Ann Miller; RN, MHA
Executive Director
Dr. Marcinko, on September 29th, 2007 at 2:54 PM Said:

FOR JANUARY 2009
A New “Look and Feel”

Beginning this year, the Medical Executive-Post will have a slightly new “look and feel.” The changes are being made after several cogent suggestions from astute subscribers. Hopefully, our growing status in the traditional print, and new-wave electronic publishing medium, will be elevated too. No doubt, you will note and appreciate the following changes:

• Longer posts and stories
• More in-depth reporting
• Audios and pod-casts
• More photos and images
• Crossing referencing
• More op-ed pieces
• Personalized by-line stories
• Added videos and webcasts
• Larger fonts-varying styles

We hope these changes will enhance the quality and subject-matter gravitas of the Medical Executive-Post in 2009. Our goal is to increase readership and extend our subscriber base with richer media presentations.

And so, please tell us – how are we doing? As a social network of health economics and financial professionals, laboring at the “intersection of medical-mission and profit-margin”, we are at your service.

View Annual Administrative Report: http://healthcarefinancials.wordpress.com/2009/01/05/annual-executive-post-report-for-2008-09/

Fraternally,
David Edward Marcinko
Hope Rachel Hetico
Ann Miller
Editors and Staff
Editorial Staff, on September 30th, 2007 at 12:00 AM Said:

FOR DECEMBER 2008
We’re Going “Green“ in 2009

The Medical “Executive-Post” is going “green” by rolling out its newly updated digital edition. Each day, the digital edition will provide health and financial industry coverage of information critical to your work in a fast, flexible and convenient format delivered directly to your e-mail inbox. It’s perfect for the busy life of any physician, health care executive or financial advisor interested in this vital and ever-changing space.

More info: http://healthcarefinancials.wordpress.com/2008/12/02/we%e2%80%99re-going-green/

Try our Premium Print Guide in 2009

And, for deeper hospital and institutional insight, try our quarterly 2 volume – 1,200 pages – premium subscription print journal: “Health Care Organizations [Financial Management Strategies], for only $535/year.

Order the Premium Print Guide: http://www.stpub.com/pubs/ho.htm

The subscription print guide includes up to four annual quarterly updates. Now, enjoy a 30-day risk-free trial in a unique loose-leaf binder format.
Forward: http://healthcarefinancials.wordpress.com/2008/03/09/david-b-nash-md-mba-facp/

Special E-P price:$535/yr. Call 1-800-251-0381
More information: http://www.stpub.com/pubs/ho.htm
To email purchase: email: orders@stpub.com
Visit: http://www.HealthcareFinancials.com

-Publishers, Editors and Staff
Publishers, on September 30th, 2007 at 1:01 AM Said:

FOR NOVEMBER 2008
EXCLUSIVE SPECIAL REPORT

AUTHOR: Jeffrey Coons; PhD, CFA
AUTHOR: Christopher J. Cummings; CFA, CFP™
TOPIC: Participant-Directed Investment Menus

Despite current market uncertainty, this white-paper will examine several different ways of categorizing investment options and discuss their usefulness in an average healthcare participant’s efforts to build a long-term investment program with an appropriate risk/return trade-off. We will specifically examine the problems associated with manager style classifications (e.g., “growth” versus “value” or “growth & income” versus “growth”, etc.), with the general conclusion that style categories fail to pass the test of the four basic questions listed below.

EXCERPT:

The goal of designing a participant-directed investment menu should be to provide enough diversification of roles to allow participants, physician-executives and trustees to make an appropriate trade-off between risk and return, without having so many roles as to create participant confusion. Ultimately, the burden on plan fiduciaries to adequately educate employees is largely driven by the investment decisions we require them to make in the plan, with more choices necessitating a greater understanding of the fundamental differences between and appropriate role for each choice. The logical questions that arise when selecting options on a menu are:

1. Are there clear differences among the options?
2. Are these differentiating characteristics inherent to the option or potentially fleeting?
3. Are the differences among options easily communicated to and understood by the typical plan participant?

Most importantly, if healthcare participants are given choice among these different options, can the decisions they make reasonably be expected to result in an appropriate long-term investment program?

Don’t miss it!
READ IT HERE:
http://healthcarefinancials.wordpress.com/?p=2084&preview=true
Moderator, on October 8th, 2007 at 1:35 PM Said:

HDHCPs

We can take this scenario one step further. Not only should doctors post their charges, many believe so should hospitals, medical clinics and other healthcare facilities.

For example, just recently, thirty-three state legislatures called for the nation’s hospitals to make their prices transparent through the publication of charges.

The average charge for a hip, knee or ankle replacement is $38,443, while a heart valve operation is $124,561. Such trends indeed demonstrate advancing industry competition and patient empowerment thru P4P initiatives, Evidence Based Medicine, and Consumer Directed Healthcare, etc.

Interestingly, a random “secret shopper” call around our town for pricing information from docs and hospitals produced misguided comments like:

* It’s illegal to quote fees
* Don’t worry, we accept all insurance plans and HMOs
* We can’t give out that information
* I don’t have that information
* Why don’t you apply for Medicaid public assistance?
* We’ll get back to you
* etc.

Your own thoughts are appreciated?
The Editors
An RN, on October 10th, 2007 at 7:15 PM Said:

I did some research on CDHCPs and physician charges. It seems that Torrance California based HealthCare Partners now notes on its Website that it charges $15 for flu vaccines, $61 for a chest X-ray, and $424 for a colonoscopy.

But, you are right. Thus far, docs and most clinics and hosptitals do not want to compete based on price, let alone quality, like the rest of capitalistic society. Not yet, anyway!
A moderator, on October 11th, 2007 at 11:17 AM Said:

Good comments, all.

But, the point of an interactive blog is to have a dialogue, to learn from others’ POV, to advance our collective knowledge, experience and wisdom, and to offer solutions or new options to various problems.

So, let’s keep up the chatter on this, related, or any other topics of healthcare administration modernity.

-The Moderators
Dr. Marcinko, on October 13th, 2007 at 12:49 PM Said:

An anonymous private viewer sent me this report which appeared in Modern Healthcare magazine, in January, 2007.

“This week, the CEO of Boston’s Beth Israel Deaconess Medical Center did an astonishingly candid thing.

He posted his salary on his blog, discussed what his additional financial incentives were, described how his salary was set by board members and–get this–asked his readers, flat out, in all apparent humility, whether they thought he was overpaid. (Yes, the public can get these numbers on their own, through public not-for-profit documents, but still, how many CEOs take this extra step?)

The executive, Paul Levy, vowed to post any responses he gets to the question on his “Running A Hospital” blog, as long as they don’t contain unprintable language. Early feedback is quite thoughtful and nuanced.”

So, why not tell us what you think about this topic?

DEM
Moderator, on October 15th, 2007 at 1:31 PM Said:

How About Medicare Data Transparency?

In a decision that could have major implications for the fee and clinical outcomes transparency movement, HHS was recently forced to release Medicare claims data for physicians practicing in Illinois, Maryland, Virginia, Washington and Washington, D.C., according to the U.S. District Court for D.C.

The case was brought by to two organizations, Consumers CHECKBOOK and the Center for the Study of Services, which hope to use the data to analyze physician performance.

HHS argued releasing the data would violate physician privacy, but the court rejected that argument, noting Medicare claims constitute only a portion of physicians’ incomes. (The AMA hasn’t weighed in yet on how it feels about this ruling.) Under the terms of the decision, HHS released the data on Sept. 21 for online and public use. The groups involved have requested similar data for the other 46 states.

Your opinion counts?

-The Moderators
A Manager, on October 15th, 2007 at 4:41 PM Said:

I sure was.
Thanks for the info.
I will look right into the matter.

Incidentally, I have been using this health IT dictionary, which is an excellent related resource on the general topic.

http://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5/102-1513624-8633705?ie=UTF8&s=books&qid=1192466267&sr=1-5

Best of luck to all!

-A HIT Manager
Martin Jensen, on October 15th, 2007 at 7:53 PM Said:

FYI, I have been covering the NPI issue on my blog, the HIT Transtion weblog at http://blog.hittransition.com. You can read up on NPI issues by clicking on the National Provider Identifier category link in the right-hand margin.
Darrell, on October 15th, 2007 at 10:44 PM Said:

Does anyone know what percentage of providers already have NPI numbers?
Thanks.

-Darrell
Anonymous, on October 16th, 2007 at 6:02 PM Said:

CMS Announces New Income-Based Premiums

Forget about P4P for the providers; just look what CMS just did to MC patients based on income.

While the standard monthly Medicare Part B premium in 2008 will remain less than $100, the roughly 5% of individual and married enrollees with higher incomes will pay more if they choose to remain in the outpatient program.

Individual income Joint income Premium

Less than $82,001 Less than $164,001 $96.40
$82,001-$102,000 $164,001-$204,000 $122.20
$102,001-$153,000 $204,001-$306,000 $160.90
$153,001-$205,000 $306,001-$410,000 $199.70
More than $205,000 More than $410,000 $238.40

Source: Centers for Medicare & Medicaid

Now, what say ye?
Barbara, on October 19th, 2007 at 12:56 AM Said:

NPI Readiness

Darrell, the CMS reported that as of January 2007, over 1.6M providers have obtained an NPI.

And, a recent survey of the health care industry, conducted by the Workgroup for Electronic Data Interchange (WEDI), indicates that providers should have already obtained an NPI and be focusing on implementation and testing with health plans and clearinghouses. If you have not obtained your NPI by now you should do so immediately so that you can begin the implementation and testing process.

Thanks

NOTE: For related health IT terms: http://www.HealthDictionarySeries.com
-The Moderators
Hope, on October 19th, 2007 at 10:41 AM Said:

NPI Questions

More NPI information and education can be found at the CMS website NPI page: http://www.cms.hhs.gov/NationalProvIdentStand

Providers may also apply for an NPI online at http://www.nppes.cms.hhs.gov or may call the NPI enumerator to request a paper application at 1-800-465-3203.

Dr. David E. Marcinko
Hope Hetico; RN, MHA, CMP
[Chief and Managing Editors]
http://www.HealthCareFinancials.com
Darrell, on October 19th, 2007 at 2:52 PM Said:

Dear Barbara:

You told me that 1.6M providers had obtained NPI numbers a year ago. Can you tell me what the sample size was back then? I was also hoping for more recent information.

Hope, I looked over the website you mentioned and there is nothing offered that comes close to answering my questions.

I would also like to know how the numbers are broken down by Type 1 and Type 2 as well as by state and specialty. I was hoping that I would not have to file a request under the FOIA to obtain this information.

Whether or not I personally have an NPI number or not should have nothing to do with my request for important information that some seem to want to keep hidden.

Darrell Pruitt DDS
Hope, on October 19th, 2007 at 7:16 PM Said:

Any CDHCP fee-schedule study for hospitals and clinics at the procedure-code level must present (1) an analysis of suggested rate changes designed to enhance the defensibility and transparency of proposed pricing, and (2) maximize the amount of revenue collected per dollar of rate increase.

This analysis must be designed to allow management to impose a variety of restrictions on rate increases. All things being equal, the following parameters should also be considered:

• Pricing transparency
• Cost-based pricing
• Across-the-board price adjustments
• Market-based pricing constraints
• Historic self-pay recovery
• Patient consumer demographic distributions, and
• Any other unique local situations.

Your thoughts on CDHCPs at the enterprise wide level are appreciated?
-Hope Hetico; RN, MHA, CMP
Anonymous, on October 22nd, 2007 at 12:45 AM Said:

Definition of HL7?

Can anyone tell me what exactly HL7 is, and why?
Thanks

-A
Hope Hetico; RN, on October 22nd, 2007 at 12:49 AM Said:

What is HL7?

ANSWER: According to the webstite: http://www.HL7.org

“Health Level Seven (HL7) is one of several American National Standards Institute (ANSI) – accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data.”

“Headquartered in Ann Arbor, MI, Health Level Seven is like most of the other SDOs in that it is a not-for-profit volunteer organization. Its members– providers, vendors, payers, consultants, government groups and others who have an interest in the development and advancement of clinical and administrative standards for healthcare—develop the standards. Like all ANSI-accredited SDOs, Health Level Seven adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest.”

A frequent misconception about Health Level Seven (and presumably about the other SDOs) is that it develops software. In reality, 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.

Members of Health Level Seven are known collectively as the Working Group, which is organized into technical committees and special interest groups. The technical committees are directly responsible for the content of the Standards. Special interest groups serve as a test bed for exploring new areas that may need coverage in HL7’s published standards.

A list of the technical committees and special interest groups as well as their missions, scopes and current leadership is available on their web site.

Best.
Hope Hetico; RN, MHA
Atlanta, Georgia
Anonymous Doc, on October 22nd, 2007 at 10:37 AM Said:

Hello All,

The material on electronic medical records and HIT in your print-guide is excellent. Dr. Mata and Dr. Metfessel are unbelievable writers, experts and thought leaders on hospital and enterprise-wide information technology systems.

But, is there an information source on EHRs for us solo or small medical group practitioners? Any info at all is appreciated.

Thanks.
Staff, on October 22nd, 2007 at 10:39 AM Said:

A Doc,

Try these website resources, without guarantees or “quid-pro-quo”:

http://www.EMRupdate.com
http://www.GreenwayMedical.com
http://www.e-MDs.com
http://www.EMRexperts.com
http://www.NextGen.com
http://www.AllScripts.com

Thanks for the compliments on “Healthcare Organizations [Financial Management Strategies].”
Other sources are encouraged.
All the best.

-Moderators
Joseph, on October 28th, 2007 at 1:03 PM Said:

Cart Before the P4P Horse?

Sorry senior patients, but MC premiums are a bargain.
So, let’s not put the cart before the P4P horse.

According to Stephen Beller PhD, of National Health Data Systems Inc, something must be done to increase the value (cost-effectiveness) of medical care delivered to patients in our broken healthcare and unsustainable Medicare model.

Beller suggests that the problem with today’s pay-for-performance [P4P] and no-pay-for-poor-performance initiatives is a cart-before-the-horse issue for which there is a solution–one that requires a shift of focus and priorities, and to stop pretending we know more than we do.

Instead of pretending, we should be obtaining and using the knowledge we need by investing more in clinical research (in both lab and field) and advanced information systems that provide next-generation decision-support, collaboration, and continuity of care capabilities.

He recommends that our focus be on transforming the current healthcare system to a value-based system that pays for the research, collaboration and information systems needed to establish, evolve, disseminate and use evidence-based guidelines that are tailored to each patient’s particular needs.

Financial incentives then should go to the providers who engage in this knowledge-building and utilization process, rather than simply rewarding those who follow today’s inadequate guidelines.

Once valid and reliable patient-specific best practice guidelines are established, some pay for performance (P4P) makes sense. If premature with P4P however, we might actually do more harm than good, as we risk lulling ourselves into a false sense of security.

Any thoughts?
Joseph
Dr. Marcinko, on October 28th, 2007 at 1:22 PM Said:

Reimbursement Alternatives!

Readers might wish to check out this related article:
http://content.nejm.org/cgi/content/extract/357/15/1547
in the New England Jouranl of Medicine.
It points out two potential future reimbursement changes.

1. One, is to not pay for medical mistakes.
2. The other is to not to pay for lack of performance (British initiative).

Your informed thoughts are appreciated.
-Dr. Marcinko
Ann, on October 29th, 2007 at 4:41 PM Said:

P4P Benefits versus Costs?

Q: Are the benefits of pay-for-performance programs worth the cost and hassles to provider organizations to participate.

Answer: A recent poll by Health Data Management suggests to-date:
Agreed = 306 [42.21 %]
Disagreed = 419 [57.79 %]

Feel free to opine relative to your own healthcare organization.
-The Moderators
Howard, on October 29th, 2007 at 5:28 PM Said:

Hospitals and Fee Schedules

Did you know that hospital chain Health Management Associates [HMA] has vowed to take a tougher line in collecting from self-pay patients, in a move designed to rid the chain of a reputation for being less aggressive than its competitors?

According to sources this week, the chain told the investment community that this loss comes partly from a higher volume of uninsured patients attracted by its generosity.

HMA, which has 59 hospitals, has taken a beating financially over the past year. Despite an 8.2 percent gain in revenue, net income for the third quarter ended Sept. 30 was $30.5 million, less than half of the company’s $74.4 million net income for the third quarter of 2006.

HMA, which already gives uninsured patients 60 percent discounts off of gross charges, will now begin asking patients to sign a promissory note before leaving the hospital and moving their accounts to collection agencies sooner.

How does this bode for CDHCPs and private pay patients?
And, as a patient, don’t forget an invoice review firm, like http://www.billadvocates.com

-The Moderators
Anonymous II, on October 30th, 2007 at 11:57 AM Said:

Virtual Medical Visits and Questions Regarding Future 802.11n Wireless Deployments

While most experts do not expect wholesale virtual medical visits (VMVs), or even a ratified IEEE 802.11n standard anytime soon, several vendors have already starting shipping “Pre-N” products, leading more healthcare organizations to question how the upcoming standard will play into their Wi-Fi plans.

The promise of increased coverage, security and performance of 802.11n has created a firestorm of questions and uncertainty within the HIT community.

For example, here are five key questions that every HIT administrator should consider:

• What modes of 802.11n should be used?
• Is our wired LAN or health network ready for 802.11n?
• What will users, nurses or doctors require for 802.11n?
• What HIT security changes will need to be made?
• What changes to wireless management are required?

Ultimately, HIT administrators need to get a head start on understanding 802.11n and how the next Wi-Fi standard will impact not only their wireless network, but their wired infrastructure as well.

And so, although 802.11n is not likely to become a Wi-Fi standard until 2009, 802.11n planning must start now to overcome operational and technology issues that may portend new architectures and deployment guidelines for a successful rollout of VMVs, or similar, in your healthcare organization.

Any thoughts are appreciated?
-Moderators
Anonymous, on November 6th, 2007 at 12:20 AM Said:

RE: NPI Database
From: A friend
A free and very easy-to-use NPI number database lookup is available here: http://npinumberlookup.org

Best.
-Anonymous
A Reporter, on November 7th, 2007 at 11:36 AM Said:

Zagat to Rank Doctors

Zagat Survey and WellPoint will soon allow consumers to rate physicians. In the next several months, an online physician ranking guide based on patient input to more than one million members will be released. The guide will rank physicians based on trust, communication, availability and office environment on a 30-point scale. The guide also will include patient comments. At least 10 responses about a physician will be required before any information is posted.

WellPoint plans to roll out the survey to all of its 35 million members. Physician ranking sites provide transparency and are part of consumer-driven health and P4P initiatives, according to some experts.

Source: Chicago Tribune via American Health Line [11/6/07]
A CMITO, on November 7th, 2007 at 8:06 PM Said:

More NPI Links

CMS Resources:
http://www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp

WEDI National Provider Identifier Resource Center:
http://www.wedi.org/npioi/public/articles/index.cfm?fuseaction=link

National Plan and Provider Enumeration System (NPPES)
https://nppes.cms.hhs.gov/NPPES/Welcome.do
A Health Accountant, on November 12th, 2007 at 11:46 AM Said:

… But a Modest Medicaid Pay Increase

According to the Kaiser Family Foundation and Health Management Associates, thirty-three states plan to increase their Medicaid payment rates for doctors in 2008. Many also are ready to expand eligibility and to use the program to cover more of the uninsured. Enrollment dropped in 2007 for the first time in a decade, apparently due to the improved economy and new citizenship rules.
Ann, on November 13th, 2007 at 2:13 PM Said:

Increased Medical Practice Costs

Two recent MGMA studies highlight the rising costs faced by US medical practices. One study shows that costs are increasing more rapidly than revenue for many practices; another indicates that participation in the Medicare quality reporting program burdens practices with additional costs and administrative hassles.

And so, have you discerned this trend in your practice, clinic or medical facility; and what are you doing about it?
An Accountant, on November 15th, 2007 at 11:47 PM Said:

Blue Cross / Shield “Never-Events” and P4P?

According to Kevin Shanklin, executive director at the Blue Cross and Blue Shield Association, discontinuing payments for NEs may take several years as coding rules are updated to make them easier to identify in claims. And, although no Blues plans are denying payments for never events currently, some will be moving more quickly than others to discontinue payments.

#1: So, do you believe that other insurers will adopt similar policies?

#2: Should the Blues be “taken-to-task” for procrastination with the obvious?

#3: Finally, how should NEs affect P4P initiatives?
Hope, on November 21st, 2007 at 10:23 AM Said:

FOR OCTOBER 2008
EXCLUSIVE SPECIAL REPORT
American Medical News Interview [September 15, 2008]

INTERVIEWED: Dr. David Edward Marcinko; MBA, CMP™
REPORTER: Karen Caffarini
POSITION: Executive-Post Publisher-in-Chief, former president of a PPMC in the Mid-West and Certified Financial Planner ™; noted author, speaker, health economist and medical practice management evangelist.

TOPIC: “Medical Practice Appraisals and Valuations”
[[Unedited Question-Answer Interview]

EXCERPT: “The allocated purchase price must be reported to the IRS. Goodwill is considered a capital asset. Therefore, the seller will want to allocate as much of the selling price to goodwill as possible. The buyer will want to allocate more of the selling price to non-goodwill assets because goodwill amortization is not tax deductible while depreciation and amortization of other assets is tax deductible. This “negotiated” goodwill will stand as the IRS value.

Thus, the IRS has effectively forced the controversial goodwill determination on practice buyers and sellers. This makes it even more imperative for buyers to specifically identify any hidden practice assets they are acquiring at the time of purchase; or for purchasers to discover them.”

Dark Humor
Q: What asset class might have less value right now than a toxic credit-debt-swap-obligation [CDSO]?
A: A private medical practice!

Don’t miss it!
READ IT HERE:
http://healthcarefinancials.wordpress.com/2008/10/09/q-a-interview-on-medical-practice-valuations/
Executive-Post, on November 22nd, 2007 at 2:03 PM Said:

FOR SEPTEMBER 2008
EXCLUSIVE SPECIAL REPORT
HIPAA Rules and Dentistry

AUTHOR: By Darrell Pruitt; DDS
POSITION: A private practice dentist in East Fort Worth, Texas and previous contributor to the Executive-Post on the NPI conundrum.

TOPIC: A Survey of Dentists [Pilot Study]

A survey of 18 dentists was performed using the Internet as a platform. The dentists were presented with ten HIPAA compliancy requirements followed by a series of questions concerning their compliancy as well as the importance of the requirements in dental practices.

Frustration with the tenets of the mandate, as well as open defiance is evident by the written responses. In addition, it appears that a dentist’s likelihood of satisfying a requirement is related to the dentist’s perceived importance of the requirement. Even though this is a limited pilot study, there is convincing evidence that more thorough investigation concerning the cost and benefits of the requirements need to be performed before enforcement of the HIPAA mandate is considered for the nation’s dental practices.

EXCERPT: “Dr. Gerald Daniel seems to have captured many of the dentists’ feelings about the HIPAA Rule when he lamented, “We try to comply, however many times I feel every government agency in the country wants to run my practice without regard to the problems, expense or aggravation it causes the health provider.”
Don’t miss it!

READ IT HERE:
http://healthcarefinancials.wordpress.com/2008/09/01/hipaa-rules-and-dentistry/
Executive-Post, on November 23rd, 2007 at 11:03 AM Said:

FOR AUGUST 2008
EXCLUSIVE SPECIAL REPORT
Physician Recruiting Success
AUTHOR: Allison McCarthy; MBA

POSITION: [Principal-Barlow/McCarthy]
http://www.barlowmccarthy.com Contact: 866.315.7774

Allison McCarthy has worked in healthcare for more than 20 years, first as an allied health professional and then moving into physician strategies leadership positions in both community and academic medical centers. As an experienced speaker, she presents at national and regional conferences and is a lead faculty member at the Physician Recruitment Intensive Training program provided by the American Academy of Medical Management (AAMM). Ms. McCarthy is the author of A Practice Development Primer and President of the New England Society for Healthcare Strategy.

TOPIC: Physician Recruiting Success [Senior Leadership's Contribution]

EXCERPT: “If you’re recruiting physicians to your organization, then you probably feel challenged by internal disconnects that hinder your progress. More than likely you deal with one or more of them daily. And for many of these issues you need your senior leader to be your ally, champion and advocate, helping you navigate around those obstacles.

But, exactly what skill set within your leader is your most important resource? And how can you optimize those attributes when you need them?”

Don’t miss it!
READ IT HERE: http://healthcarefinancials.wordpress.com/2008/08/01/physician-recruiting-success/
Executive-Post, on November 25th, 2007 at 5:00 PM Said:

FOR JULY 2008
EXCLUSIVE SPECIAL REPORT
Understanding Financial Designations and Certifications

AUTHORS: Dr. David Edward Marcinko; MBA, CMP™ and Hope Rachel Hetico; RN, MHA, CMP™

POSITION: Publisher-in-Chief, and Managing Editor of the Executive-Post, respectively.

TOPIC: Financial Designations and Certifications [Alphabet Soup of Industry Obfuscation and Self-Promotion, or Real Gravitas – You Decide?]

EXCERPT: “Until recently, most financial advisors were regulated by the NASD, the National Association of Securities Dealers. Now the Financial Industry Regulatory Authority or FINRA is the largest non-governmental regulator for all securities firms doing business in the United States. It is a self-regulatory agency comprised of the nation’s brokerage firms. Upon completion of a required exam the FINRA will issue a variety of licenses. The most common are the Series 6, 7, and 24.

The Series 6 is essentially a license to sell packaged products, namely mutual funds. It is most commonly held by insurance agents and bank representatives. It is considered a very easy test. Holding such a license allows the holder to collect commission income through its member firm.

The Series 7 exam is a bit more difficult and includes issues relating to individual securities such as stocks, bonds and limited partnership interests. The pass rate is lower than the Series 6. The probable culprit is the extensive questioning on margin and options, topics most are unfamiliar with prior to entering the securities business.

The Series 24 covers issues of compliance and supervision and is required of Branch Managers of brokerage firms. All registered representatives (the proper name for a broker) must be supervised by someone with a Series 24, also known as a principal’s license.

Checking the background of a registered representative, a branch manager or a member firm is easily done through NASD and/or FINRA Regulation, Inc. NASDR/FINRA maintains the Central Registration Depository (CRD). The CRD can be checked for a description of a disclosed event by phone or by Internet. One should request information on an advisor’s firm as well as the individual. A reputable advisor at a disreputable firm has its own set of potentially dangerous implications.

Regardless of the above, these tests produce licenses to sell financial products. They are not educational achievements. There is virtually no academic barrier to entry for them. Stock-brokers today – hate the term – and prefer “financial advisor”; yet the term has no real meaning other than as a sales license.

Some are college graduates, and beyond; while some other experts argue too many are not!”

Don’t miss it!
READ IT: July 1, 2008
http://healthcarefinancials.wordpress.com/2008/07/01/alphabet-soup-of-financial-designations-and-certifications/

Related: 8 Things your Financial Planner won’t tell You!http://articles.moneycentral.msn.com/RetirementandWills/CreateaPlan/8ThingsYourFinancialPlannerWontTellYou.aspx
Sharon, on November 26th, 2007 at 11:41 AM Said:

Don’t Forget Money Velocity!

The velocity of money is the rate of circulation in the money supply. The more often money changes hands, the greater the level of commerce. The velocity of money is determined by money supply, interest rates, inflation, commerce and the Federal Reserve.

Medical professionals, like most consumers, tend to hold less money as interest rates and inflation increase, and therefore the velocity of money increases.

Velocity is reduced when people increase their money holdings. This occurs in periods of low interest rates and low inflation; the opposite when rates and inflation are high.

Most domestic and health economists suspect we are entering a period of slower growth and reduced velocity.

I see the results of money velocity and the Fed in my daily medical clinic revenue cycle management work.

Sharon
Healthize your Christmas : 10 Healthy Holiday Foods by Health Tips, on November 26th, 2007 at 1:25 PM Said:

[...] Domestic and Health Economic Indicators! [...]
Executive-Post, on November 27th, 2007 at 12:52 AM Said:

FOR JUNE 2008
EXCLUSIVE SPECIAL REPORT
Evolutionary Shifts in the Primacy of Medical Ethics
[Philosophic Ruminations and Personal Interviews]

AUTHOR: Render S. Davis; MHA, CHE of Crawford Long Hospital at Emory University
Atlanta Georgia USA

POSITION: Render S. Davis is a certified healthcare executive. He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs at Crawford Long Hospital of Emory University from 1977-95. He is currently an Administrator for Special Projects and Co-Chair of the Ethics Committee of Crawford Long Hospital, and an independent healthcare consultant in the areas of policy and ethics. He is a founding board member of the Health Care Ethics Consortium of Georgia and has served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and has chaired the Annual Conference Planning Committee since 1995.

TOPIC: Evolutionary Shifts in the Primacy of Medical Ethics

EXCERPT: ”For more than 2000 years, the principle of beneficence, the profession’s obligation to be of service to others, was the foundation of the practice of medicine.
In taking the Hippocratic Oath, physicians swore that they would “perform their art solely for the cure of patients,” and patients viewed their doctors as wise, caring, and paternalistic healers unwaveringly committed to their welfare.

Until the era of modern medicine dawned in the early Twentieth Century, sincere caring and compassionate service probably were the most effective instruments in the physician’s meager armamentarium” … What has changed today; if anything?

Don’t miss it!
READ IT HERE: http://healthcarefinancials.wordpress.com/2008/06/01/evolutionary-shifts-in-the-primacy-of-medical-ethical-principles/
Mary, on November 27th, 2007 at 5:03 PM Said:

From Heroes – like Cecelia – to Credentialing Zeroes

As a nurse like Cecelia, I just learned that Officials of the VA recently admitted that about 17,000 of its 56,000 physicians practicing within the system have triggered “red flags” in its electronic re-credentialing system.

More importantly, the VA hasn’t determined whether these physicians should keep practicing!

They made this confession during a Congressional hearing, months after it detected on a spike in deaths the 115-bed Marion (IL) Medical Center. And, this summer, several administrators were reassigned, and three surgeons had their privileges limited, in the wake of the discovery.

National healthcare, indeed!
Please opine, or post more abut this ongoing investigation as it develops.

-A concerned RN
Health Tips Blog » Reporting Healthcare Fraud and Abuse, on November 27th, 2007 at 5:31 PM Said:

[...] Here is an interesting post today with a quick excerpt by Dr. David Edward Marcinko; MBA, CMP™ Publisher-in-Chief. Fraud and Abuse Reporting Incentives. Under the Health Insurance Portability Accountability Act, the Department of Health and Human Service (HHS) has operated an “Incentive Program for … [...]

Editor’s Note: And for related risk management information, take a look at:
http://www.jbpub.com/catalog/9780763733421
Hwoarang » Concierge Medicine - New Wave or Drought?, on November 27th, 2007 at 5:53 PM Said:

[...] Check it out! While looking through the blogosphere we stumbled on an interesting post today. Here’s a quick excerpt. Boutique Medical Practices – Wave of the Future or Mirage? By Dr. David Edward Marcinko; MBA, CMP™ Publisher-in-Chief. Gaining Traction – But Still Novel. Briefly, a new-wave boutique, or concierge medical practice business model requires … [...]
Ann, on November 27th, 2007 at 7:57 PM Said:

Stay cool all Doctors,

Look; remember when cuts like this have been proposed before, Congress often rode in and stopped CMS from implementing such payment reductions.

Now, the Senate Finance Committee that is considering a package which would suspend the reduction for two years, prevent reductions in rehabilitation therapy and increase reimbursement for rural providers.

So, stayed abreast for even more changes, and opine?
-Ann
Richard, on November 27th, 2007 at 8:01 PM Said:

We are Not Surprised at All!

Full-time physicians spend an average of one full day a week providing services for patients that are not reimbursed by Medicare, according to a study published in the Annals of Internal Medicine.

Researchers said the services that are going un-reimbursed are not unusual or luxury services, but are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs.

The average episode of non-reimbursed care lasted just 10 minutes, but they happened often enough to add up to 7.8 hours every week.

Researchers contended that the study results could potentially prod insurance companies and Medicare to catch up to physicians’ current levels of productivity by reimbursing them for the care that is increasingly taking place outside of formal office visits.

Now, we ask, is anyone surprised?
How about you?

-Richard and Hope
Insurance News Aggregator » One Health Insurance Policy Solution, on November 28th, 2007 at 6:43 PM Said:

[...] Original post here [...]
geekounet » One Health Insurance Policy Solution, on November 28th, 2007 at 7:47 PM Said:

[...] Check it out! While looking through the blogosphere we stumbled on an interesting post today. Here’s a quick excerpt. A Real Insurance Solution By Dr. David Edward Marcinko; MBA, CMP™ Publisher-in-Chief. Market Driven Health Insurance Alternatives. According to Michael K. Evans, former chief economist for the American Economics Group, Washington, DC, … [...]
kerii, on November 29th, 2007 at 2:24 AM Said:

Yes, BUT… There are still a LOT of fixed income and elderly people that have to suffer due to the increasing medicare premiums they have to deal with. Thats why AARP has set up http://www.thisissoridiculous.com so that we can sign a petition to make our voice heard. They also offer updated news, videos and the opportunity to e-mail your congressman to let him know how you feel. I’m working to help AARP promote better Medicare. This is an important issue in the US right now and we can’t let it get any more out of hand than it already has.
Sharon, on November 29th, 2007 at 2:17 PM Said:

No financial fiascos to report; but I found this post elsewhere and thought it very germane, and it does seem to confirm your thoughts.

Fiduciary Flap Trips Up CFP™ Board
By Kristen French and John Churchill

The rift in the investment-advisor industry came into sharp focus when the CFP Board announced that it put off making proposed changes to its Code of Ethics in order to consider the heated reactions of industry members.

The flap over the board’s Code of Ethics has been ongoing since the proposed changes were announced in late 2006. But, really, this is just the latest scuffle in an ongoing battle over the differing legal responsibilities that investment-advisor reps and registered reps have to clients — in other words, over the broker/dealer exemption (a.k.a. the Merrill Lynch rule) and the term fiduciary.

The CFP Board’s Code of Ethics governs the more than 52,000 holders of the CFP™ designation. Most of these CFP™ holders are financial planners and registered investment advisors (who are governed by the Investment Advisers Act of 1940), but, increasingly, brokers at big wire house firms (who are governed by the Securities Act of 1933 and the Securities Exchange Act of 1934) have been earning the CFP as well.

Last summer, the CFP™ Board proposed amendments to its Code of Ethics that would allow CFP holders to “opt out” of their fiduciary duty to clients as long as they disclosed it in writing to the client. But the leadership of the Financial Planning Association, which represents financial planners, blasted the proposal, as did FPA members in comment letters to the CFP Board and FPA.
The “revisions fail to enhance consumer protections or advance the profession of financial planning,” wrote Dan Moisand, FPA™ president, in a letter to the CFP Board.

Subsequently, Sarah Teslik, the CFP™ Board’s CEO and leader in the effort to change the Code, resigned in mid-October, stating that her resignation had nothing to do with the uproar. The CFP™ Board and membership, is now working on new drafts.

-Sharon
Hope, on November 29th, 2007 at 4:24 PM Said:

Readers,

You may want to followup with these 2 links on the valuation of a medical practice:

“How much is a plastic surgery practice really worth?”
http://www.psp-interactive.com/issues/articles/2006-08_10.asp

“Appraising a Medical Practice”
[The Art of the Deal for Buyers and Sellers]
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/685.htm

Best.
Hope
Hope, on November 29th, 2007 at 4:30 PM Said:

Readers,

You may want to follup up with this link:
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/624.htm

“Don’t Make These Mistakes”
[Ten Common Investing Maladies]

Best.
Hope
Hope, on November 29th, 2007 at 4:38 PM Said:

Readers,

You may want to followup with this link:
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/667.htm

“Hedge Your Bets”
[Hedge Funds Risky, But Worth a Look]

Best.
Hope
Editors, on November 29th, 2007 at 4:52 PM Said:

Try this related link, too:
http://www.myconciergedoc.com

Best.
Hope
Hope, on November 29th, 2007 at 5:30 PM Said:

Look what was just posted on MSN!
Take a look at this related link:

http://www.msnbc.msn.com/id/22024234/

Best.
-Hope
Hope, on November 29th, 2007 at 5:54 PM Said:

Good P4P post and comments, all.

Now, check out this link for additional opinions and a closer look
from the medical profession.

http://www.arthritispractitioner.com/article/7684

Best.
Hope
Hope, on November 29th, 2007 at 9:59 PM Said:

Remember, every valuation firm or medical practice appraiser should provide a complete range of medical business valuation services.

And typically, there are at least three types or levels used in the industry today:

1. A Comprehensive Valuation is an extensive service and is designed to provide physician-owners and/or potential purchasers with an unambiguous range on the value of a medical practice, ASC or healthcare entity. It is supported by all procedures that appraisers deem relevant to the engagement with onsite visit mandatory. It s suitable for contentious situations like divorce, partnership dissolution, sale, etc. The report includes a formal written “Opinion of Value” suitable for litigation support activities like depositions and trial. It is also useful for external reporting to bankers, investors, the public, etc.

2. A Limited Valuation is the next step in acuity from a comprehensive appraisal as it lacks the performance of additional procedures that are suggested in an USPAP/ IRS appraisal. This type of assignment can be considered an “agreed upon procedures” appraisal that should only be used in circumstances where the client is the only user of the appraisal or as an organic growth ingredient; but not for external reporting. No onsite visit is needed for this US mail or fax delivered valuation. A formal “Opinion of Value” is not rendered.

3. Ad-Hoc Valuation is the lowest level engagement where the appraiser is to provide a very gross and non-specific approximate indication of value based upon the performance of limited benchmark procedures. No onsite visit is needed. Neither a written report nor an “Opinion of Value” is rendered. Voice based consultation.

Other types of vlauation engagements include forensic nvestigations provided for medical income and personal asset determinations and tracings as an essential component of valuation services.

Another type is the CYA report that is an opinion whether or not a valuation is required. This opinion is ideal for the client or attorney who is unsure if a practice has value and wishes to “cover your assets”.

Note: USPAP = [UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICE]

Thanks.
Hope
Christy, on November 30th, 2007 at 1:59 AM Said:

HIT Study with Current Update

I am not sure about the future of the 802.11n wireless
transmission standards, but I do know that doctors are well known technophobes. And, it seems that so are patients; sadly.

And, despite the increasing availability of free electronic personal health recording systems, like those from MSFT, RevolutionHealth and soon-to-be Google, etc; patients have been slow to adopt them as well.

In fact, a late 2006 study by the Markle Foundation found that more than 200 e-PHR systems are now available, and new products are continually being announced.

Nevertheless, the studies also show that availability is not translating into use, with only about five percent of all patients using PHRs a full year later.

So, why this slow e-PHR adoption by patients?

Perhaps both parties should review:
http://www.HealthDictionarySeries.com

Christy
Executive-Post, on November 30th, 2007 at 11:03 AM Said:

FOR May 2008
EXCLUSIVE SPECIAL REPORT
SIX-SIGMA PRIMER [Physicians, Hospital Administrators and Healthcare Executives]

A very special report on improving medical care quality and related healthcare delivery initiatives thru manufacturing concepts of six-sigma, by a leading physician-executive and senior six-sigma practitioner from Creative Health, USA. This feature was prompted by the many inquires after an original brief post on the same topic.

AUTHOR: Dr. Daniel L. Gee MD MBA, Principal from Creative Health USA, in Scottsdale Arizona. Dr. Gee believes that; “six-sigma is more than simply allocating resources to correct a problem – it’s a proven methodology designed to uncover, isolate, understand, and remedy the root causes of problems”.

POSITION: Dr. Daniel L. Gee is an expert in operating suite dynamics and logistics, having helped establish two hospital-based obstetrical anesthesiology programs, in Phoenix. Formerly, he was managing partner for a multi-specialty anesthesiology practice in the southwest, and Chief of Anesthesiology at John C. Lincoln Hospital in Phoenix. Dr. Gee designed pharmaceutical protocols for clinical practice, was a speaker for Glaxo Pharmaceuticals and served on formulary committees and as an investigator for clinical trial programs. He received a BS with Honors from University of Southern California, an MBA from Arizona State University, and his medical degree from University of Arizona. He is a Diplomate of the American Board of Anesthesiology and an active medical practitioner.

TOPIC: Six-Sigma Primer [Physicians, Hospital Administrators and Healthcare Executives]

EXCERPT: “The key to winning in sports is to gain a competitive edge. Athletes must train harder and seek out new training methods; new ideas of physical or mental conditioning just to stay ahead. Likewise, in healthcare, gaining and maintaining a competitive edge or, even surviving, in today’s healthcare environment will demand strong managerial skills and an organizational culture devoted to cutting edge thinking.

All stakeholders in healthcare, from physicians to hospital board members, are searching for ways to deliver quality and service for greater patient satisfaction at affordable costs. They want to improve reimbursements, operational efficiencies, retention of labor, medical and pharmaceutical error reduction and above all, minimize expenditures.

Achieving these lofty goals requires looking beyond the borders of one’s own industry for management initiatives that drive both quality and low cost while serving the customer in his or her own best interest. The healthcare industry’s holy-grail of providing quality while minimizing cost is often thought of as extremely difficult to attain, until now.

What is happening in the manufacturing and outside service industries is a valuable lesson for healthcare managers and providers to learn and stay competitive. The hottest management improvement initiative sweeping many industries is the one approach with the most visible success above all improvement methods so far. It is not a hot new fad or passing fancy but rather, a flexible system built on the best of past management ideas and proven practices of the business world’s most successful companies. It is a philosophy designed to markedly improve an organization’s performance and its management leadership.”

Don’t miss it!
READ IT HERE: http://healthcarefinancials.wordpress.com/2008/05/01/six-sigma-primer
Pam, on November 30th, 2007 at 12:13 PM Said:

The Phantom Net Income Problem

Yes, we had accounting problems and here is an example for emerging practitioners who wonder where all that net income the account says was made – actually is.

Most times, a true “cash” net profit never existed, as it was only a “phantom” accounting artifice for tax purposes.

This happens because depreciation often causes discrepancies between “check book” profit, which is how much cash you actually have left over after paying the bills, and taxable income.

Amortization is the same concept as depreciation but it applies to intangible assets, like medical practice goodwill.

Trust this helps.
Office Manager
Pam
Pam, on November 30th, 2007 at 1:07 PM Said:

Income Statement Often Difficult to Interpret

Another problem of income statement interpretation is depreciation, and its relative, amortization

Depreciation merely takes the cost of a tangible asset, like equipment, and divides this expense into the successive time periods over which the asset is expected to help produce income.

Logically, if you’re trying to figure true practice costs, a piece of durable equipment often helps produce income long after it was purchased.

The Office Manager
Pam
Joseph, on November 30th, 2007 at 1:12 PM Said:

Income Statement Limitations

Once a practice is ongoing, and no longer in estimated pro-forma financial statement form, the most common limitation of the accountant rendered income statement – even with trained interpretation – is poor classification and categorization.

For tax purposes, many types of expenses can be grouped together and still render a correct net profit figure.

As an example, $500 in seminar tuition that is miss-classified as medical supplies expense still renders the correct bottom line but states-states expense in two very different categories. Budgeting and cash flow forecasts may be adversely affected.

It is common to see income statements that categorize expenses into illogical groups.

As another example, all forms of insurance expense may be grouped together. Yet auto insurance probably belongs with other auto expenses. Workman’s Compensation insurance is actually a payroll expense. Building liability insurance probably belongs with the other premise(s) figures.

Using a single insurance category essentially understates all these other expenses and there may not be time, interest or ability to re allocate the insurance expenses more logically.

So, be careful, especially when buying or selling a practice and relying on financial statements.

Joseph
The Accountant
Editors, on November 30th, 2007 at 1:26 PM Said:

What is Goodwill?

Goodwill is basically the value of a medical practice as a going concern minus the book value of the assets.

In a mature practice, where accumulated depreciation has decreased the book value of the assets below true market value – and the reputation of the practice allows selling it for a premium price – goodwill can be considerable but not reflected on the balance sheet.
Dave, on November 30th, 2007 at 1:31 PM Said:

More Poor Income Statement Characterizations

All good concepts above; but wait – there are even more!

For example, other illogical income statement categorizations may occur because: 1) the accountant does not understand your medical practice; 2) cannot or will not customize your accounts; 3) is only interested in the tax implications; or 4) has encountered a lack of proactive input from the doctor or medical practitioner.

Furthermore, if you have your accountant enter your checks into a software program, additional blending of categories can occur as low-level employees often incorrectly key in your information.

Such “blending” of categories negates any opportunity to objectively see where all the money goes. It makes cost containment and expense reduction initiatives difficult, and can increase or decrease actual practice “worth.”

FMV calculations and appraisals – for sale, retirement, merger or dissolution – also become extremely difficult … and expensive.

So, do it right, now – or get it wrong, later.

Thanks.
Dave
Editors, on November 30th, 2007 at 1:47 PM Said:

Here is a similar link – for all medical professionals – on the same topic of investing errors. Be sure to avoid them, if possible.

“Twelve Common Investing Mistakes”:
http://www.podiatrytoday.com/article/5259

Dave
Executive-Post, on December 1st, 2007 at 2:38 PM Said:

FOR APRIL 2008

EXCLUSIVE SPECIAL REPORT
“MEDICAL PRACTICE VALUATION BLUNDERS”
April 1st 2008

A very special tax season report on the top-ten medical practice fair-market-valuation blunders to avoid, by leading health economists from the Institute of Medical Business Advisors, Inc in Atlanta, GA. http://www.MedicalBusinessAdvisors.com

Subscribe Now: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

AUTHORS: Dr. David Edward Marcinko; MBA, CMP™ – a CEO and former Certified Financial Planner™ – with important contemporaneous contributions by Hope Rachel Hetico; RN, MHA, CMP™

POSITION: As a clinician and past president of a privately held Physician Practice Management Corporation (PPMC) in the Midwest, Dr. David Edward Marcinko helped consolidate 95 solo medical practices, with $50 million in sales revenues as the company’s IPO roll-up attempt was aborted due to adverse market conditions, in 1999. A nationally recognized leader in the healthcare management, economics and financial advisory industry, he is a pioneer in utilizing technology to improve quality education and advisory services, while simultaneously reducing delivery costs http://www.stpub.com/pubs/authors/MARCINKO.htm

Hope Rachel Hetico RN MHA has a well-documented history of identifying innovations in education and accelerating their adoption by the healthcare industrial complex. Formerly, she was a healthcare administrator, financial advisor and medical insurance professional. She was also a Certified Professional in Healthcare Quality™ and National Corporate TQI Manger for Abbey Healthcare http://www.stpub.com/pubs/authors/HETICO.htm

TOPIC: “The Top-Ten Medical Practice Valuation Blunders to Avoid”

EXCERPT: “The science of the modern medical practice valuation can be traced to the Estate of Edgar A. Berg v. Commissioner (T. C. Memo 1991-279). In this case, the Court criticized CPAs as not being qualified to perform business valuations, failing to provide analysis of an appropriate discount rates, and making only general references to justify their “Opinion of Value.”

In rejecting accountants, the Court accepted IRS economists because of background, education and training, as well as discount rate calculations and reproducible evidence applied to the assets being examined. This marked the beginning of the Tax Court leaning toward the side with the most comprehensive appraisal. Previously, it had a tendency to “split the difference.”

Now, some feel the Berg case launched the valuation profession; especially for contemporaneous health economists and fiduciary medical practice advisors.”

Don’t miss it!
REQUEST IT NOW: Complimentary by email.
medical-practice-valuation-blunders.pdf
Hope, on December 1st, 2007 at 3:40 PM Said:

“In Defense of the VA System”
By Maggie Mahar

Here is a tiely health policy article published on March 05, 2007

http://www.thehealthcareblog.com/the_health_care_blog/2007/03/policy_in_defen.html

Enjoy.
-Hope
Editors, on December 1st, 2007 at 3:51 PM Said:

How Will You Get Paid?
By Paul Levy

Here is the link for an interesting article on P4P and related compensation issues:
http://www.thehealthcareblog.com/the_health_care_blog/2007/04/how_will_you_ge.html

Paul Levy is the President and CEO of Beth Israel Deaconess Medical Center in Boston. He became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so. The recent MRSA clinical and economic dilemma suggests he was prescient.
Editors, on December 1st, 2007 at 8:13 PM Said:

Have We Reached the HIT Tipping Point?

Microsoft launched its Consumer health service called Health Vault-to signify Security on October 04 2007.

Following the launch with massive marketing – the blogosphere and media were filled with analysis and comments on Personal Health Records [PHRs].

Up until then, there were only a couple of articles in the blogosphere dedicated to Personal Health Record topics. Now not only there are plethora of articles, but also polls which show that people are really interested in Personal Health Record products.

Read more here: http://personalhealth.wordpress.com/2007/12/01/microsoft-health-vault-raising-questions/

Is this the sea change we have been waiting for?

Best.
Richard
Editors, on December 2nd, 2007 at 12:58 PM Said:

Adult-Learner Testimonials
[See what they are saying about us ...]
Staff Writers

“I really like the supportive approach to learning. The limited number of desired Certified Medical Planner™ practitioners allows the professionals at iMBA, Inc., to take an evident, genuine interest in the success of practitioners. I also agree with the program’s premise that specialization is necessary for success as any type of Financial Advisor, and for providing the best advice to client-medical professionals. I also appreciate that I had the opportunity to submit my first published work.”

///////////////////////////////////////////

“The program has shined a harsh light on how much I still have to learn. I would like for part of the program to include suggestions for continued professional development and practice growth.”

///////////////////////////////////////////

“I would incorporate some form of case study for each semester that examines some particular topic. I envision almost a quarterly thesis that would be based upon a prearranged list of topics.

For example, one thesis may involve the analysis of a set of medium sized practice financials and operating results. As an alternative, the program could incorporate a juried presentation designed to incorporate a wide spectrum of the knowledge gained during the program. Perhaps, this presentation could begin late in the second quarter with subsidiary presentations designed to allow the faculty to gauge progress and suggest revisions. This would likely increase the rigor of the program and make it more difficult for some professionals to undertake it.”

////////////////////////////////////////////

“I will rank the designations I have earned or have made progress in earning:

1. CFA (really tough unless you work in securities valuation every day)
2. CPA (this was a very tough exam and required a lengthy process of learning. However, I think that much of the CPA exam, when I took it, was rote-without a full understanding of the content)
3. CFP® (this is a little more difficult than the CMP™ mainly because of the time constraints and structure of the exam. It is a little less difficult than the CPA because it incorporates some of the knowledge that CPA’s typically already possess)
4. CMP™ – Certified Medical Planner™
5. CLU (these exams were not very difficult but mainly required time and some limited reading)
6. Securities Licensure (Series 7)
7. Insurance Licensure”.

See related link for more information:
http://healthcarefinancials.wordpress.com/2007/11/28/the-financial-services-industry/
Editors, on December 2nd, 2007 at 1:04 PM Said:

Readers

Please see this related link for more information about the Certified Medical Planner™ program with logo and professional – financial services – designation.

http://healthcarefinancials.wordpress.com/2007/10/15/what-is-a-cmp/#comment-78#comment-78#comment-78

-Staff
http://www.CertifiedMedicalPlanner.com
Editors, on December 2nd, 2007 at 9:40 PM Said:

What You Can Do About Malpractice Insurance?

By David E. Marcinko; MBA, CMP™
Publisher in Chief

In order to contain liability overhead expense costs, all physicians should understand the dynamics of the insurance industry selling process; as malpractice and most all liability products are sold through one of three agency avenues.

For more information:
Link: http://www.podiatrytoday.com/article/2221

Any other thoughts?
Editors, on December 2nd, 2007 at 9:49 PM Said:

Seven Reasons to Appraise Your Practice
By David Edward Marcinko; MBA, CMP™
Publisher in Chief

For more information on this important topic.
Link: http://www.podiatrytoday.com/article/2879

Can you think of other reasons?
Economics Topics News » Blog Archive » Interest Rates and the Money Commodity, on December 3rd, 2007 at 2:25 PM Said:

[...] Interest Rates and the Money Commodity. Medial Office Equipment Interest Rate Costs. By Dr. David E. Marcinko; MBA, CMP™ Publisher in Chief. Physicians, administrators and healthcare entrepreneurs are aware of the compounding effect of interest. However, since interest is …Healthcare Financials … the post – http://healthcarefinancials.wordpress.com [...]
Marty, on December 3rd, 2007 at 6:16 PM Said:

Nice little article on autos.

What are the costs of owning a boat?
Anything special to look out for?

Thanks.
Dr. Marty
Editors, on December 3rd, 2007 at 6:17 PM Said:

What are the costs of owning a boat?
Staff Writers

The costs of owning a boat are about the same as owning a car except for a few additional expenses.

These include cleaning the hull, mooring fees; purchasing and maintaining a trailer if needed, boat launch fees, and dry storage, etc.

Best.
Editors
Auto Ownership Costs for Docs, on December 3rd, 2007 at 11:18 PM Said:

[...] Read the rest of this great post for doctors and their autos, here [...]
Ray, on December 4th, 2007 at 1:06 PM Said:

What is wrong with CAPM?

There are several problems identified by academics regarding CAPM:

1. A market portfolio of all assets is not measurable.

2. CAPM assumes systematic risk, as measured by beta, is the only factor determining an individual security’s expected return.

Thus, CAPM’s main assumption is that a particular security’s volatility – relative to the volatility of the overall market – is the relevant measure of systematic risk.

Yet, in practice, there are many systematic factors beyond just market volatility that influence a given security’s returns. For example, inflation, interest rate changes, healthcare economic and GNP growth are all systematic factors that impact all securities.

However, the degree to which they impact different portfolio and securities’ returns varies.

Your continued thoughts?
Raymond
Economists » Blog Archive » CAPM - Another Portfolio Pricing Model to Consider, on December 4th, 2007 at 1:35 PM Said:

[...] CAPM – Another Portfolio Pricing Model to Consider. By Editors. Harry Markowitz is credited with developing the framework for constructing investment portfolios based on the risk-return tradeoff, William Sharpe, John Lintner, and Jan Mossin are credited with developing the Capital Asset Pricing Model …Healthcare Financials … the post – http://healthcarefinancials.wordpress.com [...]
Economics Topics News » Blog Archive » CAPM - Another Portfolio Pricing Model to Consider, on December 4th, 2007 at 2:25 PM Said:

[...] CAPM – Another Portfolio Pricing Model to Consider. By Editors. The Capital Asset Pricing Model By Jeffrey S. Coons; PhD, CFA By Christopher J. Cummings; CFA, CFP™ While Dr. Harry Markowitz is credited with developing the framework for constructing investment portfolios based on the risk-return …Healthcare Financials … the post – http://healthcarefinancials.wordpress.com [...]
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Editors, on December 6th, 2007 at 8:50 PM Said:

About Gene Schmuckler; PhD

Years ago, I faced a major career decision because of the impending managed care environment. It was circa 1995 and I could remain as equity partner in my five-doctor medical practice, where I made a good salary and seemingly had job security, or move on to other horizons; but to what?

Shortly thereafter, I started business school and met Professor Gene Schmuckler PhD. He helped me visualize my new dream career – which turned out to be as the Founder of an independent but struggling health economics consulting firm – that offered no salary and little job security.

My medical partners at the time thought I was “ill-advised” for even considering the move and so did most of my friends and family; but not my wife. Nevertheless, I turned in my resignation five years later, and took the plunge after much preparation.

Looking back on 2000, it was the best decision I ever made in my healthcare career, and I have Gene Schmuckler among a few others, to thank for it.

In my travels, I often suggest to today’s confused and angst-ridden doctors to seek Gene out for career guidance and advice. Well experienced, he remains more than willing to let you pick his brain.

The clarity he offered me was priceless.

Dr. David Edward Marcinko; MBA
More info: http://www.MedicalBusinessAdvisors.com
mdelite, on December 7th, 2007 at 4:34 AM Said:

Lawrence R. Brownlee, MD – Tustin, Orange County, California – started a concierge medicine practice at the suggestion of some of his patients. After three years all is well.

MD Elite,
mdelite.com,
http://www.mdelite.com
Editors, on December 8th, 2007 at 12:31 AM Said:

FOR MARCH 2008
EXCLUSIVE “DDS-DMD” SPECIAL REPORT FOR DENTISTS

A very special report on dentists – their professional practice career and economic life cycle – by a leading national dental management corporate executive.

Subscribe Now: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

AUTHOR: Thomas A. Knox MBA was senior vice-president for provider partnerships at Delta Dental Plan of Minnesota, which owns a major interest in a privately held dental practice management corporation [DPMC].

POSITION: Mr. Knox held senior leadership positions in several health care organizations for more than twenty-five years. He implemented various joint ventures, partnerships and business alliances in a variety of medical organizations. He is recently retired.

TOPIC: Practice Management and Financial Planning: It’s [NOT] for Dentist’s Only

EXCERPT: “The challenge is that for many dentists their practice is too big and too profitable to sell to new dentists who have been, traditionally, the practice buyers. Almost fifty percent of present day dentists are baby boomers pushing 50-55 years of age. And unfortunately, they cannot afford to retire at this point and still maintain the lifestyle they have created.

But, the temptation is there – the thought is occurring more frequently – and it is very compelling and very frustrating.”

Don’t miss it!
REQUEST IT NOW: Complimentary by email.
ddspracticelifecyclefinplanning.pdf
Editors, on December 8th, 2007 at 2:26 PM Said:

For related info:
http://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=pd_bbs_sr_4?ie=UTF8&s=books&qid=1197123377&sr=8-4
Editors, on December 10th, 2007 at 12:29 PM Said:

IN FEBRUARY 2008
EXCLUSIVE SPECIAL REPORT – Now Available!
A chilling white-paper on medical professionals and their investing compulsions by one of the nation’s leading psychologist, gambling addiction and trauma specialist.

Subscribe and read: http://healthcarefinancials.wordpress.com/2008/02/01/289/

AUTHOR: Eugene Schmuckler; PhD, MBA, CTS Contributing Editor for http://www.MedicalBusinessAdvisors.com and http://www.HealthcareFinancials.com

POSITION: Academic Dean: http://www.CertifiedMedicalPlanner.com an online certification program with fiduciary trademark logo that teaches financial professionals about contemporary health economics, physician focused financial planning, medical practice management and related topics of business modernity.

TOPIC: The Addictive Investing Personality of Medical Professionals and Related Compulsions

EXCERPT: “Hard-working physicians and other medical practitioners confronted with the problems associated with managed care and healthcare reform may very well choose to direct a portion of their energies to “playing the market.” It is legal and ethical and offers the opportunity of quickly increasing one’s personal wealth – or NOT.

Functioning virtually alone prevents others from questioning their actions. While not directly equivalent, this action is akin to the drinker who drinks alone so that no one really knows just how much is consumed – often a recipe for financial and emotional disaster.”
Editors, on December 10th, 2007 at 12:58 PM Said:

For more physician salary info:
http://certifiedmedicalplanner.com/MDs.aspx
Bill, on December 15th, 2007 at 9:52 PM Said:

The AMA and Medical Unions
Interview Follow-up

And so, Dr. Marcinko and medical professionals of all types accuse the AMA and state medical societies of being slow to respond to their changing needs?

Just, how did this historically evolve?

Well, back in 1962, 82 percent of physicians belonged to the American Medical Association. Today, the figure is about 23 percent. Since almost one half of all physicians are employees, they are no longer as dependent upon traditional medical societies.

Going forward, it has been estimated that more than 70 percent of all medical school graduates in the first year of the next millennium will be an employee, rather than a small practice (business) owner and employer. The strength of medical societies is diminishing, and as practitioners move into employment positions, the enhanced role of unionization has arisen, and then been frustrated again.

Although the AMA removed barriers to collective bargaining a while ago, it is still adamantly opposed to strikes. And, traditional constraints under the National Labor Relations Act and other antitrust laws are being litigated. Prominent unionization campaigns occurred across the country, as the more than 50,000 physician union members united, despite a simultaneous diminution of union clout in almost all other industry sectors. But – to what real avail – aggressive tactics perhaps?

Just look at the Physicians for Responsible Negotiations (PRN), who initially turned to the Teamsters, as the Committee of Interns and Residents (CIR) won the right to organize 430 residents at the Boston Medical Center, a few years ago. In fact, the younger and more aggressive medical professionals of the CIR do not recognize a “no strike” pledge, as the older and less assertive PRN group does.

Regardless, how sad it is to tempt formerly proud and independent practitioners and student doctors to join labor unions, and become just another “medical degree with a pulse.”

Thanks for the thought-provoking interview.
Keep up the good work in Part 2.
-Bill
Editors, on December 17th, 2007 at 1:56 PM Said:

Healthcare Organizations [Financial Management Strategies]
http://www.HealthcareFinancials.com

FROM THE PRINT GUIDE FOREWORD
David B. Nash; MD, MBA

It should come as no surprise to our readers that the nation faces a financial crisis in healthcare. Currently, the United States spends nearly 16% of the world’s largest economy on providing healthcare services to its citizens. Another way of looking at this same information is to realize that we spend nearly $6,500 per man, woman, and child per year for health services.

And, what do we get for the money we spend?

This is an important policy question and the answer is disquieting. Although the man and woman on the street may believe we have the best health system in the world, on an international basis, using well-accepted epidemiologic outcome measures, our investment does not yield much! According to information from the World Health Organization (WHO) and other international bodies, the United States of America ranks somewhere towards the bottom of the top fifteen developed nations in the world, regarding the outcome in terms of improved health for the monies we spend on healthcare. From a financial and economic perspective then, it appears as though the 16% of the GDP going to healthcare may not represent a solid investment with a good return.

It is then timely that our colleagues at the Institute of Medical Business Advisors, Inc. [www.MedicalBusinessAdvisors.com] have brought us their greatest work, Healthcare Organizations: [Financial Management Strategies], a two-volume set of nearly 1,200 pages.

Certainly, this Guide, and its quarterly updates, is not for everyone. It is intended only for those executives and administrators who understand that clinics, hospitals and healthcare organizations are complex businesses, with advances in science, technology, management principles and patient/consumer awareness often eclipsed by regulations, rights, and economic restrictions. Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject matter experts.

Fortunately, Healthcare Organizations: [Financial Management Strategies] provides that blueprint. Allow me to outline its strengths and put it into context relative to other policy works around the nation.

For nearly two years, the research team at iMBA, Inc., has sought out the best minds in the healthcare industrial complex to organize the seemingly impossible-to-understand strategic financial backbone of the domestic healthcare system. The Guide is organized into two volumes in order to appropriately cover many of the key topics at hand. It has a natural flow, starting with Competitive Strategy and moving through Asset Management, Cost Management, and Claims Management. Volume 1, most especially the Competitive Strategy section, has broad appeal and would be of interest to most people in the health insurance industry, including managed care entities, hospitals, third party benefit managers and the pharmaceutical industry.

Volume 2 continues in a well-organized theme, progressing from Risk Management and Compliance to Health Policy, Information Technology, and most importantly, Financial Benchmarking. Volume 2 would be of greater interest to those in the policy sphere, both in Washington, DC, in state legislatures, consulting companies, medical colleges, and graduate schools of health administration, public health and related fields.

Every day colleagues ask me to help explain the seemingly incomprehensible financial design of our healthcare system. These two volumes would go a long way toward answering their queries. I also believe both volumes would be appropriate as text books and reference tools in graduate level courses taught in schools of business, public health, health administration, and medicine. In my travels about the nation, many faculty members would also benefit from the support of these two volumes as it is nearly impossible, even for experts in the field, to grasp all of the rapidly evolving details.

On a personal level, I was particularly taken with the Competitive Strategy section and it brought back enjoyable memories of my work nearly twenty-five years ago at the Wharton School, on the campus of the University of Pennsylvania. There, I was exposed to some of the best economic minds in the healthcare business and it was a watershed event for me forming some of my earliest opinions about the healthcare system.

I also very much enjoyed the section on Health Policy, most especially, the section on the Sarbanes-Oxley Act for hospitals and healthcare organizations. I believe we have not fully embraced the comprehensive nature of Sarbanes-Oxley on the hospital side, and envision a day when hospital boards will be held accountable for quality, in the same way that proprietary corporations are held accountable for the strength and comprehensiveness of their audit reports. Simply put, Sarbanes-Oxley for quality is around the corner and this volume goes a long way toward preparing our basic understanding of the Act and its potential future implications. Congratulations to all authors, but this one in particular deserves specific mention. As a board member for a major national integrated delivery system, I am happy that there appears to be a greater interest in the intricacies of Sarbanes-Oxley on the healthcare side of the ledger.

In summary, Healthcare Organizations: [Financial Management Strategies] represents a unique marriage between the Institute of Medical Business Advisors, Inc., and its many contributors from across the nation. As its mission statement suggests, I believe this massive interpretive text carries out its vision to connect healthcare financial advisors, hospital administrators, business consultants, and medical colleagues everywhere. It will help them learn more about organizational behavior, strategic planning, medical management trends and the fluctuating healthcare environment; and consistently engage everyone in a relationship of trust and a mutually beneficial symbiotic learning environment.

The Editor-in-Chief and his colleagues at the Institute of Medical Advisors, Inc should be complimented for conceiving and completing this vitally important project. There is no question that Healthcare Organizations: [Financial Management Strategies] will indeed enable us to leverage our cognitive assets and prepare a future generation of leaders capable of tackling the many challenges present in our healthcare economy.

My suggestion therefore, is to “read it, refer to it, and reap.”

David B. Nash; MD MBA FACP
The Dr. Raymond C and Doris N. Professor and Chair
Department of Health Policy
Director, Office of Policy & Clinical Outcomes
Jefferson Medical College
Thomas Jefferson University
Philadelphia, PA USA

Website: http://www.HealthCareFinancials.com
TOC: http://www.stpub.com/pdfs/toc_ho.pdf
More info: http://www.stpub.com/pubs/ho.htm
To Purchase: Call 1-800-251-0381
Subscribe by email: orders@stpub.com
Insurance News Aggregator » The Health Insurance Paradigm Shift, on December 17th, 2007 at 2:20 PM Said:

[...] Original post here [...]
Health Insurance: Affordable Health Insurance » The Health Insurance Paradigm Shift, on December 17th, 2007 at 2:23 PM Said:

[...] Sue J had some great ideas on this topic. You can read a snippet of the post here. “Medical Industry Changes to Wholesale Mentality.” By Staff Writers. Until a decade ago, most doctors were probably more concerned with acquiring, maintaining or improving their medical acumen than worrying about practice management or … [...]
Insurance » The Health Insurance Paradigm Shift, on December 17th, 2007 at 3:48 PM Said:

[...] Here’s another interesting post I read today by Staff Writers and Editors [...]
Insurance News Aggregator » Insurance Agents - Raising the Bar, on December 18th, 2007 at 11:40 AM Said:

[...] Original post here [...]
Insurance » Insurance Agents - Raising the Bar, on December 18th, 2007 at 12:01 PM Said:

[...] Here’s another interesting post I read today by the Post Editors [...]
New Never-Events Policy | ok, on December 20th, 2007 at 3:23 AM Said:

[...] Original post by the Executve Post Editors [...]
Insurance and things » Blog Archive » Medical Practice Business Insurance, on December 20th, 2007 at 8:31 PM Said:

[...] Read entire post at The Executive Post @ Healthcare Financials.com [...]
Executive Post Editors, on January 3rd, 2008 at 10:42 AM Said:

As predicted, physicians will get a six-month reprieve from a 10.1 percent across-the-board cut in Medicare payments that was scheduled to go into effect January 1, 2008.

In fact, there wil be a slight increase! Go figure.
-Ann
Mary, on January 4th, 2008 at 1:15 AM Said:

Readers and Subscribers,

Transfusion LLC is a new company that recently jumped into the business of converting practices to concierge medicine.

This new competitor realized – like many physicians – that MD-VIP’s $500 per/patient per/year “franchise fee” is probably not really worth it.

Another alternative would be to hire a local marketing and advertising firm for your emerging CM practice. Of course, as the CM concept grows in the public’s eye, and pressure to reduce prices and increase medical quality blooms along with increased internet transparency for related information dissemination, the need for intermediaries of all types will decline.

Feel free to visit them online for further information about their offerings.
http://www.Transfusionllc.com

Or, for another POV, try this link:
http://cleveland.dbusinessnews.com/shownews.php?type_news=latest&newsid=144622

Best
Mary
Dr. Drew, on January 4th, 2008 at 1:52 AM Said:

Dear Executive Post,

What is an investment policy statement [IPS]; how do I – or my financial advisor – construct one; and why is it needed?

I recently learned about this document from a friend and understand that it may be important to my investment goals.

PS: My stock-broker and CPA didn’t have a clue!
Please help.
Thanks in advance.

Fraternally,
Dr. JB Drew
Baltimore, MD
Editors, on January 4th, 2008 at 1:52 AM Said:

Dr. Drew,

Thanks for using our “Ask-a-Consultant” feature.
It is just one of our free subscription perks.

A: Now, please see this Executive Post link:

http://healthcarefinancials.wordpress.com/2008/01/04/investment-policy-statement-construction/

Trust it is helpful to you – and all our readers and subscribers.

-The Editors
vijaya, on January 4th, 2008 at 11:18 AM Said:

I liked this site and want more information on accounting and financial matters.
Thanks.
Sam Martin, on January 5th, 2008 at 10:24 PM Said:

USPAP does not require that all three approaches be utilized in all cases. Rather, an appraiser must use the approach(es) deemed applicable in a particular assignment, required to yield credible results.

Even if the IRS wants all three approaches, if one or more of the approaches is not relevant, it would be a violation of USPAP to use the inappropriate approach, as that could lead to assignment results that are not credible.
Joe, on January 6th, 2008 at 2:01 AM Said:

Sam may be technically correct in his comments above.

However, how does one decide what is most “appropriate” or “relevant.”

So, the IRS and USPAP guidlines must be used with care, medical experience and foresight. Excellent point, however. Feel free to visit these sites for additional info:

* National Assn of Independent Fee Appraisers
* National Assn of Review Appraisers and Mortgage Underwriters
* American Society of Appraisers

Good thoughts, all!
-Joe
Rick Mata M.D., on January 8th, 2008 at 5:10 AM Said:

I think the R&D efforts of academic medical centers, especially those who produce US patents, have found ways around these HIPAA constraints.

Before entering any treatment trial, the patient basically has to forfeit most of the HIPAA rights to qualify.

Also, If any portions of the trial are part of health care treatment or operations, the privacy of the data is no longer only the patient’s property.

Richard J. Mata; MD
Ann, on January 8th, 2008 at 12:50 PM Said:

Another national medical provider identifier deadline is approaching.

As of March 1, 2008, doctors who bill Medicare electronically must include NPIs on all claims in addition to the older IDs they have been using. The older “legacy” identifiers alone will not suffice. And, after May 23, 2008, physicians will be required to use only NPIs on electronic claims submitted to Medicare and all other health care payers. Therefore, any information discrepancies must be cleared before then.

Although electronic deadlines don’t apply to physicians who file only paper claims, those who send their claims to a clearinghouse intermediary must comply.

Thanks
Ann
Jamie, on January 8th, 2008 at 7:38 PM Said:

Speaking of Supply-Demand

I understand that the South Carolina Supreme Court is now considering a case which could result in discounts of 50 percent off of hospital bills for patients through 2004.

The dispute arose from a state law requiring hospitals to offer the best rates possible if bills were paid within seven days. The court will decide whether uninsured and underinsured patients should get those discounts back.

Of course, lawyers for the patients want to get the case certified as a class action. Unfortunately, the dispute is moot for many patients since the state law was changed in 2006.

However, the American Hospital Association [AHA] recommends they write off bills for uninsured patients with annual incomes 300 percent of the poverty rate, and offer a sliding scale to all other patients.

Any other thoughts on such economic imperfections?
-Jamie
Jamie, on January 8th, 2008 at 7:43 PM Said:

I understand that the Vermont Association of Hospitals and Health Systems has become the third group to officially declare that its members won’t bill patients or insurance companies for a core set of adverse events.

The association has agreed not to bill for eight serious events, drawn from a list of 28 “never-events” developed by the National Quality Forum [NQF]. Vermont hospitals now won’t bill for air embolism-associated injury, artificial insemination/wrong donor, incompatible blood-associated injury, med error injury, retention of foreign objects within a patient, wrong-patient and wrong-site surgery and wrong surgical procedure.

So, what about the other 20 N-Es?
-Jamie
The Happy Hospitalist\, on January 9th, 2008 at 2:58 AM Said:

Our numbers blow this study away.
It’s not even close.
Mary, on January 9th, 2008 at 2:29 PM Said:

Here is another link, on ETFs, from the WSJ with a nice historical review:

http://online.wsj.com/article/SB119930962346763093.html?mod=%28_pageid_%29_leftbox

PS: Congratulations for being syndicated and picked up by the Wall Street Journal.
Editors, on January 12th, 2008 at 4:02 PM Said:

The percentage of physicians (aged 50-65) who would not recommend a medical career to their children was 57%; as noted by a Merritt Hawkins report in, 2007.

Editors
Hope, on January 12th, 2008 at 8:11 PM Said:

All readers:

To find out: “Why Aren’t More Students Applying To Medical School?”
Check out this link by Maggie Mahar: http://www.thehealthcareblog.com/the_health_care_blog/2007/11/why-arent-more-.html

Best.
Hope
Ray, on January 13th, 2008 at 8:32 PM Said:

Too Few Doctors 2:

The real problem with US healthcare is not only too many patients, but increasingly too few doctors. And, I fear that this is an inversely proportional divergence that is only going to exacerbate. Of course, we need that nebulous characteristic of “compassionate quality” too; not just “more asses” when it comes to doctors.

Sure whish I had the answer to this dilemma?
-Raymond
Sharon, on January 13th, 2008 at 8:34 PM Said:

Physician Unhappiness:

Did you know that in its 2007 workforce study, the Massachusetts Medical Society found that 37% of physicians in the state were considering leaving the profession because of factors like liability insurance cost, and increasing administrative burdens?

-Sharon
Pat, on January 14th, 2008 at 12:05 AM Said:

Provider Numbers for Locum Tenens Providers

To improve your practice revenues, it is important to use the correct provider identification number [PIN] for each claim for medical service that is submitted for payment.

Claims for services that have been performed by a provider who does not have a current provider identification number, need to be “held” until his/her identification numbers can be obtained. This will slow the cash flow for the medical practice or healthcare organization, but the risk of submitting false claims and the subsequent penalties outweigh the inconvenience.

We often see these problems with LT doctors. A locum tenens physician is one who is filling in for another physician and is an independent contractor (non-employee) of the organization.

He/she may provide these temporary services for up to sixty (60) consecutive days. The claim for service(s) is billed using the provider number of the absent physician with the HCPCS modifier, “-Q6”.

-Pat
Management, on January 17th, 2008 at 2:17 PM Said:

NEW YEAR 2008 PROGNOSTICATIONS
JANUARY SPECIAL REPORT: 2008 Prognostications from Healthcare Financials

A Medical “Executive-Post” Op-Ed Essay
Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief

A new heuristic study by the Institute of Medical Business Advisors Inc., http://www.MedicalBusinessAdvisors.com and http://www.HealthcareFinancials.com suggests that the New Year 2008 could be a big one for the healthcare industrial complex – with these dozen economic observations and postulated structural changes that could profoundly affect the industry – listed in no particular order of importance.

Report Link: http://healthcarefinancials.wordpress.com/2008/01/23/2008-prognostications-from-healthcare-financials/

And, best wishes to all our Healthcare Organization: [Financial Management Strategies] print subscribers, contributors, Executive Post electronic bloggers, viewers and supporters.

May the New Year 2008, bring health, happiness and self-actualization to all who labor in our industry despite Herculean obstacles”

“Live passionately – practice well – exceed expectations – never yield!”

Dr. David Edward Marcinko; MBA
Editor and Chief
Hope Rachel Hetico; RN, MHA
Managing Editor

Editors, Reporters, Writers and Staff
HO: [FMS]
http://www.HealthCareFinancials.com
http://www.stpub.com/pdfs/toc_ho.pdf
More info: http://www.stpub.com/pubs/ho.htm
To Purchase: Call 1-800-251-0381
email: orders@stpub.com

PS: Your email address and contact information is always safe with us.
We will not rent or sell your email address to any third party.
Donna, on January 18th, 2008 at 3:10 AM Said:

Thanks for the timely post.

In related news: “Did Vytorin’s makers intentionally suppress unfavorable trial results?” Rep. Bart Stupak will hold hearings to try to find out.

More: http://www.newsweek.com/id/94969
Management, on January 18th, 2008 at 7:11 PM Said:

DECEMBER 2007 – JANUARY 2008
Very POPULAR!

A dynamic two-part personal interview with one of the nation’s leading health economists and industry “movers and shakers.” More vital information and dropped names than can be imagined!
Read Now: http://healthcarefinancials.wordpress.com/2007/12/01/dr-david-e-marcinko/

WHO: Dr. David Edward Marcinko; MBA
Founder and CEO: http://www.MedicalBusinessAdvisors.com a private health economics, business management and financial advisory and consulting firm with no debt, no investors and no plans to go public.

TOPIC: Medical Unions and Related Competitive Thoughts

REPORTER: Hope Hetico; RN, MHA, Certified Medical Planner
Adjunct Professor for: http://www.CertifiedMedicalPlanner.com and Managing Editor of our companion-quarterly institutional print-guide HealthCare Organizations [Financial Management Strategies] http://www.HealthcareFinancials.com

EXCERPT: “So, for a time, there were too many doctors chasing too few patients. Hence, the start of a supply side disequilibrium driving medical fees – with assistance from managed care entities that recognized the trend early on – down, down, down; much to the fiscal detriment of medical providers. Except perhaps, to the benefit of the patients they served.”

WHEN: Thanksgiving Day, 2007

LOCATION: A restaurant in Atlanta, Georgia serving deep fried turkey – a Southern delicacy and tradition – with a side order of insightful, controversial and experiential opinions … and more!
Therersa, on January 18th, 2008 at 7:56 PM Said:

Health System Bans Drug Company Logos

According to the Minneapolis Star-Tribune, the SMDC Health System of Duluth, MN just launched a new policy that bans all drug company “freebies” with company names or logos on them.

Thanks to the new policy, SMDC employees have turned in thousands of items, including clocks, mugs, calculators, tape dispensers and stress balls. Of course, the Pharmaceutical Research and Manufacturers of America [PRMA] called the measure “draconian.”

The health system is also refusing to let drug companies sponsor educational conferences or display materials at them; a move which will cost the organization at least $100,000 a year.

Yet, SMDC hasn’t banned all drug companies from its presence. It’s still going to allow them to provide educational sessions for doctors and patients. However, the materials they use must pass through the system’s educational specialists, who will attempt to fact-check the content and provide scientific balance.

From one nurse’s POV – forget the golf balls and other tschochkes – and try something of real value.

-Theresa; RN
Sharon, on January 18th, 2008 at 8:10 PM Said:

About the HHS Patient-Safety Data Delay

Did you know that Modern Healthcare just reported that Sen. Ted Kennedy has written a letter asking why HHS hasn’t filed regulations that would implement a 2005 law creating patient-safety organizations that collect and analyze healthcare facility data?

Sen. Kennedy apparently asked the Government Accountability Office [GAO] to investigate the HHS after its failure to respond to his two prior requests in 2007.

Kennedy, along with the Joint Commission [JCAHO], and the American Medical Association [AMA], are pressing HHS to implement the Patient Safety and Quality Improvement Act [PSQIA] of 2005. But, still no luck?

Now, is anyone still in favor of national healthcare?
-Sharon
Hope, on January 18th, 2008 at 8:15 PM Said:

The Doctor Will See – Your Credit Now

First Posted MSN: Friday, January 18 at 04:32 AM CT by Bob Sullivan

The folks who invented the credit score for lenders are hard at work developing a similar tool for hospitals and other health care providers.

The project, dubbed “MedFICO” in some early press reports, will aid hospitals in assessing a patient’s ability to pay their medical bills. But privacy advocates are worried that the notorious errors that have caused frequent criticism of the credit system will also cause trouble with any attempt to create a health-related risk score. They also fear that a low score might impact the quality of the health care that patients receive.

Complete report: http://redtape.msnbc.com/2008/01/the-doctor-wi-1.html#posts

So, what do you think about this new credit score and its relevance – if any – to concierge medicine and HD-HCPs, etc?
-Hope
Donna, on January 19th, 2008 at 2:17 AM Said:

The Vytorin study noted above confuses patients, and divides doctors. Now, heart patients wonder whether to switch to generic cholesterol drug?

Full story: http://www.msnbc.msn.com/id/22733541/wid/11915773?GT1=10815

-Donna
Questionable Insurance Policies for Doctors « Medical “Executive Post” at Healthcare Financials.com, on January 20th, 2008 at 1:31 PM Said:

[...] Agents: http://healthcarefinancials.wordpress.com/2007/12/18/insurance-agents-raising-the-bar [...]
Cindy, RN, on January 23rd, 2008 at 8:07 PM Said:

Pennsylvania’s hospitals announced yesterday that they will not charge for care related to serious medical mistakes such as wrong-body-part surgery and substantial medication errors.

The announcement follows similar stands by hospitals in Massachusetts and Minnesota, as noted on this blog and elsewhere. But, it only applies to patients who are on public healthcare coverage, like the PA Medical Assistance program. The move, was announced by the Hospital & Health System Association of Pennsylvania

QUERY: And so, am I to pay for mistakes and NEs because I am employed and have private health insurance overage – please opine – help me understand – and explain?

-Cindy, RN

As Dr. Phil would say; “is the word STUPID stamped on my forehead?”
Dr. Maurice, on January 23rd, 2008 at 8:16 PM Said:

Did you know that here in the state of California, we have launched a Web site listing what discounts hospitals will offer uninsured patients. Applications for these programs are also available for download; and policies for about 82 percent of the state’s 405 acute-care hospitals are supposedly posted – to date – with more to come.

The site was enabled because of a 2006 law, the “Hospital Fair Pricing Program”, which prohibits hospitals from charging low-and moderate-income patients more than their highest rates charged to government insurance programs in which they participate.

Talk about price transparency – what do you think?
-Dr. Maurice
Editors, on January 27th, 2008 at 10:19 PM Said:

“Executive-Post” Readers and Subscribers,

Here are some related links regarding APCs and similar topics:

Statement of AABB Before CMS’ Advisory Panel on Ambulatory Payment …
… Advisory Panel on Ambulatory Payment Classification Groups September 2007 …. CMS Publishes 2008 Hospital Outpatient Prospective Payment System Rule …
http://www.aabb.org/Content/News_and_Media/Statements/statement090607.htm – 177k – Cached – Similar pages

Ambulatory Payment Classification – AccountancyAge KnowledgeBank …
KnowledgeStorm provides free research of Ambulatory Payment Classification related enterprise software and services. KnowledgeStorm allows you to find the …
http://techfinder.accountancyage.com/search/keyword/vnuaccountancyage/Ambul
atory%20Payment%20Classification/DirectSSkw/Ambulatory%20Payment%20Classifi
cation – 138k – Cached – Similar pages

OCEAPC – NTIS Products
Assign an Ambulatory Payment Classification (APC) number for each service … When filing claims in 2008 from:. January 1 to March 31, you should use …
http://www.ntis.gov/products/families/oceapc.asp – 21k – Cached – Similar pages

Federal Advisory Committee Act (FACA)
Advisory Panel on Ambulatory Payment Classification Groups … Page Last Modified: 01/10/2008 11:03:04 AM Help with File Formats and Plug-Ins …
http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificati
onGroups.asp – 18k – Cached – Similar pages

Ambulatory Payment Classification – What does APC stand for …
Definition of Ambulatory Payment Classification in the list of acronyms and abbreviations provided by the Free Online Dictionary and Thesaurus.
http://acronyms.thefreedictionary.com/Ambulatory+Payment+Classification – 38k – Cached – Similar pages

CourseAvenue, Inc. – Introduction to Ambulatory Payment …
The prospective payment system established prospective payment rates for covered outpatient hospital services using Ambulatory Payment Classification groups …
http://www.courseavenue.com/IntroductiontoAmbulatoryPaymentClassificationsA
PCs.aspx – 40k – Cached – Similar pages

Ambulatory Payment Classes [APCs] « Medical “Executive Post” at …
The Ambulatory Payment Classifications (APCs) system was designed to explain … their segmentation into even more classes [tranches] for 2008 affected you? …
http://healthcarefinancials.wordpress.com/2008/01/05/ambulatory-payment-cla
sses-apcs/ – 43k – Cached – Similar pages

STRAIGHT TALK – Be Aware: Medicare’s Ambulatory Payment …
Since the Centers for Medicare and Medicaid Services’ Ambulatory Payment Classification (APC) system was introduced in August 2000, hospitals have struggled …
http://goliath.ecnext.com/coms2/summary_0199-2739303_ITM – 33k – Cached – Similar pages

Search Today’s SurgiCenter
Ambulatory Payment Classification (APC) represents a unit of payment for Medicare … the ASC payment rates that will apply to services provided in 2008. …
http://www.surgicenteronline.com/CMS/CMSdbsearch.asp?searchTerms=+APC – 27k

Best.
-Hope Hetico; RN, MHA
Editors, on January 28th, 2008 at 1:15 PM Said:

ON HEALTH INSURANCE: An Overview for the US

Posted for Alan by the “Executive Post”
The Alan Katz Health Care Reform Blog
http://alankatz.wordpress.com/about/

Earlier this month, America’s Health Insurance Plan’s (AHIP) published its annual Health Insurance: Overview and Economic Impact in the States.

It provides a snapshot of the economic impact health insurance has on state economies along with some interesting statistics.

All readers, subscribers, physicians and healthcare executives are urged to review it.
-Hope Hetico; RN, MHA

Alan Katz is a past president of both the National and the California Association of Health Underwriters. In 2003 NAHU named Alan the Health Insurance Person of the Year, awarding him that year’s Harold R. Gordon Memorial Award. He was named CAHU Member of the Year in 2000 and 2007.
Ann, on January 28th, 2008 at 9:19 PM Said:

According to Charlene Marietti of Healthcare Informatics magazine, 2008 will be a year of changes in HIT. She believes the outlook for physician groups points the menacing triad of:

1. More work,
2. Lower reimbursements, and
3. Evolving service models.

What do you think?

-Ann Miller; RN
Ann, on January 28th, 2008 at 9:25 PM Said:

According to Anthony Guerra, Editor-in-Chief of Healthcare Informatics magazine, CMS’s latest P4P and HIT initiative to only reward better patient outcomes that are achieved using Electronic Medical Records [EMRs] is somewhat Machiavellian?

And so, what do you think of these rules – which admittedly lack clarity to date?

-Ann Miller; RN
Ann Miller; RN, on January 29th, 2008 at 6:53 PM Said:

Past Governmental Anti-Fraud Success

As demonstrated in the post above, the federal government has grown increasingly effective at Medicare fraud recovery, but state Medicaid programs lag behind, according to New Directions for Policy, a Washington, DC research firm.

For example, in the case of Medicare fraud recoveries a few years ago, the federal government’s return on investment improved to nearly 9-to-1 in 2001 from 8-to-1 in 2000. Medicare fraud recoveries from healthcare providers grew 71% to $1.2 billion in 2001, while enforcement costs increased 6.3% to about $72.8 million.

State Medicaid fraud collections, totaled $43 million in 2001. And the federal government, which recovered $2.85 billion from Medicare fraud from 1997 to 2001, collected $115 million in Medicaid fraud recoveries during the same period, according to Medicaid Policy, a Washington consulting firm.

As so, the suggestion by Dr Marcinko that – forewarned is forearmed – is a good one!
-Ann
Ann, on January 30th, 2008 at 1:03 AM Said:

New Study Shows Lower Costs in Consumer-Driven Plans–But the Findings Won’t Settle the Debate Over Just How Effective C-D Plans Are

Check out this link with multiple informed opinions, studies and cogent thoughts on HSAs and MSAs.

http://healthpolicyandmarket.blogspot.com/search/label/Health%20Savings%20Accounts

Best.
-Ann
Ann Miller; RN, on January 30th, 2008 at 1:09 AM Said:

Drug-name Mix-ups Getting Worse

Kid given schizophrenia drug Zyprexa instead of Zyrtec for allergies
http://www.msnbc.msn.com/id/22901039

For your review.
-Ann
Barbara, on January 30th, 2008 at 3:42 PM Said:

MY CUDOS,

Did you know that most of the nation’s hospitals have been teaching their employees, for the past year, how to ferret out fraud and report it to the government under this new federal law?

Starting Jan. 1, 2007, companies that did at least $5 million a year in Medicaid business have been educating all employees and officers on how to detect fraud, waste and abuse.

Moreover, physicians and health care providers must tell employees that if they report fraud, they will be protected against retaliation and may be entitled to a share of money recovered by the government.

Health care providers must also establish policies to make sure that their contractors investigate and report fraud, while the new requirement will also apply to many pharmacies, HMOs, home care agencies, suppliers of medical equipment, physician groups and drug manufacturers.

And so, my “cudos” to Dr. Ginn, Ms. Hertico and the “Executive Post” for this alert.
-Barbara
Barbara, on January 30th, 2008 at 3:46 PM Said:

THE WHISTLE-BLOWERS,

Did you know that whistle-blowers tipped off the government to $1.3 billion worth of fraud, largely at hospitals or other health care providers?

Yep, it true!

In all, about $3.1 billion in settlements was recovered, a record amount – from individuals and companies during the 2006 fiscal year, while whistle-blowers were paid $190 million over the year for alerting the government to the fraud. Whistle-blowers have helped the government recover an estimated $18 billion since 1986, when Congress approved laws to strengthen their protections.

It seems the “Executive-Post” is on target, once again!
Source: Associated Press, November 21, 2006.

-Barbara
Linda; RN, on January 30th, 2008 at 3:49 PM Said:

Brief Historical Review of the “Never-Events” policy

The National Quality Forum’s [NQF] list of 28 Serious Reportable Events (sometimes called “never events” – medical errors that should never happen to a patient), is not exactly new.

In fact, was initiated in 2006; prompting the Leapfrog Group to give public recognition to hospitals that agree certain steps should be taken whenever a serious reportable adverse event occurs in their facility.

Through the 2007 Leapfrog Hospital Quality and Safety Survey, hospitals will be given the opportunity to receive public recognition for agreeing to do the following if a “never event” occurs within their facility:

• Apologize to the patient and/or family affected by the never event.
• Report the event to one organization; ie., JCAHO, state program or Patient Safety Org.
• Perform a root cause analysis, consistent with the chosen reporting program.
• Waive all costs directly related to the NE and refrain from seeking reimbursement from the patient or a third party payer.

Of course, the issue is ever evolving as reported in the Executive Post.
Source: Leapfrog Group, November 15, 2006
-Linda
Sharon, RN, on January 30th, 2008 at 6:32 PM Said:

Did you know that the recent push to limit whistle-blowers is realy “old news?”

I mean, the American Hospital Association (AHA) and three other provider groups urged the U.S. Supreme Court to limit the definition of who qualifies as a “whistle-blower” plaintiff in False Claims Act [FCA] lawsuits, back in 2006.

For example, whistle-blower laws require plaintiffs to be the “original source” of information in a complaint.

In a friends-of-the-court brief, provider groups often argue that the 10th Circuit previously accepted too broad a definition of “original source.”

A clear, consistent and strict ‘original source’ rule could “ward off illegitimate qui tam strike suits,” the AHA and other groups said in an amici brief.

In addition to the AHA, politically active groups include the Federation of American Hospitals [FAH], Association of American Medical Colleges [AAMC] and American Health Care Association [AHCA].
-Sharon

Reference: Mark Taylor, Modern Healthcare 10/17/06
Ann, on January 30th, 2008 at 7:36 PM Said:

Potential Economic “Cause and Effect”

Drug giant and Dow component Merck reported a fourth-quarter net loss of $1.63 billion, or 75 cents per share, a decline from the profit of $473.9 million, or 22 cents per share, it earned in the same quarter a year ago.

The company’s results were slammed by charges related to settlements of lawsuits for its Vioxx painkiller.

Excluding charges related to those settlements, Merck beat Wall Street’s estimates today:

Merck earned 80 cents per share, above the consensus estimate of 74 cents per share.

Merck lowered its 2008 guidance to between $3.80 and $4.00 per share, down from a range of $3.96 to $4.06 per share; this day.

-Ann
Hope, on January 30th, 2008 at 8:38 PM Said:

FYI:

According to Dr. James Feldbaum [www.Feldbaum.com] of http://www.Healthcare-Informatics.com the pay-for-performance initiatives will require an EMR in place to participate.

He says that the Bush administration has recruited about 1,200 doctors nationally to adopt an EMR in their medical practice in return for higher Medicare payments. Medicare will pay the physicians extra for completing tasks online, such as when ordering prescriptions or recording the results of lab tests. The highest payments will go to those physicians who most aggressively use the technology and who score the highest in an annual evaluation.

He opines that we will see the third party payers follow suit.
What do you think?

-Hope
Hope, on January 30th, 2008 at 9:21 PM Said:

FYI:

For another interesting perspective, take a look at this link:

Microcapitation: A Closer Look and New Perspective on Capitation

http://crossoverhealth.wordpress.com/2007/12/21/microcapitation-a-closer-look-and-new-perspective-on-capitation/

-Hope
Ann, on January 31st, 2008 at 6:30 PM Said:

SAR-BOX AND TAX-EXEMPT HEALTHCARE ENTITIES

When discussing the Sarbanes-Oxley Act, it is worth noting that while all hospitals may not be affect by it – all nonprofit hospitals, clinic and healthcare organizations are exempt from corporate income taxes as well as state and local property taxes – wherever they are located.

Ironically, this exemption is may be more valuable to health entities located in most affluent areas because target population income is higher and property values are worth more.

As David A. Hyman and William M. Sage point out in the current issue of Health Affairs magazine:

“All else being equal, a hospital that provides little charity care and is located in a “desirable” location (in terms of property values) will receive a much greater financial benefit when its income and property go untaxed than a hospital that provides lots of charity care and is located in an ‘undesirable’ location.”

Thus, many suggest that current subsidies are ‘upside-down’ in that they are worth more to non-profit healthcare organizations that are likely to provide the least charity care.

Of course, this irony is not addressed in the Sarbanes Oxley Act; at all!

-ANN
Janet, on January 31st, 2008 at 6:42 PM Said:

Not So Fast!

Of course, with Medicare payments to physicians in doubt for the final half of FY-2008, lawmakers and CMS already are thinking about physician fee-schedules for the last half of 2008 and in 2009.

The six-month 0.5 percent boost is set to run out at the end of June and be replaced with a 10.1 percent reduction. This means that Medicare would cut doctors-pay across the board by 10.6 percent; from July 1 through the end of the year.

Anticipating this, according to the American Medical News, Finance Committee members are working on an 18-month payment plan, instead of another six-month fix, so that an 18-month measure would put off the next round of scheduled cuts until 2010.

This would also free Congress from negotiating a CMS 2009 payment update during the presidential election season.

And so, is this just a matter of more politics as usual?
-Janet
Japhet, on January 31st, 2008 at 11:14 PM Said:

More about Captain Perez,

I had the honor of being CPT Perez’ Executive Officer during her time with the 67th CSH in Tikrit. And, this article barely touches the many qualities and professionalism this fine nurse exhibited..

CPT Perez is not only an inspiration to those she left behind, but an inspiration to everyone she meets. She not only volunteered to join the Army , she made sure she placed herself close to units scheduled to deploy to vsrious war zones.

During her time in Tikrit, she dedicated most of her efforts in training the medics working with her and making improvements to the Emergency Medical Care the hospital provided.

Upon re deployment, and still concerned for the wounded, CPT Perez volunteered to go to Fort Lewis and joined another organization getting ready to go back to support Combat Operations.

CPT Perez is an asset that can make any organization successful. The Army and her Soldiers will definitely miss her, but will forever be grateful for her unselfish dedication and service.

Thanks Teresa.
-Japhet
Thomas A Muldowney, on February 1st, 2008 at 12:25 AM Said:

Hi Dr. Drew,

The website blog post (above) leaves a careful and accurate description of an Investment Policy Statement [IPS]. If read carefully, you’ll see it is a written description of your targeted investment goals.

Over time, you will be able to compare your actual investment results to appropriate standards to see if your investment choices have lived up to the expectations that you laid out when you made the original investment [Not too different from any means of medical or other quality control initiative].

The IPS is important in many ways. One of them for your consideration, for example, is this:

You probably have a target investment (retirement) goal.
You will need a certain amount of money at that time in order to actualize your goal.
The acquisition/build-up of this money includes only three variables:

1. Money
2. Rate of Return, and;
3. Time.

You select the time (date of retirement); you select the amount of money that you expect to save, inherit or accumulate on a periodic basis in order to reach your goal; and then you apply to the time and money – a targeted-rate-of return.

The IPS defines how you are going to develop the needed investment rate-of-return for several asset classes. It also often defines acceptable volatility and delivers a reasonable understanding of your chances of reaching your goal.

The IPS is a valuable tool to help you keep your investments – and thus your goals, profession and life – on track.

Best of Luck.

Thomas A. Muldowney; MSFS, CLU, CRC, CFP®, CMP®
Certified Medical Planner™
http://www.SavantCapital.com
Editors, on February 1st, 2008 at 1:28 AM Said:

Captain Perez,

Try this link for more information on “CPT Terry”, from “Defend America.”

http://www.defendamerica.mil/CallAction/CalltoAction.html

-Editors
Editors, on February 1st, 2008 at 8:57 PM Said:

Preliminary CMS P4P Results

According to a new report in Modern Healthcare, hospital costs and mortality rates are going down under the new CMS’s pay-for-performance initiatives.

Under the Hospital Quality Incentive Demonstration [HQID] project, which began in 2003, the median hospital cost per patient has declined by more than $1,000 across the first three years of the project. And, the median mortality rate went down by 1.87 percent.

The Premier healthcare alliance, which manages the project, reached this conclusion after analyzing more than one million patient records from more than 250 participating hospitals.

According to another analysis, hospitals nationally could save 70,000 lives per year and cut costs by more than $4.5 billion annually if they made the same improvements as the participating hospitals over a three-year period.

Any thoughts or comments?
-Ann
Denise, on February 1st, 2008 at 9:13 PM Said:

Defining “Non-Profit” In Ohio

Did you know that Ohio Attorney General Marc Dann wants to better define what the state’s not-for-profit hospitals must do to keep their state property tax exemption?

Among other things, the AG wants to see poor and uninsured patients pay no more than insurance companies pay for care. As part of the initiative, he plans to hire experts to study charity care issues and look at what other states are doing.

He’s interested, for example, in a Minnesota accord under which hospitals agreed not to use abusive debt collection practices or charge uninsured patients more than insurance companies. He also plans to join Sen. Chuck Grassley (R-Iowa) who has been examining the issue of hospital charity care for years.

This initiative comes as several Ohio communities have begun questioning the tax-exempt status of their local not-for-profit hospitals.

For example, one community is challenging the tax exemption enjoyed by a Beachwood, OH facility run by the Cleveland Clinic, arguing that it provides no charity care or other community benefits.

And so, is this a SAR-BOX matter akin to the “goose that killed the golden egg?”

Please comment.
-Ann
Somebody, on February 3rd, 2008 at 7:27 PM Said:

Could results vary with demographics and hospital settings?
Editors, on February 3rd, 2008 at 7:41 PM Said:

The Happy Hospitalist makes a good point.

Does anyone have any research, data, results or empirical evidence to refute or support the NJEM study.

-Hope
Debra, on February 3rd, 2008 at 9:38 PM Said:

Proposed Medicare Budget

I recently read in the Wall Street Journal that President Bush’s proposed Medicare budget would cut $15 billion to hospitals over five years through a reduction of annual updates for inpatient care. It would cut $25 billion from payments to hospitals serving large numbers of poor people, as well as cut $20 billion from payments for capital projects such as putting up new buildings and buying equipment.

The president would also cut $1.2 billion from Medicaid next year and nearly $14 billion over five years, while payments would not be cut to private insurance companies who manage Medicare Advantage plans, which cost more than traditional Medicare plans.

And, so, with the population aging, and baby-boomers needing more care than ever, does this mean that Medicare was over-paying hospitals for all these years?

-Debra; RN
Christy, on February 3rd, 2008 at 10:03 PM Said:

Seeking Dossia® PHR Info?

Does anyone have current information on the Wal-Mart pilot-testing program Dossia®, their massive Personal Health Record [PHR] initiative?

I understand the current pilot study includes about 20 Wal-Mart employees, as well as a few other folks from partner firms like Applied Materials, AT&T, Pitney Bowes, Cardinal Health and Sanofi-Aventis, etc.

The PHR technology is based on Indivo, an open-source PHR system developed by the Children’s Hospital of Boston, back in 1998. So, you can see my concern about using open-source code almost a decade old!

Thank so much.
-Christy
Jeff Seymour, on February 4th, 2008 at 1:15 AM Said:

Good article. A counter point: bear in mind that MDs need be concerned with asset protection. Clearly, a 2 yr reserve in a taxable account in the Drs. name is going to be problematic.
-Jeff Seymour; CFP
Dr. Marcinko, on February 4th, 2008 at 1:24 AM Said:

Verification Might Spur HIT Initiatives,

I believe that if medical providers adopted a set of common practices for validating the identity of online consumers, not only would our records be safer, it’s more likely that Personal Health Records [PHRs], and other HIT initiatives, would become more popular with all patients.

Of course, the use of “knowledge-based authentication systems” – a security method that uses one’s knowledge of facts only they should know – to establish identity is vital. In addition, confirmed identities managed by reliable third-parties, such as financial institutions, should also be included in the security-mix.

Of course, the devil-is-in-the-details, and who among us can define a ”reliable third party”, with the daily barrage of security breaches coming at us at increasingly faster rates?

Nevertheless, hospital rules and regulations mandated by both the Sarbanes-Oxley Act, as well as the Patriot Act, might be satisfied in this manner.

So, let’s start with the HIT lexicon: http://www.HealthDictionarySeries.com

But, that’s just my opinion.
What do you think; please opine?

Dr. David Edward Marcinko, MBA
Publisher-in-Chief
Hope, on February 4th, 2008 at 1:51 AM Said:

BREAKING-NEWS
Did you know?

With the addition of fiduciary requirements to the CFP® Board’s Standard of Professional Conduct, the adoption of the Pension Protection Act [PPA], and the vacating of the broker-dealer exemption, the need for health economics education in the physician advisory space is at an all-time high.

Our online Certified Medical Planner™ program imparts the healthcare industrial complex specificity – physician focused financial planning knowledge – and integrated medical practice management expertise that is needed to help devise solutions and raise the bar of advisory competence for all those serving medical professionals in the modern era.

Best.
Hope Hetico; RN, MHA
Certified Medical Planner™
Hope, on February 5th, 2008 at 1:51 AM Said:

CONs IN FLORIDA:

Did you know that Florida’s Governor Charles Crist (R) wants his state to repeal its certificate-of-need rules for acute-care hospitals?

The governor just included a proposal to eliminate CON rules in his fiscal 2009 budget, arguing that such a move would “increase competition and efficiency in the healthcare marketplace.”

As Executive Post readers know, the idea seems to be popular beyond the governor’s mansion, as the state’s Agency for Health Care Administration [AHCA], which oversees the CON process there, made a similar proposal late last year.

And so, could this be a trend?

-Hope
Emily, on February 5th, 2008 at 12:41 PM Said:

What’s up with the NBGH?

Did you know that the National Business Group on Health [NBGH] – a coalition of big employers which represents scores of Fortune 500 companies including Wal-Mart, Microsoft, General Motors and GE – said it would support efforts to require individuals to have health insurance coverage for themselves and their dependent children?

However, it opposes any mandates that would require employers to either offer health coverage to workers or pay the government.

Now, can any one please explain the point of this NBGH announcement?

Thanks.
Emily
Jake, on February 5th, 2008 at 12:49 PM Said:

Retail Clinics Help People

Did you know that the Institute of Medicine (IOM) has called for the creation of yet another public database that gauges the effectiveness of drugs and health services?

Yep! According to the Kaiser Daily Health Policy Report, the database could house a credible synthesis of studies which could help minimize the use of questionable services and target services to the patients most likely to benefit.

The report laid out plans for a private or public-private entity that could produce the database, and said a properly-conducted, systematic review should make obvious the gap between what is known about the effectiveness of a particular service and what clinicians and patients want to know.

And so, do we really need to spend more money, time and effort or learn about domestic US healthcare delivery system problems; or should we start providing real solutions like retail health clinics?

Less talk, more action!
-Jake
Tom, on February 5th, 2008 at 12:59 PM Said:

MSFT-Mayo?

I just heard that Microsoft is partnering with the Mayo Clinic to develop consumer health management tools based on its HealthVault connectivity PHR platform.

At its October 4 launch last year, Microsoft claimed about 40 HealthVault partners, and more than 200 companies have agreed to use the technology. But, some say that the strategic co-development relationship between Mayo and MSFT is more extensive than its other partnerships.

So, I’m interested to learn whether this deal – much like the recent one with IBM – might suggest that Mayo wants to become a software powerhouse in its own right?

Any gossip tidbits out there – for the grist mill?

-Tom
Jennifer, on February 5th, 2008 at 1:08 PM Said:

Compensation for Virtual Medical Visits

Slowly, it’s beginning to look like health insurers are accepting the virtual medicine trend. For example, I understand that Aetna and Cigna just agreed to reimburse doctors for online visits. Might other insurers soon follow?

Typically, insurers are paying about the same for online visits as they do for on-ground consultations. While some of these “virtual visits” are done via Web and e-mail, with broadband Internet access becoming almost universal, doctors can easily conduct video visits using an inexpensive PC camera. Doctors are slow HIT acceptors.

Meanwhile, other telemedicine options are emerging, as well. For example, devices that can remotely check blood pressure and other vital signs, as well as blood sugar levels are growing cheaper and more common.

What a brave new world!
-Jennifer
Jim, on February 5th, 2008 at 3:35 PM Said:

Readers may be interested in this comment:

http://www.healthcare-informatics.com/ME2/Default.asp

Also, another article came out today:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6937785EA1184EB180B78D04AD2AE205

Best.
James Feldbaum; MD
Physician Consultant
Clinical Transformation, Interoperability, and CPOE
http://feldbaum.com
13994 Siena Loop, Bradenton, Florida 24202
941-266-0426
Raymond, on February 5th, 2008 at 6:27 PM Said:

Rand Report

A new study from the Rand Corporation and the University of Southern California suggests that state hospitals in California collect more from the uninsured than they do on-average from government payers.

Now is anyone still surprised?
-Raymond
Judy, on February 6th, 2008 at 1:36 AM Said:

More on Concierge Medicine

“75% of doctors report a growing dissatisfaction with the practice of medicine”
(2005 GAO 05-929 Concierge Care)

Catching-on, in Cleveland and the heartland.
Visit this post for related info:

http://cleveland.dbusinessnews.com/shownews.php?type_news=latest&newsid=144622

-Judy
Elaine, on February 6th, 2008 at 12:46 PM Said:

UHC and HD-HCPs

Did you know that United Healthcare [UHC] is expanding a program to lower out-of-pocket expenses for new subscriber’s to some of their HDHCPs if benchmarks for body mass, blood pressure, cholesterol and tobacco avoidance are met?

The pilot program is voluntary, but employees can earn deductible credits, while employers can save 12 percent to 20 percent annually on health care costs depending on plan type.

And so, is UHC getting “warm-n-fuzzy” in the face of its many recent debacles?
-Elaine
Editors, on February 6th, 2008 at 9:30 PM Said:

More on UHC

Read more scary stuff about UHC from this link.
http://www.thehealthcareblog.com/the_health_care_blog/2007/12/unitedhealth-cu.html

-Anonymous
Executive-Post, on February 7th, 2008 at 1:17 PM Said:

MMA 2003-2008

Did you know that enrollment in the Medicare Part D prescription drug benefit program for 2008 increased by 6.2 percent; to 25.4 million beneficiaries?

The Centers for Medicare and Medicaid Services [CMS] just reported that among the 44.2 million Medicare beneficiaries, 17.4 million enrolled in stand-alone prescription drug plans and eight million have enrolled in Medicare Advantage plans. Moreover, 14.2 million Medicare beneficiaries receive prescription drug coverage through retirement, veterans or other programs.

Currently, more than 39 million Medicare beneficiaries, or 90 percent, have prescription drug coverage through the prescription drug benefit or some other source, while the estimated cost of the Medicare prescription drug benefit through 2017 decreased by $117 billion from an estimate done last year.

-Donna
Executive-Post, on February 7th, 2008 at 1:49 PM Said:

More on Electronic Prescribing

For an excellent blog on:
The Real State of Play in eRx
By Jonathan Pearlstein

Please read this link:
http://www.thehealthcareblog.com/the_health_care_blog/2007/04/techphysicians__2.html

-Editors
Executive-Post, on February 7th, 2008 at 5:09 PM Said:

Non-Profit Credit Ratings

Did you know that a new report concludes that quality incentives could potentially translate into a credit-rating boost for not-for-profit hospitals?

According to Moody’s Investors Services, when hospitals work to improve quality, it can result in improved operations, higher patient volume and market share, better rates from health plans and ultimately, an improved economic and financial managerial picture.

Now, is anyone surprised over this organizational behavior conclusion?
-Executive-Post
Executive-Post, on February 7th, 2008 at 6:16 PM Said:

New Financial Planner “CFP® Board Ethics”

Did you know that the CFP® Board adopted new ethical standards, last year?

Read this interesting post by Mike Benson for more details
http://wealthfly.com/blog/2007/06/04/cfp-adopts-new-ethics-standards/

So, what about the “old” ethics?
Hope Hetico; RN, MHA
Certified Medical Planner™
Executive-Post, on February 7th, 2008 at 6:23 PM Said:

Rand Report on Broker-Dealers

Matt Abar just released this interesting post on the new Rand Report
http://wealthfly.com/blog/2008/01/30/the-rand-reports-unfortunate-conclusion

Confusing and not very flattering, is it?
-Executive Post
Executive-Post, on February 7th, 2008 at 7:45 PM Said:

Whistle Blowers

Did you know the Department of Justice [JOD] just reported that Merck & Co. will pay more than $650 million to resolve two whistle-blower lawsuits, one of which was filed by a physician who said substitutions were made to his prescriptions under a pricing agreement with hospitals?

More information on this breaking story is appreciated.
-Editors
Executive-Post, on February 8th, 2008 at 1:26 PM Said:

The ASC Freeze

Did you know that President Bush proposed a two-year freeze on Medicare payment updates to ambulatory surgical centers [ASC]?

The proposal – on top of an existing six-year freeze – is to be followed by three years of annual increases that would equal the Consumer Price Index [CPA] minus 0.65 percent. And, economic estimates suggest a savings of $450 million over five years, mimicking cuts to other health care providers.

According to Modern Healthcare, CMS paid $2.9 billion to ASCs in 2006.
-Editors
Executive-Post, on February 8th, 2008 at 11:14 PM Said:

History of HSAs and HD-HCPs

An interesting story-line by Matthew Holt:
Medicare and HSAs: Ready for their Close-Ups

http://www.spot-on.com/archives/holt/2006/01/health_care_policy_and_politic.html

-Editors
Executive-Post, on February 9th, 2008 at 1:49 AM Said:

Certified Medical Planner™ program

For more information:
http://www.medicalbusinessadvisors.com/institute-courses.asp
-Editors
Executive-Post, on February 9th, 2008 at 1:52 AM Said:

The Executive Post
Forge a Strategic Partnership with Us

http://www.medicalbusinessadvisors.com/sponsors.asp and
http://www.medicalbusinessadvisors.com/institute-institutional.asp
-Editors
Financial Advisor, on February 9th, 2008 at 2:56 PM Said:

Cash CD Account Risks

I think this issue requires a multi-variable analysis for sure.

And, perhaps a better question might be how can the physician evaluate the risks associated with high-yielding, brokered bank certificate of deposits for these short-intermediate term cash funds?

For example, the doctor-investor should determine if the CD is issued by a federally insured institution. If the answer is yes, the investor knows that a portion of his money is safe if the institution fails. If the answer is no, the doctor should obtain the institution’s ratings from the appropriate rating agencies and analyze the institution’s financials.

Second, the doctor-investor should investigate the volatility of the CD’s return. When interest rates rise and fall the price of a brokered CD will fluctuate in a manner similar to that of a bond. Therefore, short-term securities will be less risky than long-term securities.

Of course, the above are applicable to all of us, and the issue of tax-exempt versus taxable accounts has not been addressed. But, with declining interest rates – and physician incomes – the difference may not be dramatic for some MDs. And, you can always place the funds in the account of a spouse; if you trust him/her.

Nevertheless, I do agree with the trend to expanding one’s emergency fund, regardless of occupation; and perhaps even more for physicians as the original post authors’ suggest.

-A Financial Advisor
Allen Taylor, on February 9th, 2008 at 6:34 PM Said:

I found your site on technorati and read a few of your other posts. Keep up the good work. I just added your RSS feed to my Google News Reader. Looking forward to reading more from you.

Allen Taylor
Jennifer, on February 9th, 2008 at 9:04 PM Said:

The ASCA

Did you know that Ambulatory Surgery Center Association [ASCA] President Kathy Bryant just called President Bush’s proposed two-year freeze on Medicare payment updates to ASCs “totally unacceptable?” She also suggested that Congress reject the plan.

-Jennifer
WILMA HAYE, on February 10th, 2008 at 3:55 AM Said:

A beautiful woman. I am so proud to say that i know her.
Executive-Post, on February 10th, 2008 at 7:20 PM Said:

The Money MDs

Here is an interesting related link:

http://themoneyforlifebook.wordpress.com/2008/02/08/is-your-advisor-an-md/

Seems as though everyone wants to be a “doctor”; except maybe the doctors.
Dean Calvert, on February 11th, 2008 at 7:38 AM Said:

Good information and reading.
I will definitely bookmark you to check for new updates.
Thanks.
Dean
Executive-Post, on February 13th, 2008 at 10:35 PM Said:

More on UHC,

According to Modern Physician, New York Attorney General Andrew Cuomo just announced an industry wide investigation into an alleged scheme in which insurers and health information firm Ingenix® manipulated reimbursement rates.

Cuomo issued 16 subpoenas to insurers and plans to file a lawsuit against Ingenix®, its parent, UnitedHealth Group, and three UnitedHealth subsidiaries.

And so, it seems reasonable to wonder if there are any other shoes to drop on the whole UCH mess.
Executive-Post, on February 14th, 2008 at 11:27 AM Said:

More on Sarbox and Non-Profit Hospitals

Did you know that a Massachusetts healthcare workers’ union is arguing that BOD members of non-profit Beth Israel Deaconess Medical Center should be required to follow Sarbox disclosure rules with its audits? The request springs out of a long-standing battle between the 1199 SEIU United Healthcare Workers East, which has been organizing at the Harvard-affiliated facility, according to a new report.

The SEIU argues that nonprofit directors who observe Sarbox rules when sitting on public-company boards are required to do the same on Beth Israel’s board. Of course, that includes the six of Beth Israel’s members, who sit on such public firms as Staples, Brooks Automation and Charles River Laboratories.

It seems that the SEIU believes Beth Israel has been commingling bad debt and charity care expenses in its 2005 and 2006 annual reports. Naturally, this would make it look less healthy than it is and give it more leverage against unionization.

What a snarly situation … say it aint so, Beth Israel?
Executive-Post, on February 14th, 2008 at 3:56 PM Said:

Hospital prompt-pay discounts

Did you know that the HHS Office of the Inspector General [OIG] recently gave its approval for prompt-payment discounts to patients who pay their hospital medical bills quickly?

The advisory opinion was needed because of self-referral inducement fears that seemed to encourage patients to buy medical services that might not be needed. The OIG noted that a safe harbor already existed to protect waivers of coinsurance and deductibles for inpatient services under some circumstances.

But primarily, the government didn’t want hospitals to give a discount and then try to get more money by calling the discounted fees bad debt.

How this all might impact medical practice or healthcare entity value is difficult to access.
Executive-Post, on February 14th, 2008 at 11:37 PM Said:

Osteopaths

The report also indicated the number of osteopaths rose from 1,748 to 3,163.
-D.O. reader
Temporary Test Blog » Blog Archive » Traditional Methods of Healthcare Finance, on February 17th, 2008 at 1:19 AM Said:

[...] Original post by Executive-Post [...]
Health Care Finance » Blog Archive » Traditional Methods of Healthcare Finance, on February 17th, 2008 at 2:04 AM Said:

[...] Original post by Executive-Post [...]
Beth, on February 19th, 2008 at 5:05 PM Said:

Theresa,

Congrats. I know that if anyone deserves this award it is YOU!
Hope you are safe. Kay and I would love to see you when you are at home.

Beth H. Rodgers, RN
Sue Massey, on February 21st, 2008 at 5:46 PM Said:

Executive-Post,

I found your site on google blog search and read a few of your other posts. Keep up the good work. Just added your RSS feed to my feed reader. Look forward to reading more from you.

- Sue
Ann Miller; RN, on February 23rd, 2008 at 2:15 PM Said:

Did you know that the popularity of retail health clinics is growing slowly, according to a survey by Deloitte’s Center for Health Solutions?

I bet Jake did!

In an online survey that drew roughly 3,000 responses, about 33 percent of people didn’t like the idea of retail clinics. On a scale of one to 10, with one being “not at all comfortable” and 10 being “completely comfortable,” this group placed themselves at one, two or three, reported the Wall Street Journal.

Only 16 percent, on the other hand, put themselves at eight, nine or 10; while respondents were more comfortable with retail clinics staffed by nurse practitioners if they were told that the nurses were affiliated with a local doctor’s office.

Of course, Wal-Mart is taking the concept a step further as it affiliates with selected hospitals in target market cities. And so, it seems that medicine is evolving from a retail – to wholesale – and back to a retail business model; but now at greatly reduced price points.

Any comments on the evolution; or is it revolution?
-Ann
Ann Miller; RN, on February 23rd, 2008 at 2:22 PM Said:

Did you know that prices for hospital services rose 1.1 percent in January, up from a 0.6 percent increase in December?

The increase was the highest jump since April 2002 when it increased 1.2 percent, according to the U.S. Bureau of Labor Statistics’ [US-BLS] seasonally adjusted Consumer Price Index [CPI], according to Modern Physician.

For the 12 months ended in January, the hospital CPI was up 8.8 percent, compared with a 6.4 percent rise in the year-ago period, while the physician CPI rose 0.2 percent in January, down from the 0.3 percent rise in December.

For the 12-month period, the physician CPI rose 3.5 percent, compared with a 3.2 percent increase in the year-ago period.

And so, how does this compare with your local geographic area?
-Ann
Executive-Post, on February 24th, 2008 at 9:24 PM Said:

An Independent Executive-Post

We journalists love to cite the fact that the press is the only industry protected by the Constitution of the United States.

A free press, as Thomas Jefferson noted, is part of our system of checks and balances; it is one of the few guarantors of democracy.

But, for the press to remain free, we need to preserve both the reality and appearance of that freedom.

This is our goal for the Executive-Post.
“Your voice – Our platform”
Please help us attain it, through your support.

Thank you.

Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
Hope Rachel Hetico; RN, MHA, CMP™
Managing Editor
Ann Miller; RN
Executive Director
Troy, on February 26th, 2008 at 6:17 PM Said:

Hello,

Please allow me the honor of being an Executive-Post CERTIFIED MEDICAL PLANNER site-blogger, and prospective student (I mean, online adult-learner)!

I have several iMBA books, and they are insightful, easy to read and valuable. I ordered several for clients and am still checking into the CMP program myself; but wanted to be among the first to congratulate you on this blog. It is a great idea!

You are indeed the next (or is it Net) generation of health econmic advisors for physicians and medical professionals. Keep up the good work!

-Troy
Ann, on February 26th, 2008 at 8:47 PM Said:

About PQRI

Did you know that according to Modern Physician, just 16% of eligible physicians participated in the voluntary Physician Quality Reporting Initiative [PQRI] last year?

It was a program that provides a 1.5% bonus payment to practices that report on quality measures, according to data released by the CMS.

Talk about P4P!
-Ann
Physician Hospital Organizations, on February 28th, 2008 at 12:25 AM Said:

[...] Executive-Post wrote an artilce worth reading today. Here is a quick excerpt: David Edward Marcinko; MBA CMP™ Publisher-in-Chief A Physician Hospital Organization, or PHO, is a blend of private doctors and hospitals, maintaining its concentration and control of surgical, rather than medical care.

His Managed Care dictionary is great, too.
Physician Business Owners, on February 28th, 2008 at 2:52 PM Said:

[...] Executive-Post always has something good to say. I like this one posted earlier today. Follow the link for the whole article. Medical Accounting News for 2008. Staff Writers. By now, most physician business owners understand the general rules regarding the filing requirements for IRS Form 1099-MISC. Nevertheless, in review …
Ann, on February 28th, 2008 at 9:31 PM Said:

CMS P4P Data Report

Did you know that according to the Centers for Medicare and Medicaid Services [CMS], preliminary reports by the Physician Quality Reporting Initiative (PQRI) revealed that only about 99,000 physicians and others – 16 percent – who could have reported on 74 quality measures actually did so in 2007?

Follow-up reports in Modern Physician revealed that several specialties like anesthesiology, ophthalmology and emergency medicine had higher than average rates of participation in the program. The PQRI offered physicians who successfully reported on a designated set of quality measures a bonus payment for covered Medicare physician fee schedule services.

The 2008 PQRI reporting period, which spans the entire calendar year, will offer the same bonus payment for reporting on 119 measures.

And so, do doctors really want P4P; or is their “P” not worthy of the “P”?
-Ann
Mary, on February 29th, 2008 at 11:31 AM Said:

Hi all,

Here is the link from the Center on Budget and Policy Priorities to an excellent article which argues against HSAs/MSAs.
http://www.cbpp.org/6-12-06health.htm

HEALTH SAVINGS ACCOUNTS UNLIKELY TO SIGNIFICANTLY REDUCE HEALTH CARE SPENDING
By Edwin Park

I don’t agree with it at all, having had an HSA for almost eight years now, but the difference in opinion is interesting. The time lag since publication in 2006 also provides some insight and clarity into a changing positive sentiment on the model.

Please enjoy and comment with my compliments.
Best.
-Mary
» Ahmad Hashem, MD, Ph.D free medical web log: On my blog you will find stories from other writers which I have found inspiring, educational, or just fun. Follow the links to read the whole story directly from the author., on February 29th, 2008 at 12:25 PM Said:

Hashem; MD, Ph.D. Posted in February 29th, 2008. Executive-Post put up a good read today.
Executive-Post, on February 29th, 2008 at 3:14 PM Said:

Who Foots the Bill for Medical Errors?

Another interesting and related post on Never-Events.
http://www.msnbc.msn.com/id/23341360

Best
-Hope
Executive-Post, on March 7th, 2008 at 4:57 PM Said:

Folks,

Under pressure from large private insurers, state governments and Medicare, hospitals around the country are now agreeing not to charge when they make certain medical mistakes – also called “never events” – because they shouldn’t happen.

Please check out this related link:
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/HospitalsWontGetToBillForErrors.aspx

-Ann
Executive-Post, on March 10th, 2008 at 11:26 PM Said:

D2C Ads

Did you know that according to the Kaiser Family Foundation, prescription drug ads and direct to consumer [D2C] ads prompted nearly one-third of Americans to ask their doctors about an advertised medicine, and 82 percent of those who ask say their physicians recommended a prescription?

The findings in a national survey by USA Today and the Harvard School of Public Health come as drug advertising hit a record $4.8 billion in 2006, up from $2.6 billion in 2002.

Among people who requested a drug, 44 percent said physicians gave the one they asked about, while slightly more than half said doctors prescribed a different drug. The percentage of people getting a drug after asking about an ad shows an increase from 2005, when Kaiser found that 75 percent said the doctors recommended some type of drug.

-Ann
Executive-Post, on March 10th, 2008 at 11:32 PM Said:

Cats and Dogs-No More

Did you know that members of Montgomery County’s bar association and medical society in Pennsylvania, along with Abington Memorial Hospital in PA, are launching a pilot project they hope will keep more malpractice disputes out of court?

Lawyers and doctors will work in teams to mediate conflicts between patients and the hospital or doctors, in the hope that the new approach will resolve problems more quickly and humanely, without the aspersions of both sides that can occur in malpractice battles, according to the Philadelphia Inquirer.

Doctors and nurses are being trained to listen to aggrieved patients and explain what happened in as much detail as possible and, if that is not enough, patients can move to mediation, while patients still have the option of going to court.

-Ann
Executive-Post, on March 10th, 2008 at 11:39 PM Said:

Confidential Medical-Error Reporting,

Did you know that Federal regulators recently proposed sweeping patient safety rules to give physicians a confidential and voluntary way to report medical errors, never-events and “near-mistakes?”

The rules, released on February 12, 2008, by the Agency for Healthcare Research and Quality [AHRQ], would implement the Patient Safety and Quality Improvement Act [PSQI] of 2005, which authorized creating patient safety organizations to which doctors, hospitals and other institutions could report mistakes, according to the American Medical News.

The PSQIs would identify trends in errors and share them with the medical community, with the goal of gathering information on outcomes for many patients to detect patterns of risk and harm in a variety of health care settings, from doctors’ offices to hospitals.

The patient safety regulations would create uniform national peer review protections, acknowledging that physicians and others are sometimes reluctant to participate in quality review activities because they fear that the information ultimately could be used against them in a medical liability lawsuit or by a disciplinary body.

-Ann
Executive-Post, on March 10th, 2008 at 11:49 PM Said:

Medicare Fraud Audits

Did you know that the Centers for Medicare and Medicaid Services [CMS] will fight to preserve its audit programs? Why? Because they work!

For example, over the last year, contractors collected $371.5 million in allegedly improper Medicare payments from medical providers in California, Florida and New York. And, CMS may soon be rolling the audit program to more than a dozen additional states.

Of course, the programs have upset more than a few stakeholders, worried that contractors may be unfairly targeting legitimate claims to collect their 20 percent commission. They’re also furious that contractors get to collect the money immediately, then force hospitals to go through appeals if they want it back.

Not only have hospitals complained bitterly, at least one federal legislator isn’t happy with the arrangement. Rep. Lois Capps (D-CA) has filed a bill calling for a one-year moratorium on the program.

CMS, for its part, is retooling the program to address critics’ concerns. Perhaps most importantly, the agency is working on regulations that would allow providers to defer repayment of contested claims until the appeals process is completed. It will also require contractors to have a medical director on staff, limiting how far back auditors can delve into claims (three years), and barring audits of claims before Oct. 1, 2007.

Whether these proposals will help keep the program alive is anyone’s guess; according to Fierce Healthcare.

-Ann
Financial Planning on The Finance World For News and Information Around The World On Finance » Blog Archive » Edwin P. Morrow; CFP, ChFC, CLU, on March 11th, 2008 at 12:03 PM Said:

[...] Edwin P. Morrow; CFP, ChFC, CLU Each aspect of practice becomes critical, just as action is needed. Some of the activities of operating a successful financial planning practice generally attract more attention than others, such as […] [...]
Jake, on March 12th, 2008 at 10:49 AM Said:

A New Drug Pricing Report

Did you know that according to Delta Marketing Dynamics, the nation’s pharmaceutical companies increased wholesale prices for the 50 top-selling branded drugs by an average of 7.82 percent in 2007? And, similar increases of 6.73 percent and 6.22 percent were noted in the previous two years that were almost double the overall U.S. economy’s 4.1 percent annual inflation rate.

Some individual drugs even had double-digit price increases over three years. For example:

• GlaxoSmithKline PLC raised the price of antidepressant Wellbutrin XL by 44.5 % from 2005-07;
• Sanofi-Aventis SA raised the price of sleep drug Ambien 70.1 percent;
• Shire PLC increased the price of attention-deficit disorder medication, Adderall XR, by 33.5%;
• Cholesterol fighting Lipitor-the world’s top selling drug that made $13 billion in 2007 for Pfizer Inc-rose 16 %.

The report was published in the Wall Street Journal.
-Jake
William, on March 12th, 2008 at 11:12 AM Said:

Enter the Recovery Audit Contractors

Did you know that private companies are auditing medical records to determine if doctors erred when billing Medicare?

If so, they may be required to return overpayments as more than $300 million was collected by the federal government – in three year and from just three states – according to Associated Press reports.

Of course, a national rollout of “recovery audit contractors” will soon be monitoring health care providers in 19 more states beginning this spring. An additional five states will be audited in the Fall of 2008.

The Office of Management and Budget [OMB] estimated that Medicare payment errors total about $10.8 billion a year. Yet, a report from the Centers for Medicare and Medicaid Services [CMS] showed that contractors reviewed about 930 million claims in Florida, California and New York during the program’s first 2 1/2 years, and identified errors in less than 0.2 percent of the claims.

And so, why the disparity? Your thoughts are appreciated.
-William
Anonymous, on March 12th, 2008 at 7:58 PM Said:

One-Third of Employers Offer Consumer-Driven Option,

Did you know that: “More than one-third of surveyed employers offered a consumer driven health plan option in 2007, according to a recent benefits survey from the International Foundation of Employee Benefit Plans.”

(Wolters Kluwer Financial Services)
About Insurance, on March 12th, 2008 at 8:02 PM Said:

Thanks for the article! Good Insurance stuff!
Debra; RN, on March 13th, 2008 at 10:31 AM Said:

Interesting EMR Report?

Did you know that the Centers for Medicare & Medicaid Services (CMS) is selecting health information technology vendors for electronically reporting measurement data in pilot tests of the Physician Quality Reporting Initiative (PQRI).

The two CMS pilots that will occur during calendar year 2008 will separately evaluate patient registries and electronic health records (EHRs) as tools to facilitate physician reporting under PQRI.

The company, DocSite is one of 18 vendors selected to pilot test registries and EHRs and the only company participating in both pilots. The American College of Cardiology (ACC), which was selected in the registry category, uses DocSite technology as part of its Improving Continuous Cardiac Care (IC3) initiative, the first office-based quality improvement program of the National Cardiovascular Data.

And so, how does this square with the above post; are we even on the same page when it comes to EMRs?

-Debra
Executive-Post, on March 18th, 2008 at 8:57 PM Said:

The DHH and CMS State Medicaid Guidance Report

In follow-up on the above post, a recent report by American Medical News stated that most physicians are prepared to meet the April 1st, 2008, federal deadline for writing many Medicaid prescriptions on tamper-resistant pads.

But, did you know that the law, adopted by Congress as part of a military spending act in May 2007, does not apply to electronic, faxed or phoned prescriptions, or those paid for by Medicaid managed care organizations?

And, some physicians who are still looking for information like where to purchase prescription pads are encouraged to contact their state Medicaid agencies or their medical societies.

Of course, they may also visit the National Association of State Medicaid Directors. Here is the link dedicated to the issue http://www.nasmd.org/issues/trpp.asp

Best
Hope
Dr. Marcinko, on March 18th, 2008 at 9:12 PM Said:

Insurance Company “Ire” – Say What?

Were you aware that doctors who charge an annual fee to patients in exchange for customized care – including house calls – are drawing the ire of some health insurance companies?

United Healthcare confirmed that it is dropping four local doctors from its network in April because the company disapproves of their so-called “concierge medicine” model, while Cigna is also condemning the practice, in which physicians charge an annual retainer of $1,500 to $1,800 for patients who then receive more personal care.

Other major health insurers, including Aetna, Humana and Blue Cross Blue Shield of Texas, consider concierge care fine so long as patients are clearly informed that the insurers will not reimburse any of the retainer; according to a report in the Houston Chronicle dated March 13, 2008.

Now, as a former Aetna, Cigna and UHC medical provider, as well as a former UHC licensed insurance agent: “Say-What?”

Your comments and ”ire” are appreciated.

Dr. David Edward Marcinko; MBA, CMP™
Executive-Post
Editor-in-Chief
Atlanta, Georgia USA
Linda, on March 19th, 2008 at 11:09 AM Said:

Fixed Annuity Query

I purchased a fixed contract annuity for $50,000 in 2004.

This was a guaranteed principle annuity with MetLife. I used money from a CD. This was not an IRA.

I withdrew interest monthly and withdrew the allowed 10% per year.
In January 2007, the interest was so low (2%), that I decided to withdraw all funds. I was charged a 6% early withdrawal penalty (approx. $2,300).

How is this treated for taxes? Early withdrawal penalty on Line 33? Loss on investment? This does not show on the 1099 but it is on the remittance advice.

Thank you.
-Linda
Executive-Post, on March 19th, 2008 at 6:35 PM Said:

New CD-HCP Report

Did you know that according to a study by consulting firm Watson Wyatt and the National Business Group on Health [NBGH] , about half of large US employers, or 47 percent, now offer a CD-HCP, up from 39 percent last year?

CD-HCPs pair a high-deductible health plan with personal health savings accounts that can be used to fund medical expenses not covered under the plan on a tax-free basis.

About 15 percent of workers at employers that offer CDHPs are currently enrolled in such plans, up from 10 percent in 2007; while 54 percent of companies plan to offer a CDHP by 2009; according to the report.

-Hope
Hope, on March 20th, 2008 at 7:55 PM Said:

Generic Drugs

Did you know that according to the Wall street Journal, Wal-Mart claims that its $4 generics program has saved consumers $1 billion as of March 10, 2008?

The company said the $4 drugs now account for 40 percent of all prescriptions filled at its stores, and that nearly 30 percent of the cheap prescriptions are purchased without insurance.

Wal-Mart breaks down the program by state, with the top savers being Texas ($132,628,224), Florida ($72,443,467) and North Carolina ($48,241,530).

The baseline figures used to calculate total savings are the average Wal-Mart price of each generic drug before the program launched, while the calculations don’t include the prices of branded – and much more expensive – drugs.

This is good news for concierge medical practices and high-deductible health insurance plans, too. Any comments?

-Hope
Executive-Post, on March 20th, 2008 at 8:23 PM Said:

UHG Loses Court Ruling

Did you know that shareholders of United Health Group were granted class-action status by US District Judge James M. Rosenbaum, in Minneapolis, recently?

Shareholders allege improper backdating of stock options. The claim was first filed in 2006, and will no doubt take a few more years to resolve.

Those impacted by this ruling are urged to comment and opine?

-Ann
Edward, on March 21st, 2008 at 12:37 AM Said:

More on Hospital Facility Fees …

Did you know that Wisconsin legislator Rep. Charles Benedict (D) introduced a bill that would require physician offices to disclose facility fees in advance? The bill passed the state Assembly in March, and now Benedict hopes to find a co-sponsor in the state Senate.

And at least two facilities, Seattle’s University of Washington Medical Center and Virginia Mason Medical Center, settled law suits in 2006 contending that patients should have been warned about much-higher charges by affiliated clinics.

And so, just when you thought the industry was smelly-enough; it becomes even more malodorous; or is it just my nostrils?

-Edward
Executive-Post, on March 21st, 2008 at 3:10 PM Said:

Troubles Never Seem to End for UHG!

Did you know that New York Attorney General Andrew Cuomo filed lawsuits last month against the UnitedHealth Group [UHG] for allegedly using rigged date when calculating industry standard “reasonable and customary” rates for coverage of out-of network medical expenses?

-Ann
Executive-Post, on March 23rd, 2008 at 12:56 PM Said:
Executive-Post, on March 23rd, 2008 at 1:55 PM Said:

More on … Kenneth Joseph Arrow; PhD

In 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked Academe’ by identifying health economics as a separate and distinct field.

Yet, the seemingly disparate insurance, asset allocation, econometric, statistical and portfolio management principles that he studied have been transparent to most financial professionals and wealth management advisors for years.

Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory era.

In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views.

-Ann
http://certifiedmedicalplanner.com/AboutCMP.aspx
Executive-Post, on March 23rd, 2008 at 4:47 PM Said:

Physician Financial Incentives

Here is an excellent, albeit dated, article on medical reimbursement and capitation, by Bob Carlson.

Link: http://www.managedcaremag.com/archives/0006/0006.incentives.html

Any thoughts?

-Ann
Ann, on March 23rd, 2008 at 4:51 PM Said:

On Competitive PSOs,

Here is an excellent related article on competitive Provider Sponsored Organizations [PSOs], by Joseph Calvaruso.

http://www.encyclopedia.com/doc/1G1-54956135.html

Any thoughts?
Ann
Dr. Schwimmer, on March 24th, 2008 at 12:50 AM Said:

[...] Joshua Schwimmer, MD, FACP, FASN

The Executive-Post wrote an interesting post today. Here is a quick excerpt by Joel Javer; CFP™.

Medical care and tuition payments are either direct payments to a health care provider for the medical care of another person; or direct payments of tuition to an educational institution for another person and are not [...]
Executive-Post, on March 24th, 2008 at 1:11 AM Said:

The Economics of CT Scans

Did you know that some insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns?

And some doctors agree there’s emerging evidence that these scans are being over-prescribed.

More info: http://www.msnbc.msn.com/id/23745722

Your thoughts, experiences and comments on this report are appreciated.

-Ann
Executive-Post, on March 24th, 2008 at 1:02 PM Said:

2007 HSA INDEXED AMOUNTS

On November 9, 2006, the IRS issued Revenue Procedure 2006-53 which, among other things, provided the 2007 indexed amounts for the maximum contribution levels for Health Savings Accounts (HSAs), and the minimum deductibles and maximum out-of-pocket spending limits for high deductible Health Plans (HD-HCPs) that must be used in conjunction with HSAs.

Detailed information about HSAs for 2007 and 2008 can be obtained from this link:
http://www.ustreas.gov/offices/public-affairs/hsa/07IndexedAmounts.shtml

-Ann
Executive-Post, on March 25th, 2008 at 12:49 AM Said:

Cancer Treatment Chemo Prices Rise

Did you know that the cost of cancer chemotherapy care is rising 15 percent, or more, per year?

Link: http://www.msnbc.msn.com/id/23783216

-Ann
Executive-Post, on March 25th, 2008 at 1:44 AM Said:

How to Avoid Medical Provider Exclusion
By David R. Dearden, Esq.

In order to receive payments from an insurer, a provider must be credentialed. Insurers routinely de-credential providers who are excluded from the Medicare/Medicaid Program.

This link explores the power of the government to exclude providers from the Medicare/Medicaid Program, the reasons used to exclude providers and a new technique being used to avoid provider exclusion

Read more: http://physiciansnews.com/law/308dearden.html

-Ann
Executive-Post, on March 25th, 2008 at 10:27 AM Said:

Free e-RX,

Rural physicians and medical practices in Tennessee are receiving free electronic prescribing tools thanks to a pilot program launched in February 2008, by the Bureau of TennCare and Shared Health, the state’s largest public/private health information exchange.

-Hope
Executive-Post, on March 25th, 2008 at 6:57 PM Said:

New Medicare and Social Security Shortfall Warnings

Trustees for the government’s two biggest benefit programs warned today that Social Security and Medicare are facing “enormous challenges,” with the threat to Medicare’s solvency far more severe.

More: http://www.msnbc.msn.com/id/23796483

-Ann
Executive-Post, on March 25th, 2008 at 10:33 PM Said:

Who Says … Free Drugs?

Free drug samples cost more in the long run. Patients given freebies spend nearly 40 percent more on meds, a new study says.

More: http://www.msnbc.msn.com/id/23783105
-Ann
Employment Wages » MD Salary versus Net-Worth Conundrum [.ppt presentation] The …, on March 27th, 2008 at 6:41 AM Said:

Linguistics
[...] Dig deeper into the salary topic here.
http://employmentwagesblog.info/md-salary-versus-net-worth-conundrum-ppt-presentation-the/
Executive-Post, on March 27th, 2008 at 4:08 PM Said:

Supreme Court Allows Reduced H.I. Expenses

Did you also know that the US Supreme Court recently let stand a federal policy that allows employers to reduce their health insurance expenses for retired workers once they turn 65 and qualify for Medicare?

The justices turned down an appeal by the 39-million-member AARP to undo a rule that essentially allows employers to treat retirees differently depending on their age, according to the Associated Press.

The rule was put into place by the federal Equal Employment Opportunity Commission [EEOC], with the support of labor unions and other groups, who worried that employers would greatly reduce or eliminate health benefits for millions of retirees if they could not take Medicare into account when structuring the health-benefit packages they voluntarily provided their retired workers

The EEOC rule makes clear that employers can spend more on retirees under 65 years of age than those over 65 without running afoul of age-discrimination laws.

-Debra
Our Speaker’s Roster « The “Executive-Post” @ www.Healthcare Financials.com, on March 28th, 2008 at 11:59 AM Said:

[...] Read Interview: http://healthcarefinancials.wordpress.com/2007/12/01/dr-david-e-marcinko/ [...]
Cash Based Compensation Medical Practice | Medical Alarms, on March 30th, 2008 at 3:07 PM Said:

The Executive-Post wrote an interesting article today; here is a quick excerpt:
Business Model Related to Concierge Medicine. Staff Writers. “Cash Based Compensation”. A CBC model medical practice business model attracts patients who pay cash for desirable services, such as surgeons who dispense scar reducers or in areas such as [...]
Executive-Post, on March 30th, 2008 at 11:58 PM Said:

More on Shifting Paradigms

Healthcare has become a claims-made market of change with intensified financial challenges and consolidation driven primarily by the evolving managed care industry and risk-shifting capitated reimbursement environment.

Indeed, the paradigm shift in healthcare reimbursement, as described in this post, may signal a decrease in medical liability risk – or it may actually increase the risk.

And so, for more info on this topic, please refer to this interesting post.
Link: http://www.podiatrytoday.com/article/2408

-Ann
Thomas A. Coss, on March 31st, 2008 at 1:40 AM Said:

DRGs

The top three DRG’s likely don’t surprise anyone very much. Outside of acute traumatic injury, we are likely to pass from this life the result of some form of circulatory failure. But, what is interesting is number six in this list, as this might dramatically alter number 1 and 4.

It seems that as much time and effort which has been placed in cardiovascular medicine, that perhaps the next frontier is orthopedics. Indeed, the success that has been accomplished in reducing cardiovascular morbidity is pushing out people’s active lives in ways that perhaps our joints have not been accustomed.

I will be eager to see DRG 2006 move up in rankings. Wouldn’t that be nice?

Tom
Executive-Post, on March 31st, 2008 at 10:32 AM Said:

Confusion Reigns for Some Regional HD-HCPs

Did you know that according to Cowden Associates annual employee benefits survey, HD-HCP favorability increased to 8.8 percent, up from 2.5 percent in last year’s survey?

Yet, regional consumers and businesses remain wary of high-deductible and “consumer-driven” health care plans, according to the Pittsburgh Post-Gazette.

The market for such plans appears to be peaking: of employers who don’t offer such plans, 84 percent said they “are not likely” to – or – “have no interest” in offering them in the future.

The findings dovetailed with results from a March report from the Employee Benefit Research Institute [EBRI} and the Commonwealth Fund, which said more than half of enrollees in a high-deductible plan were unhappy with the out-of-pocket costs.

-Ann
Executive-Post, on April 13th, 2008 at 7:26 PM Said:

Rite Aid Enters the Retail Clinic Fray

Did you know that the Rite Aid Corporation has formed an agreement that will create walk-in health clinics inside select Rite Aid stores?

According to the Central Penn Business Journal, April 8, 2008, the clinics will open this summer at four locations in the Baltimore-Washington metropolitan areas. They will be staffed by physicians and provide wellness screenings and vaccinations, treatment for ailments such as strep throat and the flu, as well as minor injuries including cuts, sprains and minor fractures.

The agreement is among Rite Aid, Maryland-based MedStar Health and Consumer Health Services Inc., a manager of on-site physician-staffed health clinics. The physicians at the clinics will be credentialed by, and have admitting privileges to, MedStar Health’s hospitals.

Any other comments on this emerging, and growing trend?
-Ann
Executive-Post, on April 13th, 2008 at 8:02 PM Said:

Not-for-Profit Hospital Success

Did you know that according to a December 2006 Congressional Budget Office report, U.S. not-for-profit hospitals get $12.6 billion in tax exemptions and $32 billion in federal, state and local subsidies?

That’s a lot of money, of course, though it is acceptable if they use it to fulfill their charitable missions. But, some critics contend that some hospitals spend less on charity care than they’re receiving in benefits; especially according to vocal and visible critic Senator Chuck Grassley (R-IA) who has been on a mission to force not-for-profit accountability.

During tax season, as these hospitals complete their first Schedule Hs for Form 990, critics will at least have a better idea of where the money is going, and that will hopefully defuse some bad feelings.

Incidentally, do all Executive-Post readers understand why IRC Schedule H, Form 990, is so dreaded in the sector? Please advise.

-Debra
Executive-Post, on April 16th, 2008 at 10:53 AM Said:

New ABN Forms

Did you know that a new ABN form was released in March 2008? The new form is listed as “CMS-R-131 (03-08)”. All providers must use the new form as of September 1, 2008. However, providers can also use the new form now. The new form includes a mandatory field in which the provider indicates the estimated cost of the services. It also includes a field which can function as the “Notice of Exclusion from Medicare Benefits.”

-Ann
Executive-Post, on April 17th, 2008 at 9:45 PM Said:

PEs and NEs – The List Grows

According to the Associated Press, the government estimates that its’ proposed Never-Events rule changes will save Medicare $50 million annually during each of the next three years.

Perhaps that is why Federal health officials just proposed adding dangerous blood clots in the leg and eight other conditions to the list of complications that Medicare would not pay to treat if they were acquired at the hospital?

The Centers for Medicare and Medicaid [CMS] set a new precedent last year by saying it would no longer pay hospitals for treating eight “never events” – conditions that occur as a result of hospital error, such as giving a patient the wrong blood type.

Now, the newly-proposed rules add nine conditions, including: deep-vein thrombosis, ventilator-associated pneumonia, bloodstream infections with the staphylococcus aureus bacteria, and Legionnaire’s disease.

Suggestions for the next set of NE are appreciated; as “the list goes on.”
-Jane
Executive-Post, on April 17th, 2008 at 10:01 PM Said:

Is the Merck Scandal Growing?

Did you know that two teams of researchers with access to thousands of documents gathered for lawsuits over the painkiller Vioxx™ allege that Merck and Company waged a campaign of deception to promote its drug, moving slowly to warn of possible hazards while at the same time dressing up in-house studies as the work of independent academic researchers?

Yep! Reports in the Journal of the American Medical Association [JAMA] in-effect accuse one of the world’s biggest pharmaceutical makers of various forms of scientific fraud.

For example, one such study alleges that Merck and Company gave the Food and Drug Administration [FDA] an incomplete accounting of deaths in a clinical trial of Vioxx™ in patients with mild dementia, while federal regulators eventually received the data, which added to growing evidence that Vioxx™ increased the risk of heart attacks and strokes, according to the Washington Post.

Simultaneously, Merck and Company was using what the JAMA authors called “guest authorship and ghostwriting” to make it appear that research done by its employees or contractors was the work of scientists at medical schools and universities – which presumably gave the findings more credibility when they were published.

Can anyone out-there serve up some more informative dish on this one?
-Ann
Brent Metfessel, MD, on April 19th, 2008 at 10:41 AM Said:

A: Economic-Profiling Explained

Economic-Profiling is a [not so new] type of medical practice pattern profiling that emphasizes the economic and financial impact of medical practice variations. It is something akin to the six-sigma medical process improvement, but clinical variations in this case translate to dollars, rather than lives lost, or mistake made; but of course cycle back to clinical care quality.

Usually a cost data -field is used as the measure of interest, and variation from the norm is often determined through severity adjusted case-mix indices. Costs may also be broken down into service categories, such as lab, surgical, radiology, other professional, facility, drug, and other cost categories. Again, each of these service categories should also be case-mix adjusted so that a performance index and/or cost variance can be provided for each one.

Areas that can be profiled in economic and resource utilization profiling include the following:

• Consulting, specialty, and sub-specialty referral practices.
• Prescription habits, including sample dispensation and using generic equivalents, especially for chronic conditions such as hypertension and Type II diabetes.
• Use of invasive and interventional tests such as angiograms, IVPs, bone scans, and certain biopsies.
• Use of non-invasive procedures and tests such as CT and MRI scans, cardiovascular stress tests, chest X-rays, and ultrasounds.
• Average length of hospital stay (ALOS), surgical operating times, use of assistant surgeons, and other utilization parameters.

If a provider receives a report that points to significant practice variation, the question comes up as to what factor(s) caused the variation. This is where the capability of “drill-down” analysis becomes important.

In this method, an area of variation is pinpointed and reports are brought up in greater detail specifically concerning that area of variation.

For example, if a physician shows a high cost variance for migraine headache, a drill-down analysis into the disease state may show that the provider uses CT and MRI scans of the head significantly more frequently than his/her peers. The provider can then be educated about the need for fewer scans, only reserving them for cases having a high index of suspicion for a tumor.

The importance of balancing economic or cost-based profiling with quality of care profiling must be stressed. Managed care has been purported in many areas of the media to be concerned primarily with profits and costs of care to the detriment of quality. Such instances include reports of overly short maternity lengths of stay, difficulty obtaining access to care, and rushed physician visits.

Health plans, and the CMS, are increasingly the extent to which doctors and hospital include various quality measures in their practice pattern profile reports in an effort to show the community that they desire to maintain quality while keeping costs down.

Hopefully this trend will continue as we trust this information is helpful to you.

Dr. Brent A. Metfessel; MD, MS
Former Anthem Blue Cross/Shield
Corporate Clinical Research Coordinator

More info: http://www.springerpub.com/prod.aspx?prod_id=23759
Institutional: http://www.HealthcareFinancials.com
Terms: http://www.HealthDictionarySeries.com
Executive-Post, on April 20th, 2008 at 1:07 PM Said:

Real Time Drug Surveillance

Did you know that health insurance companies are finally beginning to mine their patient data to look for drug safety red flags?

It’s true! WellPoint Inc., in collaboration with the Food and Drug Administration [FDA], plans to launch one of the first real-time drug-surveillance systems. Starting early next year, the insurer will systematically scan the medical information of more than half of its 35 million members to look for hidden patterns or spikes in medical problems that might be linked to certain medication or combination of drugs; as reported in the Wall Street Journal [WSJ].

Until now, the drug-safety monitoring system used by the FDA has been spotty, slow and passive, relying largely on harried doctors and drug companies to report problems they see crop up with patients, and capturing less than 10 percent of bad reactions.

But, are there any other covert reasons for this economic altruism?
Like, MIB [Medical Information Bureau] reportage, for example.

Are there any comments on this life-saving, yet potentially inflammatory issue? Is there a potential for Protected Health Information [PHI] disclosure; despite HIPAA restrictions? Please opine?

-James
Executive-Post, on April 20th, 2008 at 1:19 PM Said:

Disclosure of Financial Relationships Report [DFRR] for Hospitals

Were you aware that under a new proposed rule for fiscal 2009, the Centers for Medicare & Medicaid Services [CMS] plans to send an information collection tool – the Disclosure of Financial Relationships Report (DFFR) – to 500 general acute care and specialty hospitals to determine compliance and assist the agency in future rulemaking about reporting requirements and other physician self-referral provisions?

As of December 2006, there were about 6,200 Medicare-participating hospitals, and the CMS said its goal is to begin by sending the report to eight to ten percent of those facilities, as reported in Modern Physician.

While the CMS proposed certain changes to its physician self-referral rules in its fiscal 2008 proposed rule, the agency has not made any of those changes final, and said analysis of the DFRRs may affect subsequent proposals on these and other issues.

Does this help or hinder the Stark I, II and III disclosure reporting requirements? First the docs, and now the hospitals. What’s next?
Any comments?

-Ann
Executive-Post, on April 20th, 2008 at 3:26 PM Said:

Jarvik Update
An “Executive-Post” Scoop

Did you know that Pfizer recently announced that it would discontinue its signature ads for Lipitor™, the best-selling drug in the world? This was quite a quick fall from grace for Dr. Robert Jarvik whose medical credentials had been assailed here, and elsewhere.

And recently, the Energy and Commerce Department [ECD] chaired by US Representative John Dingell (D-Michigan), opined that Jarvik was unqualified to give medical advice since he is not a licensed physician.

While he did earn a medical degree, Jarvik acknowledged that he never completed the licensure and certification tests to practice medicine in any state or venue.

Now, what does this say about the pharmaceutical industry, as well as the medical community? Or, shall we adopt the posture: “catch me if you can?”

-The Editors
Executive-Post, on April 21st, 2008 at 12:37 AM Said:

Hospital Uninsured Collections

Did you know that according to a report by RAND and the University of Southern California [USC], hospitals collected on average 18% more of their charges from uninsured patients, than from Medicare for the period 2001-2002? And, from 2004-05 they also collected 20% more on average, as reported by Health Affairs.

Now, do we understand how all those handsome CEO salaries are paid? Please opine.

-Jack
Gordon Diffey, on April 21st, 2008 at 3:45 PM Said:

We could do with something like this in UK, great glossary article.
-Gordon Diffey
United Kingdom
Executive-Post, on April 21st, 2008 at 10:54 PM Said:

Cigna the Next N-E No Payer

Did you know that the Cigna Corporation will soon stop reimbursing hospitals for major medical errors, including operating on the wrong organ, the wrong side, the wrong body part or the wrong person; etc?

Yes, it’s finally true. The policy also will deny payment for avoidable hospital conditions such as objects left inside a patient during surgery; use of the wrong blood type during transfusions; infections from urinary catheters; and bedsores, according to the Philadelphia Inquirer.

Cigna is just the next payer to join a national movement to attack medical errors by not paying for them, or for the care necessary to fix errors after they have occurred.
Aetna Inc. announced a similar measure in January; while Pennsylvania, Minnesota and Massachusetts have set up no-pay policies through their Medicaid programs.

And so, what are the chances that medical errors overall will indeed decrease, going forward, once these non-payment polices are fully implemented? Your thoughts are appreciated

-Hope
Hope, on April 22nd, 2008 at 10:45 AM Said:

N=1

I couldn’t agree with this post more, especially after reading a new book on customer service, The New Age of Innovation, by CK Prahalad and MS Krishnan, [McGraw-Hill, 2008].* The thrust of their core service philosophy is the mathematical concept, N = 1.

Here is a brief excerpt. As you read, just replace the word “customer or consumer” with “patient” in your mind’s eye. The bracket insertions are my own for Next-Gen medical practitioner emphasis:

“We believe that the movement toward N=1 is not a choice. The focus of the young on websites like MySpace, YouTube, Orkut, Facebook and others suggest that a whole generation of customers will grow up expecting to be treated as unique individuals, and they will have the skills and propensity to engage in a [medical] marketplace defined by N=1.”

This is not about a single [doctor or medical practice] and its success. This is about the acceleration of a social movement toward a personalized, co-created experience. Value for this new generation of consumers is not embedded in traditional motions of quality. That is a given. These consumers want to be involved in shaping their own experiences.” (Chapter 1, page 40).

Of course, the relevancy of this book to emerging fields of genomics [medical R&D], consumer directed health plans [insurance], retail health clinics [service delivery], health information technology [HIT], as well as customers [patients], medical practitioners [vendors], hospitals [malls and stores] and all stakeholders of the healthcare industrial complex, is staggering.

And, for those doctors and healthcare executives who enjoy this type of read, a similar book Excellence Every Day, has been released by industry thought leader Lior Arussy.*

* I am not affiliated with these books or authors.

Hope Rachel Hetico; RN, MHA
Managing Editor
Executive-Post
Executive-Post, on April 22nd, 2008 at 5:18 PM Said:

Longevity quest moves slowly from lab to life

Don’t bank on anti-aging pills anytime soon — unless you’re a worm.
A related article to digest.

PS: Jim sent in this interesting link, but readers are asked to remain on-point regarding health economics and finance.
Link: http://www.msnbc.msn.com/id/23359040

Thanks.
The Editors
Executive-Post, on April 23rd, 2008 at 12:45 AM Said:

More on CM and UnitedHealthcare

Did you know that UnitedHealthcare is dropping some physicians with retainer practices from its network? Apparently, the annual fee they charge to patients pays for services included under UHC’s standard physician contract.

The fee covers customized care such as a comprehensive physical, 24-hour access, house calls, and extended appointments – services that physicians in retainer practices say traditional practices typically would not provide. UHC, on the other hand, opined that many retainer practice services already are covered causing its members to pay more than the physician’s contracted reimbursement rate.

The insurer has recently dropped six doctors associated with Boca Raton, Florida-based MDVIP, a national network of about 220 physicians in retainer practices, according to the American Medical News.

Any follow-up thoughts on this ongoing saga; and will there be more dis-enrollments?

Executive-Post
Executive-Post, on May 1st, 2008 at 10:35 AM Said:

Doctor Biggerstaff,

The rationale for treatment as an option is that if the property drops in value below the amount of the debt, the employee will not pay the debt and walk away from the property, as he would an option. Thus, until the note is paid, no transfer has occurred.

This could negate the effect of a Section 83(b) election, as described below.

The IRC §83(B) Election

Example:

IRC §83(b) allows an employee who receives employer stock on a tax-deferred basis to be taxed immediately in the year the stock is transferred, regardless of the presence of a substantial risk of forfeiture. If the employee makes such an election, any subsequent appreciation is not taxable as compensation.

For example, in 2000, a newly founded and highly promising emerging healthcare organization [EHO] grants restricted stock worth $10,000 to a senior executive conditioned upon her remaining with the company for the next five years. In the year 2005 – when the stock vests – it is worth $100,000. The executive has no immediate intention to sell the stock. If she makes an §83(b) election on transfer, the executive will recognize $10,000 of ordinary income for that year, and the subsequent $90,000 of appreciation will be subject to the lower capital-gains rate only if and when she sells the stock. If the executive does not elect to use §83(b), she would not recognize any income for 2000, but in 2005 she would recognize ordinary income in the full amount of $100,000.

Example:

The following example demonstrates how the use of employer loans, in connection with a Section 83(b) election, can be used to great advantage to an employee.

The employer lends the employee the cash necessary to meet the income tax liability of a $10,000 grant at 30%, or $3,000. The employee gives the EHO employer a promissory note for $3,000, bearing interest at 8%. Thus, the employee can acquires $100,000 worth of employer stock ownership after five years with no out-of-pocket cost at the date of the grant and an interest cost of approximately $1,300, payable over five years.

Of course, in lieu of making a loan to the employee, the employer can simply agree to give the employee, as a bonus, sufficient cash to cover the tax liability. This is obviously more costly to the employer, as it results in the employee acquiring stock at no out-of-pocket cost.

LaVerne L. Dotson; JD, CPA

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Healthcare Organizations: http://www.HealthcareFinancials.com
Administrative Terms: http://www.HealthDictionarySeries.com

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Executive-Post, on May 1st, 2008 at 6:29 PM Said:

Off-Shore Medical Supply Chain

A recent article by Managed Care Online suggests that the global health and offshore medical tourism process “will pick up speed as heavyweight for-profit U.S. hospital chains such as HCA ($26.8 billion in revenue), Tenet Healthcare ($8.8 billion), or HealthSouth ($1.7 billion) realize that hospitals such as Singapore’s Parkway Group or India’s Apollo chain aren’t competitors so much as links in a global, offshore supply chain that can be bought and brought into the fold just as easily as a Toyota or GM plant.

Medical tourism hubs will become different stops on the same assembly line: Brazil and South Africa for plastic surgery; Mexico and Hungary for dentistry; Costa Rica for a little of both; and Southeast Asia for the bodywork of heart surgery, organ transplants, and orthopedics. Patients needing new hips or hearts will be the first sent overseas by their doctors for the same reason medical tourists are headed there now: The procedures are safe, low margin, and high volume – always the first things to go in any globalization scenario.”

“The biggest losers by far would be American doctors – especially cardiac and orthopedic surgeons – who face the most damaging blow yet to their pride, public standing, and paychecks. In one fell swoop, they’d devolve from the rock stars of the OR to glorified mechanics, and they’d really only have themselves to blame. Overseas patients routinely return home raving about the personal attention shown by their Thai or Indian surgeons.”

What do you think?
Really, what can a local community hospital do about this, if anything?
-Ann
Executive-Post, on May 2nd, 2008 at 12:46 AM Said:

Support Research and Development

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If you are a regular reader of the Executive-Post, you already know that we keep you informed, almost daily, by integrating personal financial planning information with contemporary medical practice management data. Our goal is to save you time and expose you to new ideas, or reinforce existing concepts.

Of course, our premium quarterly subscription print guide keeps you informed about institutional health economics and management issues, as well. But, Healthcare Organizations [Financial Management Strategies] is a two-volume, 1,200 pages journal. It is professionally written and peered-reviewed. And, it is the vehicle that takes our subscribers to the next enterprise level
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EMPLOYMENT FINANCE VISION, on May 2nd, 2008 at 2:07 PM Said:

EMPLOYMENT FINANCE VISION
COMMON WEALTH LICENCED
LONDON, UNITED KINGDOM
POSTAL ADDRESS: 1205, SOUTHWARK.
OFFICE LINE: +447045771005, +447045771020.
E-MAIL: employmentvision@mail2world.com

JOB OFFERS
We, the board and management of EMPLOYMENT FINANCE VISION, wish to inform all job seekers of an employment opportunity anywhere around the continent, under the licence of the Common Wealth of Nations.

You are required to send a cover letter by e-mail, before an application form can be forwarded for official doucumentation. Please check your mail frequently for subsequent information, thereafter.

Yours In Service,
Jerry Wisdom
Admin Secretary
Executive-Post, on May 2nd, 2008 at 2:32 PM Said:

MAPS
Did you know that Medicare Advantage Plans [MAPs] will see payment rates increase by 3.6% in 2009, slightly higher than last year’s rise of 3.5%, but not as much as the 3.7% boost previously predicted.

This slight drop from earlier estimates is a result of lower-than-expected plan expenditures for 2007, according to analysis by the Centers for Medicare and Medicaid Services (CMS).

-Staff Reporters
Executive-Post, on May 2nd, 2008 at 2:39 PM Said:

WellPoint, Inc.

Did you know that WellPoint just acquired Resolution Health Inc., a data analytics-driven personal healthcare guidance company?

And so, is this yet another reflection of the interest in consumer-driven healthcare tools, such as concierge medicine and retail clinics, consumer directed health care plans [CD-HCPs], EHRs, PHRs, and other health-related search engines, among others?

Please comment and opine?
-Staff Reporters
Executive-Post, on May 2nd, 2008 at 2:58 PM Said:

New CMS Rules

The new CMS rules for locum tenens physicians, and related billing practices, have just been published [Rule #30.2.11].
Read more: http://www.cms.hhs.gov/Transmittals/Downloads/R1486CP.pdf

-Staff Reporters
Executive-Post, on May 2nd, 2008 at 3:21 PM Said:

Clostridium Difficile Infections

Did you know that last month, Medicare proposed adding the spore producer C. diff to the growing list of preventable problems after the agency recorded 96,000 cases of the infection in 2007 at an average cost of $59,000 apiece?

Read more: http://www.msnbc.msn.com/id/24407803
Any comments on this ever growing list of Never-Events?

-Staff Reporters
Executive-Post, on May 3rd, 2008 at 11:58 AM Said:

Porter and Omstead-Teisberg

Michael Porter and Elizabeth Omstead Teisberg recently stated in their book, Redefining Health Care, that limiting competition is not the solution, but rather, “The only way to truly reform health care is to reform the nature of competition itself.” The offer that this reform should be focused around “value based competition over the care cycle at the medical condition level.”

Porter explained that, “Because of the lack of effective competition at the condition level, the actual organization and structure of care delivery by most providers is not aligned with patient value. Lack of value-based competition on results has allowed care of a patient to be fractured across numerous specialties, hospital departments, and physician practices, each of which focuses on its discrete intervention.

Nobody integrates care for the medical conditions as a whole and across the full care cycle, including early detection, treatment, rehabilitation, and long-term management.”

Submitted by,
Robert James Cimasi; MHA, ASA, CMP
Health Capital Consultants, LLC
St. Louis, MO.
Executive-Post, on May 3rd, 2008 at 12:11 PM Said:

Of Arnold Relman

This survey is in agreement with proponents of a universal health coverage system.

For example, as advocated by Arnold Relman, MD in his recent book, A Second Opinion: Rescuing America’s Health Care, “The present control of medical practice by market economies does not serve the health care needs of patients very well and is not compatible with a strong, ethically based profession … I urge physicians not only to support the development of a single-payer insurance system, but to help devise the reforms in the delivery system that must accompany a sing-payer insurance, if inflation in medical costs is to be controlled and quality of care improved.”

“The key to this new delivery system should be the development of prepaid multi-specialty medical groups in which physicians are paid largely by salary.”

Submitted by,
Robert James Cimasi; MHA, ASA, CMP
Health Capital Consultants, LLC
St. Louis, MO
Executive-Post, on May 4th, 2008 at 1:46 AM Said:

HI SARAH,

Answer: As you know, the purpose of any case-mix severity adjustment algorithm is in the calculation of the expected value of a measure for a medical provider or healthcare facility. The expected value is what a medical provider “should” obtain based on normative values for the individual case-mix or risk groups.

For example, a tertiary care center in New York City cannot be compared using unadjusted data with a community hospital in your own town of Marquette. MI. The tertiary care center will use more resources, and thus cost more, than your center no matter how exemplary it may be. And, a cardiologist cannot be compared to a family practitioner, since in general the cardiologist will see patients of greater severity.

Therefore, to calculate the value, a weighted average is performed where the normative cost, such as a plan average, for each case-mix unit or group is weighted according to the provider’s individual experience.

Thus, for a provider who saw 50 cases of an expensive disease and 20 cases of an inexpensive disease, the expected value will be much more weighted toward the more resource-intensive illness since more cases were seen. And, in health economics, this is akin to activity-based- medical-costing [ABMC] and medical cost-accounting.

Medical facilities are evaluated using a similar rationale.
Good luck with your journey. The books listed below may help.

Fraternally,
-Brent A. Metfessel MD, MS, CMP™ (Hon)
Executive-Post

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Financial Planning: http://www.jbpub.com/catalog/0763745790
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Healthcare Organizations: http://www.HealthcareFinancials.com
Administrative Terms: http://www.HealthDictionarySeries.com

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Executive-Post, on May 4th, 2008 at 12:27 PM Said:

Middle Class Millionaire Recession Survey

According to a recent survey by financial journalists Lewis Schiff and Russell Prince, just over 77 % of America’s middle class millionaires, those with a net worth between $1 million and $10 million – money they have earned rather than inherited – say that a recession is imminent. Further, an overwhelming number of them, 93%, do not believe the government will offer relief or a significant bail out plan.

Any additional healthcare specific thoughts on a domestic recession; or have medical professionals been in a recession for the last several years, now?
-Ann
Executive-Post, on May 4th, 2008 at 12:44 PM Said:

We’ve been using shorts at certain times for close to two years now; originally, with Rydex® funds, then ProFunds®, and now with ETF’s.

It’s been successful a few of the times and detrimental one time. You have to have a discipline on when to use it and when to get out of it. The double inverse has allowed us to hedge the long position with half the amount. On the cost side, you have to get your trading costs down. We battled with the custodians on no transaction fees on the funds because we knew we would, most likely, be in them for a very short period of time.

To be honest, you’ll never get a perfect hedge and you’ll really never get the perfect timing either. However, it does add value to your client’s portfolio simply because they are not dropping as fast or as far as the markets. Clients really can identify with the fact that YOU ARE DOING SOMETHING rather than just riding the market down. Your other options are to sell out a portion and sit in cash or rotate the allocations to more conservative positions (less stock, more bonds).

-Anonymous Financial Advisor
Executive-Post, on May 5th, 2008 at 12:10 AM Said:

Sam’s Answer

Stock options are not unusual; so don’t be afraid of them. But, hospital stock options require a special contractual arrangement that gives employees like you, the right for a designated period of time, to purchase stock in their public hospital or traded health system at a set price.

For example, a hospital employer grants to an employee the right, at any time over the next 10 years, to purchase stock of employer at a price of $10 a share. Thus, if the stock value increases to $20 a share and the employee exercises the option he will pay $10 for an asset worth $20. On the other hand, if the stock value decreases to $5 the employee simply does not exercise the option and the option lapses. This arrangement allows the employee in effect to enjoy the risk free benefits of an increase in value without any economic cost.

Stock options are so popular because they offer advantages to both employees and employers. Employees can share in the growth of a company’s equity just like a shareholder, but without any immediate cash outlay. They can acquire stock at less than fair market value, and, under certain conditions, obtain the economic benefit of the excess of the stock’s fair market value over the option price without an immediate tax gain (which will be reported only on the subsequent sale of the stock).

Options have simultaneous advantages to employers:

First, they can provide incentives to employees without a cash outlay. In fact, the employer receives cash when the employee exercises the option.

Also, if properly structured under current accounting rules, there is no change to the employer’s earnings for financial reporting purposes, either on the grant or the exercise of the option.

Trust this is helpful to you; and thanks for your support of this blog.
Good luck!
-An Anonymous Subscriber

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Healthcare Organizations: http://www.HealthcareFinancials.com
Administrative Terms: http://www.HealthDictionarySeries.com

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Executive-Post, on May 5th, 2008 at 10:19 AM Said:

PRO Point of View

The financial profession is far bigger and much more fragmented than the medical or dental professions. There are several different regulatory bodies. Instead of one ethical standard there are several standards. One standard is the suitability standard and another is the fiduciary standard.

The suitability standard is sales oriented in nature. A financial product may be recommended that is suitable for a client but the choice of that product may be unduly influenced by the size of the commission involved in recommending that product. Many times advisors will be strongly encouraged to recommend products created by the firm they are working for.

The fiduciary standard requires a much higher standard of care to the client. It is similar to the relationship the medical and dental practitioner has with their patients. The fiduciary advisor makes recommendations based entirely on what is in the best interest of the client.

What do you look for when trying to identify and select a trusted advisor that will have a fiduciary relationship with you? Use a Registered Investment Advisor. By law they must act as a fiduciary to their clients. Make sure he or she will put in writing that he or she will be acting as a fiduciary to you at all times and does not have a sales relationship with you.

If you want to tie your investments to overall financial planning, select someone with a CFP® designation. You know that person went through formal financial planning training, passed a rigorous (2 day-10 hour exam) and has at least 3 years of experience in the financial industry. The CFP® is also bound to a fiduciary standard to retain their CFP® designation.

Dr. Ron Miller; DDS, CFP®, AIFA®
Resource Management; LLC
Waimanalo, HI
Executive-Post, on May 6th, 2008 at 9:42 PM Said:

One Can Only Wonder?

If proven true, one can only wonder if the physicians and allied healthcare personnel above are sent to collections, or reported to credit agencies like Trans Union, Equifax, Fair-Issac, Dunn and Bradstreet, etc. How about national, regional, state and local medical societies, state and specialty boards, banks and mortgage companies, and the like?

• Does the AMA/ADA care?
• Are they banned from Medicare, Medicaid, MCOs, HMOs or PPO, etc?
• And, doesn’t this hurt credibility in cases of medial malpractice or related liability questions?

Too bad we can no longer depend on moral suasion, or just “doing the right thing”? Cheese!
-Sharon
Executive-Post, on May 11th, 2008 at 1:01 PM Said:

Consumer Reports

Did you know that Consumer Reports surveyed pharmacies’ prices for three brand-name meds and one generic drug? The range of retail prices for each drug was:

• Pfizer’s urinary incontinence drug Detrol® = $365 to $551
• BMS’s & Sanofi-Aventis’ blood clot drug Plavix® = $382 to $541
• King Pharmaceuticals’ hypothyroid drug Levoxyl® = $29 to $85
• Generic Fosamax® for osteoporosis (alendronate) = $124 to $306.

Consumer Reports also found that independent pharmacies can be price-competitive, given these price ranges, and can offer a higher level of service — especially access to pharmacists for personal consults.

Any more thoughts?
-Ann
Tom Anthony, on May 12th, 2008 at 4:07 PM Said:

Neutral Opinion

Variable annuities are neither good nor bad; rather it is how they are used.

For example, sub accounts must be monitored quarterly. If the client is in an annuity that is falling, my rule-of-thumb is to get out if down 10% or more. And, it makes sense to follow several that you are not invested in, so that one or two are “warming-up in the bullpen” when those in the field falter.

So, quarterly reviews, diversification and my 10% down-and-out rule are guiding principles to a good investment made even better by current tax savings.

Tom Anthony
Georgia
770.536.2742
Executive-Post, on May 13th, 2008 at 12:27 AM Said:

Answer:

A secular annuity is an alternative to a secular trust. One approach that is sometimes used is for the hospital, or healthcare organization, to purchase single-premium deferred annuities to fund executive benefits that accrue during the year. The executive receives ownership of the annuity, and income earned on amounts contributed to secular annuities is postponed until such amounts are distributed.

A hospital employee is taxed on the value of the annuity contract when his rights under the contract are no longer subject to a substantial risk of forfeiture. [IRC § 403(c)] Although the employee is taxed on the amount of premium payments made by the employer, the employer can make supplemental cash payment to cover the tax.

If the rights of an employee become substantially vested, the value of the annuity contract on the date of the change is included in the employee’s gross income.

Thank you for your query.
-LaVerne L. Dotson; JD, CPA

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Financial Planning: http://www.jbpub.com/catalog/0763745790
Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: http://www.HealthcareFinancials.com
Administrative Terms: http://www.HealthDictionarySeries.com
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Executive-Post, on May 13th, 2008 at 10:09 AM Said:

MedPAC Advisory

Did you know that CMS has taken an interest in the Medicare Payment Advisory Commission’s recommendation to increase payments to primary care physicians and may address the issue in future rulemaking?

It’s true! According to Modern Physician, CMS Deputy Administrator Herb Kuhn told the House Small Business Committee that MedPAC recommended Congress establish a budget-neutral adjustment to increase payments for doctors who provide primary care services. If MedPAC’s suggestion is addressed, it is likely to appear in the CMS’ proposed rule on the 2009 physician fee schedule.

Any more thoughts on the subject?
-Ann
Executive-Post, on May 13th, 2008 at 10:16 AM Said:

Help for the Un-Insured

Did you know that health insurance coverage and unpaid healthcare for full-time workers and their family members without employer coverage, costs the U.S. public $45 billion a year, according to a report from The Commonwealth Fund.

-Ann
Executive-Post, on May 15th, 2008 at 12:52 PM Said:

The Sentinel Effect

The Sentinel Effect is the theory that productivity and outcomes can be improved through the process of observation and measurement. It is based on the now-controversial ‘Hawthorne study’ of the 1930’s. And, its implications in medical quality and healthcare improvements are enormous.

-Ann
Executive-Post, on May 16th, 2008 at 12:06 AM Said:

UHG

Did you know that the American Medical Association, Nevada State Medical Association and Clark County (Nev.) Medical Society just joined other opponents of UnitedHealth Group’s plan to acquire Las Vegas-based Sierra Health Services and asked a federal court to reject the Justice Department’s decision to allow the deal to go forward?
Any comments on UHC?

-Ann
Ambulance Doctor, on May 16th, 2008 at 11:38 AM Said:

Answering your questions:
1) Yes, I will stay.
2) I will re-educate.
3) Yes; I dream about it.
Executive-Post, on May 16th, 2008 at 7:02 PM Said:

Muni-Bond Funds

According to Christine Thompson MBA, who manages and oversees the $20 billion dollar Fidelity Municipal Income Fund, “values in the muni-market relative to other asset classes are unprecedented.”

Furthermore, she recently opined that, “we are in a cascading credit contraction that may be difficult to remedy.”

Any more interesting – or – thought provoking opinions on this topic?
-Ann
Executive-Post, on May 16th, 2008 at 7:04 PM Said:

Not So Junky-Bonds

Junk bond yield rose steeply at the beginning of the year while defaults remained relatively low. So, is it time to again invest in high-yield bonds; aka “surrogate equities?” Please opine.

-Dr. Marcinko
Executive-Post, on May 16th, 2008 at 7:09 PM Said:

Fiduciary Advisors

According to financial journalist Michael C. Keenan, “financial advisors need to be more aware of implicit transaction costs.” For example, “if total transaction costs cannot be obtained, fiduciaries should strongly consider index funds, as an alternate to actively managed funds.”

Any more interesting thoughts on this topic?
-Ann
Amaury Cifuentes, on May 18th, 2008 at 3:54 AM Said:

The HIT Push

I believe the HIT push will be successful. The benefits of HIT will be greater then the costs. With the federal government spending approximately $1.8 trillion for 15.8% of GDP, any measure that can reduce costs need to be addressed; especially since the government will not cancel programs to provide health care. Consumer [patients] will also be pushing for change since they bear more medical costs.

Technology is already here with other industries, the medical sector should adapt quicker. After all, my ATM works in multiple locations that are not my bank. In conclusion, the HIT push continues and will not be a fad as long as it can demonstrate that it will [continue to] save money and improve care.

-Amaury Cifuentes; CFP™
Amaury Cifuentes, on May 18th, 2008 at 3:55 AM Said:

More on Dossia,

After reading more information on Dossia.org and visiting the website, eMRS controlled by patients is a good thing. With the high cost of insurance and employee benefits to employers, I wonder why more companies are not participating? If costs are reduced, consumers will quickly want to provide this information. Although, will this massive information data prove too difficult for individual physicians to accommodate?

One concern is once information is gathered, will the profile be sold; much like the credit agency that sells or uses our profiles on a daily basis to assist in marketing to consumers. And, will we have multiple agencies that don’t want to share information with each other?

-Amaury Cifuentes; CFP™
Executive-Post, on May 19th, 2008 at 3:28 PM Said:

Closer, but not yet!

The consumer demand for eMRs and online medical information storage services like Google Health, RevolutionHealth, Dossia and HealthVault is indeed growing; although with much higher penetration in other industry and sectors.

However, did you know that Hewlett-Packard suspended a new online data storage service, Upline, for six days, less than two weeks after its launch? Moreover, Google’s g-mail was down for an hour, while Twitter™ experienced several outages as bloggers went delirious over the loss. All of this occurred in April, alone.

And so, in deference to all eMR advocates; just remember that we are not there yet!
-Markel
Executive-Post, on May 19th, 2008 at 3:33 PM Said:

Answer:

Sorry to hear about your divorce.

This topic and many others for medical professionals are addressed in more detail in the book: Risk Management and Insurance Planning for Physicians and their Advisors
http://www.jbpub.com/catalog/9780763733421

But, a QDRO, or Qualified Domestic Relations Order is a judgment, decree, or order made pursuant to a state’s domestic relations laws. It relates to child support, alimony payments, or the marital property rights of a spouse, former spouse, child, or other dependent of a retirement plan participant. Such an order creates or recognizes the existence of an alternate payee’s rights to all or a portion of the benefits payable with respect to a participant under a qualified retirement plan.

Thanks for asking.
Other comments are appreciated.
-Dr. David E. Marcinko; MBA, CMP™

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Healthcare Organizations: http://www.HealthcareFinancials.com
Health Administration Terms: http://www.HealthDictionarySeries.com

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 him at: MarcinkoAdvisors@msn.com or Bio: http://www.stpub.com/pubs/authors/MARCINKO.htm
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Executive-Post, on May 19th, 2008 at 4:53 PM Said:

Retail Clinics and CONs?

Did you know that Florida Gov. Charlie Crist just signed a bill streamlining the state’s certificate-of-need process. It includes a “loser pays” provision to cover a hospital’s legal fees if there is an unsuccessful appeal after a CON has been granted by the state.

But, are retail medical clinics subject to these laws?
Thanks.
-Betty
Executive-Post, on May 19th, 2008 at 11:25 PM Said:

CRM and Medical Marketing

The following poem was written by Bob Schmetterer, in Cannes France – circa 2000. It was not about medicine at all! The added parenthesis is my own. Nevertheless, it does seem appropriate for this topic.

With all the possibilities of media;
all the possibilities of digital TV;
all the possibilities of new media;
and all the new content of pipes and wireless;
with all the possibilities of integrated marketing services;
with all the strategic planning we are prepared to deliver;
with all the interactive connectivity and one-to-one marketing finally a reality;
we should be in the midst of a new creative revolution…
a new definition of (medical marketing) creativity.

Your thoughts and comments are appreciated.
-Dr. David E. Marcinko; MBA, CMP™

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: http://www.HealthcareFinancials.com
Health Administration Terms: http://www.HealthDictionarySeries.com
Physician Advisors: http://www.CertifiedMedicalPlanner.com

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Executive-Post, on May 22nd, 2008 at 1:34 PM Said:

Merck Agrees to Multi-State Vioxx™ Settlement

Did you know that Merck and Co., agreed to submit all new TV drug commercials to the Food and Drug Administration [FDA] for review before broadcast? The civil settlement ends a joint three-year investigation by 29 states and the District of Columbia into Merck’s advertising practices involving Vioxx™. The drug was taken off the market in 2004 after research showed it doubled the risk of heart attacks and strokes. That triggered thousands of lawsuits against Merck. A pending $4.85 billion settlement would end the bulk of those personal injury suits and related allegations, according to the Associated Press.

Executive-Post
-Staff Reporters
Executive-Post, on May 22nd, 2008 at 1:39 PM Said:

More on IRS Form 990

Did you know that the American Hospital Association [AHA] has filed a letter with the IRS arguing that the agency could do more to accommodate small, cash-strapped institutions in its instructions for filling out the new IRS Form 990 – and accompanying Schedule H – aimed at not-for-profit hospitals? The AHA’s input comes as part of the IRS comment period on the draft instructions, which will remain open until June 1st.

According to the Wall Street Journal, the AHA raised several concerns in a nine-page letter over core definitions. For example, it cited worries over the agency’s definition of “subsidized services,” which would exclude physician clinics, skilled nursing and ancillary services. The AHA argued that these services can often be part of a non-profit’s charitable mission.

The AHA also cited several definitions that it considered to be too broad, including “key employee” and “facility,” which would result in healthcare organizations having to engage in onerous amounts of reporting which don’t provide value to the organization itself.

And so, your thoughts on the matter – especially from tax attorney and CPA subscribers – are appreciated.

Executive-Post
-Staff Reporters
Executive-Post, on May 22nd, 2008 at 10:53 PM Said:

Big-Pharma Payola?

Did you know that according to the Associated Press, some pharmaceutical companies are using legal settlements with generic drug makers to delay the introduction of cheaper medicines? Yep, it sure seems so!

For example, in a 12-month period that ended last September 30th 2007, 14 of 33 agreements to settle patent litigation between brand-name drug companies and generics included both a restriction on the generic company’s ability to market a drug and compensation to the generic manufacturer.

The Federal Trade Commission [FTC] maintains that by jamming the pipeline of cheaper drugs, such agreements harm consumers. The agency has sued to block some agreements and is supporting legislation in Congress that would ban the practice.

What do you think of such drug-induced “greenmail”; scam or legitimate competitive posture?

Executive-Post
-Staff Reporters
Executive-Post, on May 24th, 2008 at 4:46 PM Said:

Block those Rankings – Rah! Rah! Rah!

Did you know that the Massachusetts Medical Society [MMS] filed a lawsuit to block or change a ranking program it says harms doctors and patients?

The program, used by the agency that oversees health insurance for state and local employees, ranks doctors in three tiers based on various cost and quality measures. And, patients must pay more to see a physician who isn’t in the top tier.

The president of the MMS reported in a statement that the system is flawed, with doctors “assigned costs from patients they did not treat, and for procedures they did not perform. This is misleading and simply not fair.”

Doctors and insurers have been making progress toward agreeing on a framework for doctor rating programs and increased pricing transparency. Driven largely by pressure from New York AG Andrew Cuomo, a national standard is emerging. It includes third-party review, an appeals process for doctors, and published criteria that include not only cost but also quality measures, according to the Wall Street Journal.

And so, your thoughts are appreciated. And, is this sentiment the polar opposite of the above post?

Executive-Post
-Staff Reporters
Executive-Post, on May 28th, 2008 at 10:56 AM Said:

Signature Stamps

Did you know that the Centers for Medicare and Medicaid Services [CMS] banned the use of physician signature stamps? Now, handwritten or electronic signatures are required.

Apparently, CMS banned signature stamps according to Medicare Transmittal 248 (Change Request 5971). CMS changed the context of medical reviews, and physicians inside and outside of hospitals may not use signature stamps because there’s no way to predict a Medicare audit or review. Currently, hospitals may face claims denials for services if auditors find any orders (or supporting documentation) with a signature stamp.

Transmittal 248, issued on March 28, modified the Medicare Program Integrity Manual [MPIM], and indicates that “stamp signatures are not acceptable.” And despite the fact that the transmittal seems to apply only to hospital certifications of terminal illnesses, some experts say it’s clear that the ban applies to all documentation subject to prepayment and post-payment medical review.

The transmittal also states that the “method used [to identify the person who provided or ordered services] shall be hand written or an electronic signature”, according to the Report on Patient Compliance.

Is this policy consistent with – or counter to – the above post?
-Staff Reporters
Executive-Post
Executive-Post, on May 29th, 2008 at 1:59 PM Said:

Medicare Spending and Satisfaction

Did you know that variations in regional Medicare spending do not affect beneficiaries’ perceptions of care, according to a new study in the Journal of the American Medical Association [JAMA]?

Medicare spending differences – which ranged from an annual average of $12,000 for a beneficiary in Miami, to $5,700 for one in Minneapolis – were not linked to beneficiary satisfaction, according to Jonathan Skinner, co-author of the study and Dartmouth College economist, via the American Health Line.

Is this a modification of the Arthur Laffer Curve; the economic concept that throwing more money at a problem does not necessarily fix it [i.e., law of diminishing returns]?
Your thoughts are appreciated.

-Staff Reporters
Executive-Post
Executive-Post, on May 29th, 2008 at 4:50 PM Said:

“Dirty-Claims”

Did you know that healthcare industry claims processors reported at least a four-fold increase in rejected Medicare claims, and a doubling of rejection rates for so-called “dirty” claims processed by the Blue plans on May 23, 2008?

As readers of the Executive-Post are aware, this was the first day that the federally mandated National Provider Identifier [NPI] was required. And, the rejection rate spike was similar or even higher for Medicaid claims. Are you surprised?

-Staff Reporters
Executive-Post
Executive-Post, on May 30th, 2008 at 2:36 PM Said:

More on Salary Trends

For salaries of military doctors, use the Navy’s Pay Calculator
https://staynavytools.bol.navy.mil/PCC/?B3=Launch+Calculator
For the salaries of civilian residents, take an average of several hospitals’ pay tables for post-graduate medical education.
For the salaries of civilian doctors, use information provided by Washington University’s Residency Web
http://residency.wustl.edu/medadmin/resweb.nsf/L/212DEF64C36D7FA886256F8F0072F0B0?OpenDocument

Staff Reporters
-Executive-Post
Executive-Post, on May 31st, 2008 at 4:41 PM Said:

Speech Recognition in Military Medicine

Did you know that physicians are using speech recognition tools to enhance patient electronic Medical Records [eMR] in the military? It’s true!
According to Information Week, and by 2011, the Defense Department expects its integrated, interoperable electronic medical records system to be in place at 500+ military medical facilities worldwide.
More info link: http://www.informationweek.com/1188/ehealth.htm

Executive-Post
-Staff Reporters
Executive-Post, on May 31st, 2008 at 5:04 PM Said:

More on Google Health

According to Marianne Kolbasuk McGee, of Information Week, Cleveland Clinic patients have been testing Google’s online health records initiative since February 2008.
Nevertheless, we are aware that the Clinic has allowed patient access to their medical records, for years via its MyChart initiative.
Now however, the burden has shifted from them, to the internet behemoth.
Feel free to post you experienced comments on each.

-Staff Reporters
Executive-Post
Executive-Post, on June 3rd, 2008 at 11:49 AM Said:

Banks and CD-HCPs

Did you know that banks are currently positioning themselves with the aim to become crucial players in the massive health care business in the US?

With the market becoming more and more consumer driven, financial institutions are hoping to capitalize on what could become a large and constant new revenue stream. For example, currently 4.5 million Americans have signed up for tax advantage health care programs with the prediction of fifteen million by 2010 and a total of $75 billion of new money to be managed.

Relative to MSA/HSAs, banks and financial institutions are on the cusp of getting involved in the payments and transactional settlement processes that exist in the Health Care industry. Current figures put the annual health care payment system at roughly $1.9 trillion – including billing, claims and processing. Banks and other financial intermediaries are aligning themselves to start creating products that address revenue cycle management challenges as well capture the burgeoning CD-HCP market.

You comments are appreciated.
Staff Reporters
-Executive-Post
Executive-Post, on June 3rd, 2008 at 4:39 PM Said:

EMRs at Kaiser

Did you know that the medical charts of nearly 9 million Kaiser Permanente patients, in nine states, are now electronically archived?

The plan’s HealthConnect electronic medical record system (EMRS) just completed a four-year launch. Installation cost $4 billion, including $1 billion for maintenance.

Staff Reporters
-Executive-Post
Executive-Post, on June 3rd, 2008 at 5:37 PM Said:

Enter the Nocturnists

Did you know that some hospitals are finally waking up to the fact that substandard care on nights and weekends is endangering patients — giving new meaning to the term “graveyard shift?.” Yep; it’s true according to the Wall Street Journal, May 28, 2008

Patients suffer higher rates of death, complications and medical errors when they are treated during thinly staffed off hours. Now, some hospitals are taking steps to improve safety and reduce their own legal liability from mishaps.

Of course, we have addressed this issue right here at the Executive-Post, and it has been one of the “dirty-little hospital secrets” for decades, now.

And so, your thoughts and experienced comments are appreciated?
-Staff Reporters
Executive-Post
Executive-Post, on June 3rd, 2008 at 5:42 PM Said:

Reverse Medical Tourism

Did you know that some US hospitals are trying to draw foreigners here with flat-fee rate care? Yep, it’s true according to the Wichita Eagle!

We all know that escalating health care and insurance costs are driving many Americans overseas for medical care, but some US hospitals – including at least one in Wichita – are aiming to bring foreign patients here by offering deeply discounted rates.

At the forefront are physician-owned hospitals, whose managers say they have the efficiency and flexibility to charge extremely low rates and still come out ahead. They call it “reverse medical tourism.”

Link: http://www.kansas.com/101/story/418149.html

Your thoughts are appreciated?
-Staff Reporters
Executive-Post
npi numbers, on June 3rd, 2008 at 10:37 PM Said:

Can anyone tell me what the sample size was back then? I was also hoping for more info.

Thanks.
Executive-Post, on June 4th, 2008 at 11:16 AM Said:

Secure Verifications Might Spur e-Patient HIT Initiatives

I believe that if medical providers adopted a set of common practices used for validating the identity of online consumers, not only would our records be safer, it’s more likely that Personal Health Record [PHR], and related other e-patient and HIT initiatives, would become more popular with all patients, and safer.

Of course, the use of “knowledge-based authentication systems” – a security method that uses one’s knowledge of facts only they should know – to establish identity is vital. In addition, confirmed identities managed by reliable third-parties, such as financial institutions, should also be included in the security-mix.

Of course, the devil-is-in-the-details, and who among us can define a ”reliable third party”, with the daily barrage of security breaches coming at us at increasingly faster rates.

Nevertheless, hospital rules and regulations mandated by HIPAA and both the Sarbanes-Oxley Act as well as the Patriot Act, might be satisfied in this manner.

But, that’s just my opinion.
What do you think; please opine?

-Dr. David Edward Marcinko, MBA
Publisher-in-Chief
Executive-Post, on June 4th, 2008 at 2:59 PM Said:

NPI Update

According to HFMA News, when the Centers for Medicare and Medicaid Services [CMS] launched the National Provider Identifier [NPI] program a few weeks ago, a significant minority of Medicare and Medicaid claims were rejected; in fact as many as one-quarter may have been rejected. Now, just a week later, CMS reports that medical provider’s have gotten much better.

According to the agency, most intermediaries were reporting that over 90 percent of claims were NPI-compliant, with some reporting 100 percent compliance. The problems that remained largely involved providers using legacy numbers for their secondary provider identifier field, which should also include the provider’s NPI.

You comments are appreciated.
-Staff Writers
Executive-Post
Executive-Post, on June 5th, 2008 at 12:44 AM Said:

Another example of a financial advisory mismatch

Recall the tale of Dr. Debasis Kanjilal, a pediatrician from New York who put more than $500,000 into the dot.com company, InfoSpace, upon the advice of Merrill Lynch’s star but non-fiduciary analyst Henry Bloget. Is it any wonder that when the company crashed, the analyst was sued, and Merrill settled out of court?

Although sad, this story is a matter of public record. Hopefully, doctors now understand that the big brokerage houses that underwrite and recommend stocks may have credibility problems, and that physicians got burned with the adrenalin rush of “self-directed” portfolios. And, other analysts, such as Mary Meeker of Morgan Stanley, Dean Witter and Jack Grubman from Salomon Smith Barney, are involved in similar fiascos.

Feel free to send in more examples and your own experiences.

-Staff Reporters
Executive-Post
Executive-Post, on June 5th, 2008 at 12:48 AM Said:

http://www.CertifiedMedicalPlanner.com
Adult-Learner Testimonials
[See what they are saying about us ... ]

“I really like the supportive approach to learning. The limited number of desired Certified Medical Planner™ practitioners allows the professionals at iMBA, Inc., to take an evident, genuine interest in the success of practitioners. I also agree with the program’s premise that specialization is necessary for success as any type of Financial Advisor, and for providing the best advice to client-medical professionals. I also appreciate that I had the opportunity to submit my first published work.”
-A CFP™, CPA, CLU

“The program has shined a harsh light on how much I still have to learn. I would like for part of the program to include suggestions for continued professional development and practice growth.”
-A CFP™, MSFS, CLU, AIF™

“I would incorporate some form of case study for each semester that examines some particular topic. I envision almost a quarterly thesis that would be based upon a prearranged list of topics. For example, one thesis may involve the analysis of a set of medium sized practice financials and operating results. As an alternative, the program could incorporate a juried presentation designed to incorporate a wide spectrum of the knowledge gained during the program. Perhaps, this presentation could begin late in the second quarter with subsidiary presentations designed to allow the faculty to gauge progress and suggest revisions. This would likely increase the rigor of the program and make it more difficult for some professionals to undertake it.”
-A Private Banker, MBA

“I will rank the designations I have earned or have made progress in earning:

1. CFA (really tough unless you work in securities valuation every day)
2. CPA (this was a very tough exam and required a lengthy process of learning. However, I think that much of the CPA exam, when I took it, was rote-without a full understanding of the content)
3. CFP® (this is a little more difficult than the CMP™ mainly because of the time constraints and structure of the exam. It is a little less difficult than the CPA because it incorporates some of the knowledge that CPA’s typically already possess)
4. CMP™ – Certified Medical Planner™
5. CLU (these exams were not very difficult but mainly required time and some limited reading)
6. Securities Licensure (Series 7)
7. Insurance Licensure”.
-A CFP™, CPA

Thank you for visiting us, online!
For additional information:
770.448.0769 (vm)
775.361.8832 (fax)
Executive-Post, on June 5th, 2008 at 1:48 AM Said:

Banking on Patient Control

Advocates of health records banks [HRBs] are moving the industry away from distributed health information exchange [HIE] models.

-A Medical CIO
Executive-Post, on June 6th, 2008 at 9:19 PM Said:

HIE

Did you know that the second annual Healthcare Equality Index [HEI] rates 88 U.S. hospitals on their policies and practices related to the gay, lesbian, bisexual and transgender community?

The HEI focuses on five main policy criteria: patient non-discrimination, hospital visitation, decision making, cultural competency training and employment policies.

In the 2008 Healthcare Equality Index 45 hospitals reported GLBT-inclusive policies and practices for every one of the 10 HEI rating criteria.

Link: http://www.hrc.org/issues/hei.asp
Your thoughts are appreciated?
-Staff Writers
Executive-Post
Executive-Post, on June 6th, 2008 at 9:41 PM Said:

More on Divorce Finances

Divorce: 15 Costly Mistakes
Link: http://articles.moneycentral.msn.com/CollegeAndFamily/SuddenlySingle/Divorcing15CostlyMistakes.aspx

-Staff Reporters
Executive-Post
Bill, on June 9th, 2008 at 6:10 PM Said:

More Alimony Rules

There are a few more rules not discussed in this article.

1. Taxpayers cannot file a joint return in any year alimony payments are made.
2. Alimony payments MUST be made in cash.
3. Any payments to maintain property owned by the payor spouse and used by the payee spouse (e.g. mortgage, real estate tax, insurance premiums) will NOT qualify as alimony.

Finally, alimony payments are subject to excess front-loading rules. Payments that decrease too fast (which were previously deducted by the payor) are subject to recapture rules and will be taxed as ordinary income to the payor.

For more information please visit http://www.irs.gov/taxtopics/tc452.html

-Bill Winterberg
Bill, on June 9th, 2008 at 6:27 PM Said:

Survivorship Life Insurance

Survivorship life, or second-to-die, life insurance policies offer a lower-cost option to joint life, or first-to-die, policies. The second-to-die policy offers estate liquidity for taxable estates when assets are transferred from the decedent (formerly the surviving spouse) to beneficiaries.

Surviving spouses receive an unlimited marital deduction, so generally there are no estate taxes to pay, and no need for first-to-die provisions. This is perhaps why second-to-die policies are gaining in popularity. Note that estate planning may be required in order to maximize the applicable exclusion amount for the first decedent’s estate.

However, second-to-die policies offer no liquidity for buy-sell agreements. If the decedent is a 50% owner of a medical practice, a second-to-die policy would not generate any proceeds to buy the decedent’s share. This would be a significant disadvantage to medical practice owners who own second-to-die policies.

-Bill Winterberg
Pacific Northwest.
Lee Hover, on June 9th, 2008 at 9:19 PM Said:

Hospital Reputations

If the reputations of some hospitals have suffered in the past through indiscrimate attempts to collect, this certainly will finish off the rest. Patients will not distinguish between hospital attempts to collect and those of collection agencies. And, one can be sure those agencies will not use TLC to do so.

-Lee Hoover
Executive-Post, on June 11th, 2008 at 12:46 AM Said:

Of course, the applicability of this post to an incorporated medical practice is obvious, too!

-William
Office Manger
John, on June 12th, 2008 at 10:32 AM Said:

Thanks for the [post and site].
Great information here!
-John Rueschenberg
Portland, OR
Executive-Post, on June 12th, 2008 at 11:45 AM Said:

ANSWER:
Second-to-die life insurance for medical professionals, and others, has two main advantages:

Fist, it is often less expensive to purchase than a single life policy.
And, second, if properly purchased and maintained, second-to-die life insurance proceeds can be free of both income tax and estate tax.

Rationale:

Proceeds from second-to-die insurance can be used by the ultimate beneficiaries, usually the children, to help pay the eventual estate tax on the medical practice or family stock they inherit, etc. And, the estate tax may be significant, especially if the second, insured individual dies without having remarried because the marital deduction is then unavailable.

To have proceeds excluded from a doctor’s estate, s/he must set up a trust which purchases the insurance. S/he can then make annual gifts to the trust which may qualify as a present interest, making the gifts eligible for the annual gift tax exclusion.

However, before purchasing second-to-die insurance, the doctor should see how it compares to a traditional single life insurance policy.

Dr. David Edward Marcinko; FACFAS, MBA, CMP™
Publish-in-Chief and Independent Health Economist
Former Certified Financial Planner™
Former insurance agent
Executive-Post, on June 13th, 2008 at 2:18 AM Said:

New EMTALA On-Call Policies

Did you know that the Bush administration just proposed letting hospitals with emergency departments cover their physician on-call responsibilities through community plans that coordinate resources of multiple facilities?

In a Medicare hospital payment rule released in late April, the Centers for Medicare & Medicaid Services [CMS] proposed clarifying its on-call policies under the Emergency Medical Treatment and Labor Act [EMTLA], which is aimed at preventing EDs from “dumping” uninsured or Medicaid patients at public hospitals; according to the American Medical News.

If CMS finalizes the proposal, a group of hospitals in a particular region would have the option of designating one of the facilities as the on-call site for a specific time period, for a specific service, or both. Individual hospitals with EDs still would be required to give each emergency patient a medical screening examination and to have a plan for how to proceed if a needed on-call physician was not available.

-Hope Hetico; RN, MHA, CMP™
Executive Post
Executive-Post, on June 13th, 2008 at 8:40 PM Said:

Senate Blocks Medicare Reform Bill

Did you know that the Senate just voted 54-39 to block consideration of Senate Finance Chairman Max Baucus’ Medicare reform bill, which primarily uses cuts to Medicare Advantage plans to fund higher payments to physicians. Yes, it’s true according to Jennifer Lubell of Modern Healthcare.

Senate Majority Leader Harry Reid (D-NV) changed his vote at the last minute to oppose the bill. And, Sen. Chuck Grassley (R-IA), the finance committee’s ranking member, hopes the failed bill will lead to more effective negotiations. Grassley has an alternative bill that would also halt the payment cut to physicians but contains different funding sources.

Baucus attempted to defend his legislation during floor debate, claiming it would not take money away from teaching hospitals, make drastic cuts to Medicare Advantage, or eliminate private fee-for service Medicare Advantage plans.

And so, what do you think about the Bacus’ reply and the Bill itself?
-Executive-Post
Executive-Post, on June 14th, 2008 at 8:55 PM Said:

CMS Addresses Fraud

Did you know that The Washington Post just examined Medicare’s “growing fraud problem and the need to devote more resources to theft prevention?”

According to the Post, law enforcement officials estimate that health care fraud costs taxpayers more than $60 billion annually. One “critical aspect of the problem is that Medicare … automatically pays the vast majority of the bills it receives from companies that possess federally issued supplier numbers,” the Post reports.

Scholars say that Medicare’s current computer and audit systems generally focus on over-billing or unorthodox medical treatments, rather than fraud.

CMS officials are working to improve fraud efforts “by working closely with investigators, removing the requisite billing numbers of nearly 900 companies and imposing new standards in high-fraud areas that would prevent people convicted of felonies from ever receiving a Medicare number,” according to the Post. Kimberly Brandt, director of program integrity at CMS, said, “There’s always more fraud than we have resources to combat,” adding, “We have done a much better job of realigning our resources to attack this problem.”

Source: Carrie Johnson, Washington Post via American Health Line

Your thoughts and comments are appreciated.
-Executive-Post
Executive-Post, on June 16th, 2008 at 2:34 PM Said:

More on the CEO and AIG Mess

Wall Street has lost another top executive to the subprime-mortgage mess this monring. Martin Sullivan just left the helm of American International Group (AIG) amid intense shareholder pressure.

Did you know that big shareholders — including billionaire investor Eli Broad and Legg Mason (LM, news, msgs) fund manager Bill Miller — had written letters to AIG’s board of directors, pushing the company to make changes to its leadership.

AIG has lost a total of $13 billion in the past two quarters, and the stock has plunged 52% in the past year.

Who is next, we ask? Please comment and opine.

-Executive-Post
Srinivasan, on June 19th, 2008 at 10:14 AM Said:

WOW!

I think this is one of the very few – nope actually … it’s the best written article on this subject – short, precise, simple, data-oriented and powerful!

It just shows how sound your knowledge on this subject is, Karen.

I haven’t read any of your previous article, but I will find them and read – If you have a blog site or a place where you regularly write and submit articles, please let me know.

Thanks and keep at it!

-Srini
slickvguy, on June 21st, 2008 at 11:36 PM Said:

Hello,

You said, “The option actually does not expire until Saturday, but customers must act by 5:30 p.m. on the Friday prior to the expiration.”

But, this is recently incorrect. Different firms have different cutoff times. Most use 4:30pm EST.

Best.
-Slick V. Guy
Bill, on June 24th, 2008 at 4:51 AM Said:

Hi there,
Just a minor correction. Today, pension, annuity, and retirement plan distributions are reflected on Form 1099-R, not Form W-2P.

-Bill
http://www.fppad.com
tony serafini, on June 24th, 2008 at 1:40 PM Said:

More on Kindred,

Yes; I can add to this story.
I was at Kindred in Dover NJ for several weeks and endured all sorts of horrors. You can see all of this just by going to YouTube and looking at the video. Once on YouTube, the videon can be found using search terms ‘Kindred,’ ‘hospital,’ and ‘Dover’.

-Tony
Bill, on June 26th, 2008 at 4:53 PM Said:

Hello,

This is a good article and covers the concepts of gifting well, including the annual exclusion amount, gift splitting, and unlimited direct gifts for medical or education expenses.

One correction is needed; the applicable credit amount for gifts is not tied to the credit amount for estates.

The applicable credit amount for gifts is $345,800 which corresponds to an applicable exclusion amount of $1,000,000. When the $1,000,000 exemption equivalent is used up, subsequent gifts are subject to immediate gift tax. This remains in effect even in 2010.

As you wrote, the estate credit is amount is $780,800 for 2008 (an equivalent of a $2,000,000 exclusion amount) and is $1,455,800 for 2009 (an equivalent of a $3,500,000 exclusion amount). There is no estate tax in 2010.

-Bill
http://www.fppad.com
Surety Bonds, on June 30th, 2008 at 8:47 AM Said:

Hello,
This is a very useful article, especially for anyone new to the medical field in the United States.
-Thanks
Abby, on July 8th, 2008 at 3:42 PM Said:

Hello,

Thank you for this article…it was very helpful and timely. We just received a rejection to our own offer-in-compromise and were told that “it really doesn’t matter”, according to the IRS OIC manager I spoke with. Our living expenses up here in the Northeast are far above the IRS standardized table because, “down here in Texas where I live there’s a reason for standards…it’s to make it FAIR TO EVERYONE”.

Not surprisingly, neither he nor our OIC Specialist mentioned any of the Tax Reform mandates you summarized in your article.

Well, it’s off to my Congressman’s office for a more informed opinion.
Oh, the only other thing I’d mention is that I’m pretty sure virtually every OIC is rejected at first. So, EXERCISE YOUR RIGHT TO APPEAL!

Thanks again.
-Abby
Executive-Post, on July 9th, 2008 at 11:10 AM Said:

MD Technophobes

One can only wonder if the doctors of this peer-to-peer network, used for self-ingratiating purposes, are the same MDs who claim technophobia and refuse to enter the modern era of eMRs to the benefit of their patients. Thanks for the insightful post.

-Jackson
Executive-Post, on July 9th, 2008 at 2:57 PM Said:

Hi Jackson,

You make a good point.
For example, did you know that doctors who use electronic health records [eHRs] say overwhelmingly that such records have helped improve the quality and timeliness of care? Yet, fewer than one in five of the nation’s doctors have started using such records, according to a study published online in The New England Journal of Medicine [NEJM].

Best.
Hope
Executive-Post, on July 9th, 2008 at 3:03 PM Said:

Hi All,

Did you know that a congressional probe found that 27,000 doctors, hospitals, nursing homes and hospices – paid by Medicare – failed to pay more than $2 billion in federal taxes in 2006?

Of course, Medicare officials now say they are taking steps to stop the abuse, according to the Wall Street Journal on June 20, 2008.

The Government Accountability Office reported that the total included $896 million in payroll taxes and $581 million in individual income taxes, and said its own numbers are substantially understated because it didn’t include all Medicare providers, among them those that didn’t file tax returns. The report, ordered by the Senate Homeland Security and Governmental Affairs Committee’s investigations panel, is the result of the third tax-fraud probe involving health care providers. Last year, the GAO found 21,000 of Medicare’s doctors and outpatient services owed $1 billion in taxes through September 2005, and 30,000 providers of Medicaid services owed more than $1 billion through September 2006.

What do you think of that? This takes the CCC and NHIRC to the next level, doesn’t it.
Best
-Jane
Executive-Post, on July 9th, 2008 at 3:11 PM Said:

Ending e-RX Barriers,

Did you know that the American Medical Association’s [AMA] House of Delegates [HODs] just adopted a resolution calling for an end to government-imposed barriers to electronic prescribing?

Yep! The resolution called for the removal of all federal Medicare and state Medicaid requirements mandating the use of paper prescription forms for certain drugs – that the AMA initiate discussions with the federal Drug Enforcement Administration [DEA] to allow e-prescribing of schedule 2 drugs – and that Medicare or Medicaid payments not be contingent upon adoption of e-prescribing.

Modern Physician also reported on June 18, 2008, that the resolution also called on the AMA to work with federal and private entities to ensure universal acceptance by pharmacies of electronically transmitted prescriptions.

Executive-Post
Staff Reporters
Executive-Post, on July 10th, 2008 at 4:51 PM Said:

RWJF Report,

Currently, just 17% of physicians working in ambulatory care have adopted electronic health-record systems, and only 4% have access to “fully functional” systems with key patient-safety features such as drug alerts, according to a summary of an authoritative survey funded jointly by HHS and the Robert Wood Johnson Foundation and published in the New England Journal of Medicine.

-Hope
Executive-Post, on July 13th, 2008 at 12:31 AM Said:

Pay Per Minute Practice

I recently read on The Health Care Blog, about a physician who punches a time-clock when medical office appointments begin. She has calculated her time is worth $2 per minute. Fifty-nine minutes = $118. Will you be paying cash, check, charge or finance the visit today?

On the one hand, somehow, I think the meter would make me nervous. I suspect I might begin talking very quickly. On the other hand, this is only one business model and it sure has been successful for some attorneys.

And, so your thoughts are appreciated.
-Ann
Executive-Post, on July 13th, 2008 at 1:00 AM Said:

California Sues Prime Healthcare

Did you know that California state insurance regulators have filed suit to stop growing hospital chain Prime Healthcare Services from billing commercially-insured patients for fees that insurance companies don’t pay.

Of course, “balance-billing” is explicitly forbidden in some states, but California’s law is vague on this topic; according to industry observers.

Prime is one of the fastest-growing hospital chains in California, having acquired a dozen southern California hospitals in recent years. Along the way, it has acquired a controversial reputation, as it often cancels the majority of private insurance contracts its hospitals had in place. Such cancellations allow the hospitals to bill insurers for out-of-network services, allowing Prime to charge higher fees.

In its lawsuit according to the Los Angeles Times, the state is asking the court to forbid Prime to bill insured patients for bills owed by insurers. This follows previous legal action by Kaiser Permanente, which obtained a temporary restraining order barring the chain from collecting from its members or reporting the bills to credit agencies until the case is resolved.

More: http://www.fiercehealthfinance.com/story/ca-sues-prime-healthcare-balance-billing-insured-patients/2008-07-07?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHF&dest=FHF

And so, your comments and thoughts are appreciated.
-Ann
Beverly Motley, on July 15th, 2008 at 5:40 PM Said:

Greetings!

As a compensation professional, what kinds of trends are you observing in physician compensation for multi-specialty hospitals in the Tacoma/Seatle Washington state locations? Additionally, what innovations (in 2008) are observed in the manner doctors and hospital leadership are compensated? Please e-mail today if possible to Kkyewu1@aol.com. Thank you ever so much!

Warm Regards,
Bev Motley
Executive-Post, on July 23rd, 2008 at 8:18 PM Said:

RFID Tag Danger?

Did you know that Radio Frequency Identification [RFID] tags may pose a danger in intensive care units? It’s true, if you believe recent study published in the Journal of the American Medical Association [JAMA].

Researchers looked at the effect RFID tags had on 41 different medical devices and, in 123 tests, they were able to produce 34 incidents of electromagnetic interference. Twenty-two of the incidents were described as hazardous and involved problems like a syringe pump stopping or an external pacemaker not working correctly; others were less serious, but could still prove a distraction to medical workers.

Before the tags are put in intensive care units or similar places, the study said, hospitals should require on-site tests for interference with equipment, according to a report published in the New York Times, on July 15, 2008.

You comments are appreciated.
-Ann
Executive-Post, on July 28th, 2008 at 1:27 AM Said:

Kroger

Did you know that Kroger just announced plans for its convenient care clinics, with a partnership with Nashville Tennessee’s, The Little Clinic, LLC? Does anyone have more info on this development?

-Ann
Executive-Post, on July 28th, 2008 at 11:34 PM Said:

Medicare Payment Fix

Finally, congress passes a physician Medicare payment fix.

Yep, after a series of failed attempts to stall a 10.6 percent Medicare physician pay cut, Congress finally approved a veto-proof fix. The new law will halt the July 1 pay cut for the rest of 2008 and provide a 1.1 percent pay increase in 2009.

Your thoughts are appreciated. Have we seen this scenario before; and, will we see it again next year?

-Ann
Executive-Post, on July 29th, 2008 at 4:24 PM Said:

RAC Audit Recoveries

Did you know that auditors have already recovered nearly $700 million in Medicare overpayments to hospitals and other medical providers in a half-dozen states under the controversial Recovery Asset Contractors [RAC] program that pays the auditing firms a portion of amounts they identify?

In all, the agency’s recovery audit contractor program caught $1.03 billion of improper payments over about three years, primarily in New York, California and Florida, about $992.7 million of which was overpayments by Medicare, according to the Wall Street Journal, July 12, 208.

The audits also identified about $38 million that providers should have received, but didn’t. The program’s expenses amounted to about 20 cents on the dollar, including $187.2 million paid to the audit firms, and medical providers successfully challenged about $60 million of overpayments identified by the auditors.

Auditors pointed to the low appeal rate – about 14 percent of overcharges were appealed, and 4.6 percent of the total was overturned – as evidence that the audits succeeded.

Your thoughts are appreciated as we wonder if “anyone is surprised.”

-Ann
Executive-Post, on July 29th, 2008 at 7:20 PM Said:

More about Chiropractic

Of course, there are many arguments for and against alternative medicine in general, and chiropractic in particular. And, we will not likely settle the debate here.

Q: However, a much larger question remains. Just how legitimate is domestic complementary medicine anyway?

A: More than 50 US medical schools now teach some sort of alternative medicine as part of their standard medical curriculum. MCOs, such as Oxford Health Plans, in Norwalk, Conn., HealthCare Plan, in Buffalo, NY, HealthEast, in St. Paul, MN., and Pre-paid Health Plan of Syracuse, NY., all have panels of non-traditional healthcare providers. Source: http://www.springerpub.com/prod.aspx?prod_id=23759

And so, we will post more on this topic soon.
Until then, you comments, pro and con, are appreciated.

Hope Hetico; RN, MHA, CMP™
Managing Editor
Executive-Post
Joseph Young, on July 29th, 2008 at 11:21 PM Said:

Executive-Post,

Thank you for the good tips. I am building a list of books on incorporation for do-it-your-selfers, and I’d like to include this one. I don’t know if the book goes into much detail on corporate meetings, minutes and resolutions. I see, though you have a section on preventing the corporate shield from being pierced.

Recording minutes and writing resolutions seems to be the thing that is most neglected by small business owners, like doctors, even though it is vital to fortifying your corporate veil. Small corporations (PCs and LLCs), professional practices and investment vehicle companies need to keep good corporate minutes just like large companies. I have written about this here. The process can be streamlined, systematized, even automated. There’s no reason for doctors or small incorporation owners to be intimidated by such corporate “formalities”.

With the rules on corporate ownership “transparency” tightening since September 11th, corporate governance and good minutes are more important than ever. And, of course, don’t forget their importance if you are sued or, god forbid, audited by a revenuer.

All the best!
-Joe Young
Executive-Post, on July 30th, 2008 at 1:15 AM Said:

Anti-Rx Drug Fraud Measures

The CMS will allow physicians to use approved anti-fraud print technologies in place of the mandated use of tamper-proof paper, slated to go into effect Oct. 1, when printing electronic prescriptions for Medicaid patients, according to physician informaticist Peter Basch and National Council for Prescription Drug Programs board member Michele Vilaret.

-Ann
Executive-Post, on July 30th, 2008 at 1:18 AM Said:

Anti-Rx Fraud Measures,

The CMS will allow physicians to use approved anti-fraud print technologies in place of the mandated use of tamper-proof paper, slated to go into effect Oct. 1, when printing electronic prescriptions for Medicaid patients, according to physician informaticist Peter Basch and National Council for Prescription Drug Program [NCPDP] board member Michele Vilaret.

-Ann
Executive-Post, on July 31st, 2008 at 1:14 AM Said:

A CMS Bonus to the Docs Only

Wow, the post above is amazing!

But, did you know that the Centers for Medicare & Medicaid Services (CMS) just announced more than $36 million in bonus payments to some 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative [PQRI]?

According to a CMS Office of Public Affairs [OPA], July 15, 2008 report, physicians, group medical practices, and other PQRI eligible professionals should receive their payments by August 2008. The average incentive amount for individual professionals is over $600 and average incentive payment for a physician group practice is over $4,700, with the largest payment to a physician group practice totaling over $205,700.

More than 109,000 professionals participated in the 2007; of those, over 56,700 physicians and other eligible professionals met statutory requirements for satisfactory reporting for the 2007 reporting period and are receiving incentive payments.

And sorry, no CRNAs, PAs, NPs etc., allowed.

-Ann
Amaury S. Cifuentes, on August 6th, 2008 at 4:56 AM Said:

Executive-Post Readers,

As a financial advisor, I recently interviewed Dr. Gallops of Naples Florida, who said “I can provide superior medical care with personal attention”, after successfully starting his concierge medical practice.

Dr. Gallops further explained that this business model is not for every doctor, nor for every patient. However, it has been successful for him. As an established doctor in Naples, FL with an excellent reputation, here are some of the reasons that allowed him to start his concierge medical service.

“My decision was not made overnight”, said Dr. Gallops. “I read about it seven years ago and did my research. After seeing some success stories, it still took me more than two years to transition. The final result was that it allowed me the time to focus on my patients, not insurance paperwork”.

A doctor’s reputation, ability to market themselves, and geographic area are some of the items they should consider before making a change.

In addition, consulting with advisors, health attorneys and accountants with experience in concierge medicine is desirable. But, this experience itself can be hard to tap-into, in this emerging model; and that’s why I’m a subscriber to the “Executive-Post”.

Amaury S. Cifuentes
CERTIFIED FINANCIAL PLANNER®
Certified Medical Planner™ [candidate]
Executive-Post, on August 11th, 2008 at 12:39 PM Said:

A Consultant’s View

As a practice management consultant and health economist, a core theme in all my interactions with physicians who enter into a “direct practice” (the PC way to say Concierge Medicine) relationship is one of liberation, freedom and of doing things the way that they should be done.

The doctor gets to provide a much higher level of care and to truly get to know their patients. They have the economic and social incentive to spend an appropriate time with them; getting to know them within their unique ethnocentric context as well (cultural medicine). The patients love the access, the attentiveness, and are willing to spend cash to have the type of unhurried, contemplative time with their physicians that is required to develop a trusted relationship and deliver high quality care.

Your thoughts are appreciated.
Dr. David Edward Marcinko; MBA CMP™
Publisher-in-Chief
Executive-Post, on August 11th, 2008 at 12:41 PM Said:

Hello,

The above op-editorial seems particularly germane in light of the current sub-prime credit fiasco, as well as the entire imbroglio facing the government, banking, insurance and so-called private money-management firms of Wall Street.

Is this the “perfect storm” that drives salesmen out the industry in favor of fiduciaries, RIAs, etc?

-Ann
Executive-Post, on August 12th, 2008 at 12:32 AM Said:

About Knol,

Just launched in December 2007, Knol is yet another new online competitor of Wikipedia. And, interestingly, it is becoming a haven for physicians.

According to its website, a “knoll” is an authoritative article about a specific topic; or “units of knowledge.” Knol is limited by invitation to contributors and readers, to-date.

In a key departure from Wikipedia’s all-comers sensibility, however, the new service will be edited as a “moderated collaboration”, where any reader can make suggested edits to a knoll, which the author may then choose to accept, reject or modify before becoming visible to the public.

Again, nothing really new here, but we will keep you updated, prn.

-Ann
Executive-Post, on August 12th, 2008 at 1:54 AM Said:

An Insider’s Report on the Revolution,

Steve Case’s – you remember him formerly of AOL fame – Revolution Health hasn’t quite lived up to the promise trumpeted in early days.

Recent rounds of layoffs, changes in overall strategy, and the hiring of an investment bank to explore sales lead one to think that Revolution is closer to circling the drain than it is on carrying the banner of a new approach to health care focused on the consumer.

And so, any additional insider gossip, innuendo or informed opinion is appreciated.

-Hope
cmps, on August 14th, 2008 at 12:38 AM Said:

Hi All,

With the addition of fiduciary requirements to the CFP® Board’s Standard of Professional Conduct, the adoption of the Pension Protection Act [PPA], and the vacating of the broker-dealer exemption, the need for financial planning and health economics education in the physician advisory space is at an all-time high.

And so, is this fiduciary standard the same as the so-called ERISA fiduciary standard? Moreover, can one elect or opt-out of the CFP® Board’s standard of professional fiduciary conduct?

Of course, the online Certified Medical Planner™ program imparts the healthcare specificity – physician focused financial planning knowledge – and integrated medical practice management expertise that is needed to help devise solutions and raise the bar of advisory competence for all those serving medical professionals in the modern era. And, charter-holders can never op-out of their fiduciary responsibilities.

Additional insight is requested from our esteemed readers and subscribers.
Thank you.

-Bernie
Cochsie, on August 17th, 2008 at 8:00 PM Said:

Do you have any idea what the current mood of the IRS is with respect to these discounts?

-Thanks for your response.
cmps, on August 18th, 2008 at 12:26 AM Said:

The Markle Foundation

Did you know that the non-profit Markle Foundation is moving to create a national framework of electronic medical records standards, with its Connecting for Health program?

In fact, endorsements have been from Google®, AARP, WebMD, and a host of others. And, Microsoft officials have been working with Markle since 2007 and the launch of its HealthVault eMR initiative.

More insider information from readers and subscribers is appreciated.

-Ann
greg amarantos, on August 18th, 2008 at 1:19 PM Said:

Be careful. I have a fractional interest in Mexico and the interpretation of the by-laws by the governing body is different than in the US states. We are considering litigation, so read carefully.

And, we (the owners) are trying to sell for a 33% discount from the list to get out from this debacle. I say they are worthless.

-Dr. Greg Amarantos
cmps, on August 22nd, 2008 at 2:24 AM Said:

Stark Follow-Up

Did you know that the Medical Group Management Association [MGMA] is seeking to simplify the Stark Regulations [Rep Pete Stark D-California]?

The Group, recently asked CMS to examine the rules, saying they are too difficult to understand and execute. In fact, MGMA President William F. Jesse; MD is reported to have said, “The goal of this review should be administrative simplification.”

Can anyone shed some more insight on this rule review request?

-Ann
cmps, on August 28th, 2008 at 12:09 AM Said:

NPs versus OPs

I am not sure that this evidence-based report is so unique as to not be anything but heuristic. New Patients [NPs] are indeed a key economic driver to most [discounted] managed care plans. Old Patients [OPs] are not!

In other words; As a DDS, I would take the NP’s X-ray, fill a tooth, and move on to the next NP. Old [established] Patients [OPs] just don’t generate much income for the dental provider.

So, why else would some docs take on some managed care plans whose OP reimbursement is at a net loss? For the higher paying NPs, of course!

Look at the Calculus:
NP = [+] cash flow
OP = [-] or [=] cash flow
And, this is probably not unique to other specialties, as well.

Now, let’s not beat up on the docs, or portray them all as money-hungry. For example, was this dental study “risk-adjusted” in terms of patient mobility?

The census bureau here in Atlanta, a town on-the-move, tells us that the average ‘Hotlantan” moves every 2.5 years. Hence, in some cases, the NP load may be justifiably over-weighted.

Therefore, one may rightly wonder what the patient-mobility statistics are for discounted managed care, Medicare, FFS, HAS, concierge medical practice reimbursement plans, and others etc.

Any comments?
Hope
Tracey L Croisier, on August 28th, 2008 at 7:06 PM Said:

I’m stunned into stupid silence. I just got off the phone with Evergreen’s billing office. Seems that for each dollar I’ve paid to a doctor, there’s at least another dollar that I’ll need to fork over to Evergreen for “facility fees.”

I’m pregnant with twins and have had ultrasounds every month and monthly doctor’s visits. I’m in my final trimester and am supposed to now see the doctor every two weeks and ultrasound every two weeks.

So if I’ve done the math right, there’s this mysterious ‘facility fee’ bill looming that will likely top *five thousand dollars.* Almost seems like it would be cheaper to induce labor early to save myself a couple of grand. And, no, I have received no prior warning of said fees.

Tracey
Griff Murphey DDS, on August 31st, 2008 at 4:26 AM Said:

As a dentist, I already had a state license number, a DEA number, a State Narcotics control number, a social security number, a Tax I.D. number, and that wasn’t enough. Someone decided I have to have an N.P.I. number.

But you know what, I still get asked for those other numbers and have to pay for three of them, annually. I just think it’s bureaucratic nonsense. It’s like, I’ve been in practice 34 years, and I have to justify myself on a daily basis. Its’ the “Who the heck are you”, sort of idiocy!

Best.
-Griff
cmps, on September 2nd, 2008 at 10:29 AM Said:

According to the Maryland Hospital Association the hospital workforce shortage has continued to persist in the state of Maryland, particularly for nursing.
cmps, on September 2nd, 2008 at 10:33 AM Said:

Although the federal government is going full throttle into promoting transparency in healthcare, a new study by the Center for Studying Health System Change questions its current usefulness.

What’s up with that?
cmps, on September 2nd, 2008 at 10:37 AM Said:

A final report by the inspector general’s office [OIG] of the Department of Health and Human Services [DHHS], found evidence that the Centers for Medicare and Medicaid Services [CMS] underestimated the amount of improper Medicare claims paid in 2006!
cmps, on September 2nd, 2008 at 5:21 PM Said:

Follow-Up Considerations
Darrell Pruitt; DDS
Author and Lead Researcher

Now, allow me to suggest a possible future topic: “is encryption enough?” Readers may not have noticed that under item number five,” password security,” we slipped in a couple of questions about encryption.

Question 4:
Do you think a password is an effective safeguard if a computer is stolen?
Yes: 41% (7 of 17)
No: 59% (10)

Question 5: Do you think encryption is an effective safeguard if a computer is stolen?
Yes: 71% (12 of 17)
No: 29% (5)

I left off question number six and seven only after hard consideration.

Question 6: If a healthcare provider were to lose encrypted personal information of yours or your family, would you expect to be warned of the breach, even though to do so is not required by law?

Question 7: If as a provider, you were to lose encrypted data, would you warn your patients about the breach, even though to do so is not required by law?

I even thought it would be interesting to switch the order of 6 and 7 for half of the group to see if it made any difference in responses. In the end, though, the sample size was just too small for significance and the pursuit of encryption would be a distraction.

Nevertheless, your thoughts are appreciated.
Darrell
cmps, on September 2nd, 2008 at 7:43 PM Said:

Darrell, Readers and E-P Subscribers,

This is also an issue with the bills pending in Congress.

If you review the breaches that have been the subject of media reporting, you will see that in nearly all cases individuals are notified even if the information is encrypted. At the very least, notice should be given to the Secretary of HHS of “substantial” breaches even if the information is encrypted. HHS and consumers should know which organizations are doing an adequate job of preventing privacy breaches.

I would think that organizations that had breaches would want their customers to know that the information was encrypted.

Feel free to share this with your friends.

Jim Pyles
James C. Pyles, Principal
POWERS PYLES SUTTER & VERVILLE PC
1501 M Street NW, Seventh Floor | Washington, DC 20005-1700
tel 202.466.6550 | fax 202.785.1756
jim.pyles@ppsv.com | http://www.ppsv.com
cmps, on September 3rd, 2008 at 4:57 PM Said:

RAC Study,

It seems like people aren’t very optimistic about their chances of escaping a Recovery Audit Contractor [RAC] review unscathed, according to a new study.

The study, done on behalf of Wolters Kluwer Health, concluded that 40 percent of hospital HIT directors expect to owe funds for Medicare overpayments if audited. The survey found that only 5 percent of HIT directors surveyed think that RAC audits will lead to repayment of funds from Medicare underpayments. Forty-eight percent expect their facility to come out more or less even.

Your comments are appreciated.
-Ann
cmps, on September 5th, 2008 at 11:36 AM Said:

P4P Update

Did you know that new results from the second year of a Medicare pay-for-performance demonstration project, for large physician groups, are both raising hopes and casting doubts about the concept’s feasibility?

Ten groups that are participating in the Physician Group Practice Demonstration [PGPD], a four-year effort that began in 2005, implemented care coordination initiatives and for each year of the project can receive up to 80 percent of the savings they generate for Medicare by preventing complications and hospitalizations, reported the American Medical News, on September 8.

While all ten groups hit performance targets on at least 25 of the 27 quality measures included in the project’s second year, and five practices achieved the goals on all 27 measures, only four groups qualified for performance bonuses, which totaled $13.8 million.

Participants said the demo’s weakness is in its “efficiency” component, as CMS said the savings on care would have to exceed two percent compared with a community control group, before any payout occurs. In the project’s second year, the groups saved Medicare a total of $34 million on assigned beneficiaries, but because of the threshold, CMS recognized only $17 million, while practices also extended care coordination to Medicare enrollees outside of the project but did not receive credit for any savings generated through higher quality care of those patients.

How have you fared under the P4P initiatives; please comment.

-Ann
Jodi, on September 7th, 2008 at 12:11 PM Said:

Does anyone know what we can do to eliminate these facility fees; is this legal and how can we get around it? I am very nervous about all this.

Thanks for anything you can advise.
-Jodi
Anonymous, on September 7th, 2008 at 10:28 PM Said:

Rumors and Gossip,

The hearsay is that when the abstract of this study appeared on Health and Human Services [HHS] Secretary Michael Leavitt’s blog, it caused the April firings of executive director of the ADA, Dr. James Bramson and Chief Operating Officer, Ms. Mary Logan.

(But remember, you didn’t hear this rumor from us). The ADA is currently interviewing for replacements.

-Anonymous
Darrell, on September 9th, 2008 at 12:17 AM Said:

Being a “covered-entity” just became even more expensive

An article was recently posted in ComputerWorld.com, ominously titled, “Feds finally put teeth into HIPAA enforcement.”
http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=Security&articleId=325376&taxonomyId=17&pageNumber=1

Author Jaikumar Vijayan describes the harsh ruling that followed the HIPAA inspection suffered by Seattle-based Providence Health & Services.

He writes that Lisa Gallagher, director of privacy and security at the Healthcare Information and Management Systems Society (HIMSS) in Chicago considers this as a serious corrective action plan. “Gallagher added that the deal with Providence sends a clear message to other health care providers that HHS is finally cracking down on HIPAA violators, after having been accused of lax enforcement in the past.”

And what is it like dealing with HHS?

Peter MacKoul, president of HIPAA Solutions LC, a consulting firm in Sugar Land, Texas responded: “If you look at what they’re being forced to do, it’s scary. They have lost their ability to contest anything; there’s no way of getting out of this agreement. And this is the best deal they could get.”

Just how important are computers in dental offices anyway?
-Darrell Pruitt DDS
Darrell, on September 9th, 2008 at 10:45 PM Said:

Cheerleaders for Dental HIT?
[Hype versus Reality]

I read a comment from a dental consultant on ModernHealthcare.com that I thought would be of interest to the readers of the Executive-Post. I then submitted my opinion in response to his thoughts that it would be really swell to have electronic dental records.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080908/REG/309089986

Dr. Franklin Din is a dentist turned health informatics-consultant who thinks dentists should be included in the national interoperable electronic health record system. I am sure that it is not unusual for graduates of post-doctoral fellowships in informatics to be unrealistically enthusiastic about electronic health records. What is unusual is to find one like Din who is excited about electronic dental records.

Dr. Din is obviously not a practicing dentist. So, let me present only one of so many reasons dentists [like many physicians] are not buying into EDRs.

There is an overwhelming liability for having digitalized patient identifiers on a computer sitting in a dental office: i.e., if the computer is stolen in a burglary, all patients have to be notified. Burglaries happen. So do hackers. And, dishonest employees happen as well. Whether patient identifiers have been reported lost or not, the dental practice faces a significant chance of bankruptcy.

For example, It costs more than $160 per patient record to notify them (Ponemon Institute, 2006). This means that if a doctor has 2000 patients, it will cost over $300,000, even before the HIPAA inspectors arrive. Then there is the dentist’s reputation around town to consider.

If a dentist does not report a known loss, or does not know about the loss, a law official could show up in the reception area with a subpoena for patients’ records that are needed for an ID Theft investigation. Ouch!

I think you should move-on down the road, Dr. Din.

Darrell Pruitt DDS
Fort Worth, Texas
shannon hoy, on September 10th, 2008 at 12:26 AM Said:

I am taking a healthcare policy class and need information on the development of a “never-events” policy. Do you know where to go for this?

Thanks.
Shannon Hoy
cmps, on September 10th, 2008 at 12:42 AM Said:

23andMe

23andMe just dropped their core price down to $399 and have inked a deal to get access to Ancestry.com’s database of users. Not quite an impulse purchase yet, but still getting down there.

-Ann
cmps, on September 10th, 2008 at 5:42 PM Said:

The [More Transparent] HSA Market

Well Executive-Post readers, it looks like the health savings account market continues to be a good one. Why?

J.P. Morgan just reported that its HSA business grew 60 percent in account volume over last year. What’s more, the company reports seeing a 97 percent adoption rate among eligible employees in HSA programs it sells directly to employers.

Comments anyone?
-Ann
cmps, on September 10th, 2008 at 11:03 PM Said:

Hospital Compare Updates

The Centers for Medicare and Medicaid Services [CMS] just updated its Hospital Compare Web site to include information on 30-day mortality rates for the pneumonia and inpatient asthma treatment for children.

This is the first time that the site has offered information on children’s health care, while Hospital Compare now offers data on 26 process of care measures, three outcome of care measures, two children’s asthma care measures and 10 patient experience measures, according to the Kaiser Daily Health Policy Report on September 4th.

Visitors to the site are able to determine if individual hospitals’ mortality rates for pneumonia, heart attacks and heart failures are “Better than,” “No different,” or “Worse than” the national mortality rates for those conditions.

The Web site’s rates are risk-adjusted based on the condition of patients at the time of admission and offers consumers the interval estimate and the number of eligible cases for each hospital, while the CMS urged consumers not to “shop” for a hospital based on a single process or outcome measure.

-Ann
cmps, on September 12th, 2008 at 12:46 AM Said:

Depressed Doctors,

Did you know that new doctors who are depressed are six times more likely to make medication-related errors than doctors who are not depressed, according to a study published in the British Medical Journal [BMJ].

Any comments?
Ann
cmps, on September 15th, 2008 at 12:11 AM Said:

Patient Driven Referral Services
By Darrell Pruitt DDS

In a small community people as a general rule know a lot more about their neighbors than do people in a city. They also know a lot more about the doctors and dentists in town since there are only a few. It is fairly common to talk to neighbors and friends to get opinions on who is the best dentist, who to avoid, who is the cheapest, who has the most up to date equipment….

In a small community, as well as in a city, even a neighbor’s recommendation carries more weight than a dentist’s paid advertisement. I would imagine that sales of 1 800 Dentist subscriptions are significantly lower in rural Texas than in the metropolitan areas on a per capita basis. The dentists in small communities know that they are far too easy to find to need to spend money for a referral service or for much advertisement at all.

Well, Fort Worth and cities across the nation are becoming smaller dental communities because of the internet. If any of you have googled your name, you may have picked up a hit by one or more patient driven referral services (PDRS). And if you have not done this lately, you should. There is a good possibility that the information about your practice location may contain errors. But more importantly, you may read something pleasingly flattering or terribly humbling about your practice written by a patient you saw last week.

Dr. Oogle is presently the most popular PDRS. A patient’s comments about his or her dentist is posted only after the patient accepts the terms of the agreement; which are that the patient is neither a relative nor an employee of the dentist and that the patient is not otherwise being compensated for the review. The website also requires an authentic e-mail address and other personal information for verification purposes.

There is a filtering system in place in which employees of Dr. Oogle reject (at their discretion) comments which are too good or too bad to be credible. And there are other ways in which dentists can handle bad reviews and are described on their website. And there is, I suppose, always room for an attorney or two if the other attempts at removing a bad review fail.

But if the PDRS’s survive the lawsuits, and if the first review which comes up under your name happens to be a real stinker written by an easily disgruntled and fervently vindictive patient (I think his name is Fred. You probably know him as he changes dentists often), and if you cannot get it otherwise removed, perhaps you should bury it under as many good reviews as you can encourage your patients to submit. This reaction, not surprisingly, is the reaction recommended by Dr. Oogle. In fact, they also recommend that we routinely ask our patients to submit reviews to them. I imagine that there are already dentists who have had cards printed for this purpose.

Like it or not, our patients are being given more power in the marketing of our practices and their influence is growing. Dr. Oogle’s first reviews of dentists in the greater Ft. Worth area occurred in September of ’04. By the first of February, 5½ months later, there were only 18 dentists who had been reviewed by at least one patient. As of today, one month later (March 7), there are 16 more. By the time this is published the number could be close to 50. Who knows how many reviews will be posted a year from now if the public perceives value in this kind of information. Many more of us will be listed as either good or bad dentists; legitimately or not.

Regardless of the outcome of Dr. Oogle’s venture into dentistry, the fact that the public has a thirst for “unbiased” sources of information concerning our practices tells us that more than ever before we have to treat each patient as our most important source of new business or a disappointed patient could soon become a significant obstacle for growth. Another good thing is that a patient who has to choose a dentist from a list at least soon may have some guidance; other than the fact that his insurance company thinks they are all equally swell.

Source: Twelfth Night newsletter of the Fort Worth District Dental Society, April 2005
cmps, on September 15th, 2008 at 12:56 AM Said:

More on P4P

It is not hard to see what happens when stakeholders or five-year plans determine workers’ pay. Workers disappear if they live in the land of the free. As you can see from the article below written by Andis Robeznieks for ModernHealthcare.com, we appear to be on the verge of a serious shortage of family physicians. I could have grandchildren that will need doctors some day. Let’s not eat our seed corn yet. http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080909/REG/309099982/-1/todaysnews

By Darrell Pruett DDS

Primary-care pay tied to family-doc shortage: A study
Story posted: September 9, 2008 – 5:59 am EDT

Calling it a problem “that will require reform at a national level,” University of Georgia at Athens professor and Assistant to the Provost Mark Ebell concluded in the Sept. 10 issue of the Journal of the American Medical Association that there is a link between low compensation for primary-care physicians and the nation’s health.

In a study published as a “research letter,” Ebell writes that the correlation between salary and primary-care physician shortages-which, in turn, may be tied to higher all-cause cardiovascular, cancer-specific and infant mortality rates-has persisted since his original research on this issue was published in the Sept. 22, 1989 issue of JAMA and may be reaching crisis proportions.

Comparing specialties chosen by 2007 U.S. medical school graduates and salary information obtained from the American Medical Group Association, Ebell cited how family medicine had the lowest average salary ($185,740) and the lowest percentage of filled residency positions (42.1%). The specialty with the second-lowest salary, pediatrics ($185,913) had a much higher fill rate (72.8%), but the numbers for next lowest specialty followed Ebell’s thesis. Internists, with the third-lowest salary of $193,162, had the third-lowest residency fill rate: 55.9% Neurologists, with the fifth-lowest salary ($222,998), had the second-lowest fill rate at 51.9%.

In comparison, radiologists-whose average salary was $414,875-had a residency fill rate of 88.7%; and orthopedic surgeons-whose average salary was $436,481-had a fill rate of 93.8%. Ebell noted in a news release that since 2007 medical school graduates have a median debt of $140,000, debt relief for primary-care physicians could be one possible reform.

“Rising levels of student debt, considerably lower salaries in primary-care specialties, and a perception that primary care may have a less rewarding lifestyle have led to a potential workforce crisis given the aging U.S. population,” Ebell, a deputy editor of the American Family Physician journal, wrote in JAMA.

By Andis Robeznieks
cmps, on September 15th, 2008 at 5:25 PM Said:

NPI Maintenance! … Nobody said anything about maintenance?

It is my hope that an official of the American Dental Association is reading this. A response would be wonderful, but I don’t expect it. Like all traditional institutions, it’s not part of the business model to defend actions to consumers unless a lawsuit is involved. Leaders traditionally fear consumers. And consumers are catching onto why that is so.

Some interesting information concerning the NPI number was recently posted by North Dakota Senator Tom Seymour on his website, “Frontier Focus.”
http://senator-tom-seymour.blogspot.com/2008/09/medicare-and-medicaid-services.html

In his greeting to readers, Sen. Seymour thanked them for their efforts to broadcast CMS information in the region. It is followed by a list of 15 tedious CMS issues. And to think some politicians would have universal health care modeled on Medicare to save money for the common good.

I want to focus on issue number 5, “NPPES User Maintenance Tips.”

The National Plan and Provider Enumeration System (NPPES) is something that ADA leaders failed to explain to members – even as members were encouraged to quickly apply for the NPI by representatives from the ADA Department of Dental Informatics (healthcare IT stakeholders within the ADA). Very few of my colleagues even knew that the NPI was part of HIPAA two years ago. They are still too busy providing healthcare to pay attention… so far.

The NPPES is all about the fourth cornerstone in Bush’s Executive Order a year ago – “Aligning incentives so payers, providers and patients benefit when all are focused on achieving the best care-value at the lowest unit-cost.” Most dentists in the US don’t know this yet, but soon, websites supported by the NPPES will allow the government and/or insurers to post dentists’ grade cards and what they think dentists should be paid. This will be done using data from dental claims already on record. It is unknown whether patients’ preferences will be included in dentists’ grades. ADA members were not told.

It is interesting how the clever and seemingly stealthy plans for HIPAA came together. As it turns out, when one applies for an NPI number, the provider grants legal permission for FOIA-disclosable data to be posted on the Internet by stakeholders like insurance companies. (More about the “Freedom of Information Act” later) It’s not your dad’s FOIA any more. It’s been Hillary’s since 1996.

One reason why American dentists know so little about HIPAA is because the ADA is silent. I think too many careers are pinned on a premature, stakeholder-infested plan gone bad, nation wide. It is my opinion that ADA leadership should stand up now and either defend HIPAA or abandon it. The leaders of my professional organization can no longer avoid their responsibility to keep members informed. They can’t just leave it to me. If a dentist neglects NPI maintenance, it can only mean one thing – “Payment is denied until corrections are made.” And this is just to get paid for work that happily walked out the door weeks or sometimes months before.

How did it come to the point where in the name of interoperable fantasy, providers’ payments are held for ransom? I call that tyranny.

Best
Darrell K. Pruitt DDS
cmps, on September 16th, 2008 at 12:16 AM Said:

Colleagues,

Although traditional financial planners and advisors advocate 3-6 months of cash-on-hand for emergencies; Certified Medical Planners™ http://www.CertifiedMedicalPlanner.com and the health economists from the Institute of Medical Business Advisors typically advocate at least 18-24 months of COH for medical professionals http://www.MedicalBusinessAdvisors.com

After a day like today; no one should wonder why any longer?

Financial Planning for Physicians and Advisors
http://www.amazon.com/Financial-Planning-Handbook-Physicians-Advisors/dp/0763745790/ref=sr_1_3?ie=UTF8&s=books&qid=1221520588&sr=1-3

Dictionary of Health Economics and Finance
http://www.HealthDictionarySeries.com

Hope
cmps, on September 16th, 2008 at 5:25 PM Said:

Emerging Individual Health Insurance Markets

Did you know that roughly 17 million Americans bought non-group health insurance, including full and limited coverage, directly from insurers in 2007, reported Health Plan Week, on September 10th?

WellPoint, Inc. is the nation’s largest seller of individual plans, with 1.9 million, or 21 percent, of the nine million individual enrollees who have full coverage.

-Ann
Christy, on September 17th, 2008 at 12:03 AM Said:

I think the article really hits the reality of physician recruiting on the head. It is my experience everyday with health acre organizations that there are too many people involved in the recruiting process where there really needs to be someone driving the success of the recruiting process.

Getting the leadership involved in setting the vision for the organization is first and foremost to gain the collaboration if you will of the other physicians already within the organization.

Thank you for writing this article. This is very helpful information to share with my hospital clients.

Sincerely,

Christy S. Lodwick, MHA
Impact Health Care Solutions
clodwick@impacthealthcaresolutions.com
Anonymous, on September 17th, 2008 at 12:11 AM Said:

Financial Planning and Investing Mistakes

Recall the tale of Dr. Debasis Kanjilal, a pediatrician from New York who put more than $500,000 into the dot.com company, InfoSpace, upon the advice of Merrill Lynch’s star but non fiduciary analyst Henry Bloget. Is it any wonder that when the company crashed, the analyst was sued, and Merrill settled out of court?

Other analysts, such as Mary Meeker of Morgan Stanley, Dean Witter and Jack Grubman from Salomon Smith Barney, are involved in similar fiascos. Although sad, this story is a matter of public record.

Hopefully, doctors now understand that the big brokerage houses that underwrite and recommend stocks may have credibility problems, and that physicians got burned with the adrenalin rush of “self-directed” portfolios

-Ann
Dr. Marcinko, on September 17th, 2008 at 12:17 AM Said:

Definition

me•a cul•pa (m k l p , m ) n.
An acknowledgment of a personal error or fault
[Latin me culp , through my fault : me , feminine ablative of meus, my + culp , ablative of culpa, fault.]

-Dave Marcinko
cmps, on September 17th, 2008 at 5:59 PM Said:

Black Monday

One of the oldest and most cherished tools that you will often hear about when markets sour, is what Andrew Horowitz:
calls, “Placations for a Financial Crisis”.

Here is a look at the top phrases which will be used in an attempt to soothe investors, especially following a day like Monday:

Buy on the DIPs
Diversification is key
Remember, we are in it for the long haul
Do not listen to the noise
There is plenty of liquidity in the markets
Great time to dollar cost average
The situation is well contained
They’re not losses until you sell
It is time in the markets, not market timing…
The 25 Year history of the S&P 500 shows….
Now is the time to buy, not to sell
80% of the S&P 500 returns are from the top 5 days
This is healthy for the markets
Do not let emotions control your decisions
The S&P 500 has never had a negative 20-year return

Don’t be fooled by the smokescreen that is meant to keep you invested so that fees can continually be generated from your portfolio. Be smart, do what you know to be right from all of the information that is available and resist the urge to just sit still and hope for the best. Re-evaluate your allocation, reassess your risk and act appropriately.

-Anonymous
cmps, on September 18th, 2008 at 12:32 AM Said:

Medical Practice Management Mistakes

As the managed care and health insurance crisis exacerbates, there are far too many examples of irrational practice management behavior on the part of physicians. And, it seems that no specialty is immune.

For example, just reflect a moment on colleagues willing to securitize their medical practices a few years ago, and cash out to Wall Street for perceived riches that were not rightly deserved. Where are firms such as MedPartners, Phycor, FPA and Coastal now? A recent survey of the Cain Brothers Physician Practice Management Corporation Index of publicly traded PPMCs revealed a market capital loss of more than 95%, since inception.

-Hope
cmps, on September 19th, 2008 at 12:39 AM Said:

PDRS Styled Sites:

For those inclined, please take a look at these PDRS styled sites:
http://www.DoctorScoreCard.com
http://www.Yelp.com
http://www.FindADoc.com

-Ann
Darrell, on September 19th, 2008 at 3:04 PM Said:

The Gauntlet,

I openly challenge any Delta Dental representative to discuss their product. We can do it here and now – no formalities and no committee-approved talking points. I would warn the representative to leave those at home.

You’ve got an eager crowd waiting on your response, Delta. Many are your current customers, potential customers and your preferred providers. Come on out into transparency. Be accountable.

Darrell K. Pruitt DDS
cmps, on September 21st, 2008 at 6:11 PM Said:

Publicity for 23andMe

According to journalist Matthew Holt, Sergey Brin, Google co-founder and husband of 23andMe co-founder Anne Wojcicki, has announced that he has the gene for Parkinson’s disease and that his mother carries it to. She already has the disease, as did her aunt.

Sergey has written about this on his new blog “Too” and it was picked up by the NY Times. Fortunately, if—and it’s only an “if”—Brin develops Parkinson’s it’ll be many years from now.

However, Parkinson’s is a very serious condition which people are right to dread.

-Anonymous
Darrell, on September 21st, 2008 at 11:05 PM Said:

The Gauntlet,

HIPAA sounds hollow – like a Trojan horse. It is your turn, Uncle Sam. Please send a representative of HHS or CMS to this website to discuss plans for HIPAA in medicine. You’ve got a growing audience here, and I have some important questions concerning dentistry that need to be answered immediately.

Where is Newt Gingrich? He is the one who convinced the ADA to buy into the HIPAA blunder for the common good. Come on Newt. Take a chance on accountability – for the common good.

-Darrell Pruitt; DDS
cmps, on September 22nd, 2008 at 12:34 AM Said:

It’s Defensive Medicine, that’s Why!

‘Defensive medicine’ adds to health care costs, and risks to patients, according to Benjamin Brewer MD, a family physician who writes a column for The Wall Street Journal’s Web site.

He describes the practice as “doing more tests, ordering more consults from specialists and exposing patients to the risks of radiation, invasive tests and treatments” to protect the practice from being sued.

Now, does this definition include sending patients to the ER?

-Ann
cmps, on September 22nd, 2008 at 12:36 AM Said:

Liberal ER Visits,

In the old-days, when a patient called the family doctor about a seemingly innocuous complaint, s/he usually said: “Take two aspirins and call me in the morning”.

Today, it’s more like: “Call 911, or go directly to the ER.”
That’s why!

-Anonymous
cmps, on September 22nd, 2008 at 12:38 AM Said:

Microsoft to the ER Rescue

The Microsoft Corporation, based in Redmond WA, has contracted with Seattle-based Carena to handle physician house calls for the company’s employees. Carena’s Urgent Care program is intended to reduce costly trips to the ER for injuries or illnesses that could instead be treated by as visiting physician.

-Hope
cmps, on September 22nd, 2008 at 1:14 PM Said:

Post ER Visit Compliance Report

Did you know that a vast majority of emergency room [ER] patients are discharged without understanding the treatment they received or how to care for themselves once they get home, according to a study published by the Annals of Emergency Medicine?

Researchers followed 140 English-speaking patients discharged from emergency departments in two Michigan hospitals and measured their understanding in four areas: their diagnosis, their E.R. treatment, instructions for their at-home care and warning signs of when to return to the hospital, according to the New York Times on September 16th.

Seventy-eight percent of patients did not understand at least one area and about half did not understand two or more areas, while the greatest confusion surrounded home care – instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor. Researchers said the confusion can lead to medication errors and serious complications that can send them right back to the hospital.

-Ann
RPR, on September 25th, 2008 at 6:27 AM Said:

Hi,

I read your article regarding transitioning to ICD 10, which said:

“95 percent of medical practices would have to purchase software upgrades for their practice management systems or buy all new software, while 64 percent concluded that they would have to purchase code-selection software, and 84 percent stated that they did not think public and private health plans would be ready to accept claims with ICD-10 codes by October 2011.”

I just want to know if readers think all/most medical providers in the US will want to buy a completely new system; or will they just change their database in an existing system only?

Thanks for all thoughts and comments,

-Rupali.
cmps, on September 27th, 2008 at 2:38 AM Said:

Cigna Gets into the e-Pharmacy Act

Cigna also recently launched a pharmacy management web tool to help keep its members informed about the medications they take.

But for Lilly, the threshold is $500.00

-Ann
cmps, on September 29th, 2008 at 4:38 PM Said:

According to Barry Senterfitt
Managed Healthcare Executive

Capitation and other risk-sharing arrangements have been pursued by provider organizations for the past two decades. Yet the law on whether such arrangements result in the provider organization being in the business of insurance has not fully evolved in all states; according to Mr. Senterfitt.

For example, many states do not have a statutory definition of “insurance.” Case law, attorney general opinions, and statutes related to unauthorized insurance provide guidance to determine whether a particular business arrangement constitutes insurance. Courts often look to the same common elements as most other jurisdictions when evaluating whether a contract is insurance:

• An insurable interest;
• A risk of loss (insured event);
• An assumption of risk by another party (risk transfer);
• Distribution of the risk among a large similar group; and
• Consideration for the assumption of risk (premium).

In healthcare, the risk sharing concept was addressed by the United States Supreme Court in an early case involving the establishment of a network of pharmacies. The Court held that a primary element of an insurance contract is the underwriting or spreading of risk. And, the National Association of Insurance Commissioners [NAIC)] distinguished between reimbursement methodologies that were directly tied to delivery of services from those that were not. The report found that service-based reimbursement methodologies, such as discounted fee for service, per diem payments, case rates and DRGs, were not usually regulated as insurance risk.

Other research papers and law review articles triggered by the NAIC white paper found that the general consensus is that provider organizations that contract directly with employers or individuals and assume the risk of providing services, even on a partial basis, are more likely to be regulated than providers that contract with licensed HMOs or insurers.

-Anonymous
cmps, on September 30th, 2008 at 8:28 PM Said:

Managed Care or Dental Homes
[You can't have both]

For more on this topic:

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14014

Darrell Pruitt; DDS
cmps, on October 1st, 2008 at 10:31 AM Said:

DNP Classes

The Thomas Jefferson University School of Nursing [JSN] is one of over 70 schools nationwide that offer a DNP degree. In September 2007, Jefferson welcomed its first cohort of 18 DNP students representing a wide variety of medical practice specialties, including acute care, primary care, healthcare administration, population health, education and industry. Twenty students comprise the second cohort entering in September 2008.

-Ann
Darrell, on October 2nd, 2008 at 5:17 PM Said:

Transparency is Accountability

I posted this today as part of a conversation on the PennWell (Dental Economics) forum.

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14014&page=1&commentId=2013420%3AComment%3A14060&x=1#2013420Comment14060

-Darrell K. Pruitt; DDS
Darrell, on October 2nd, 2008 at 10:20 PM Said:

Beware of the Newt

Neither patients’ nor dentists’ friend. So, I just posted this on PennWell.

Link: http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14080

And, even more about Newt Gingrich:

Yesterday, Chris Ceplenski, Senior Editor of hr.blr.com posted an article titled, “Newt Gingrich’s 3 Initiatives to Transform Health Care.”

Link: http://hr.blr.com/news.aspx?id=78929

He also suggests that for better health, optimism is cost effective medicine; so smile!

-Darrell K. Pruitt; DDS
Dana, on October 2nd, 2008 at 11:41 PM Said:

Stunned,

I am so completely stunned that my jaw is on the floor!

I had never heard of “facility fees”, before! And, what is worse, my hospital bill does not list the fee as a “facility fee”; it “hides” it in another spot. I had lap-band surgery and the “facility fee” is hidden in the implant fee @ $9405.20.

Why doesn’t Evergreen just list a “facility fee”? I am so mad right now I could just scream! Maybe if I had warning of a “fee” I wouldn’t be so mad, or when I disputed the bill, if the customer no-service clerk had told me about the fee.

I will never recommend Evergreen Hospital to anyone!!

-Dana
Dave, on October 3rd, 2008 at 12:38 AM Said:

Hedge Fund Performance

Because of the recent domestic financial meltdown on Wall Street, hedge funds are hemorrhaging cash. Dire performance has been rattling investors already concerned that the $2 trillion hedge-fund industry is fast becoming the latest casualty of a broader global financial crisis.

For example, large exchange listed hedge funds such as Man Group PLC (EMG.LN) and GLG Partners Inc. (GLG) have seen their shares tumble after revenue from performance fees has dried up. Others, such as RAB Capital PLC (RAB.LN) have introduced lock-ins of up to three years to tie in investors, while many more hedge funds have been forced to close funds.

Performance fees account for a large chunk of hedge-funds profits and can be as high as 20% of gains but are earned only if funds are up relative to their peak. Many funds are well below their peak, or high-water mark, as market volatility has made trading conditions more treacherous, than ever of late. The introduction by regulators worldwide of restricting short selling in stocks has only made matters worse.

Now, can anyone comment on the performance of those more numerous, non-listed, private hedge funds? Personal insights are appreciated from physician-investors; both good and bad?

-Dave Marcinko
David, on October 4th, 2008 at 10:50 AM Said:

Measuring the Tax Burden:

Income category 2006 AGI % of all income % of income taxes paid:
-Top 1% $388,807 or more 22% 40%
-Top 5% $153,543 or more 37% 60%
-Top 10% $108,905 or more 47% 71%
-Top 25% $64,703 or more 68% 86%
-Top 50% $31,988 or more 88% 97%
-Bottom 50% $31,987 or less 13% 3%

Source: IRS
-Dave
Darell K. Pruitt, on October 5th, 2008 at 1:09 AM Said:

Battling Dentists

I am currently involved in a historical conversation on the PennWell forum. I just invited Karen Bell, director of the Office of Health IT Adoption at HHS to take a look at the conversation. She is closely, but quietly following my abrasive comments to her that follow her interview on the Technology Review Website.
http://www.technologyreview.com/biomedicine/21428/page1/#comment-205301

Below is what I posted today on the PennWell. How long do you think it will take for the ADA to disown HIPAA? When the dust settles, how many shy leaders will suddenly find the courage to say, “I always thought it was a bad idea?”

Darrell K. Pruitt; DDS

——————————-

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14126&page=1&commentId=2013420%3AComment%3A14154&x=1#2013420Comment14154
Darrell, on October 5th, 2008 at 9:33 PM Said:

Dental Economics

I posted this on PennWell today in response to a discussion started by Kevin Henry, the managing editor for Dental Economics and the Chief Editor for Dental Office magazine.

Parasites Drop Off
http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14118

I bet this earns me even more traction. It’s like pornography to latent libertarians.

Darrell K. Pruiett; DDS
Hope, on October 5th, 2008 at 10:32 PM Said:

BALANCE BILLING DEFINITION

According to the http://www.HealthDictionarySeries.com, balance-billing may be defined as:

(1) Physician charges in excess of Medicare or contractually allowed amounts, for which Medicare or contractual patients are responsible, subject to a limit.

(2) In Medicare and private fee-for-service health insurance, the practice of billing patients in excess of the amount approved by the health plan. In Medicare, a balance bill cannot exceed 15 percent of the allowed charge for nonparticipating physicians.

Best.
Hope Rachel Hetico; RN, MHA
Managing Editor
Health Dictionary Series™
cmps, on October 6th, 2008 at 1:51 AM Said:

Good evening,

As the media relations contact for the Aon study referenced in your posting, thank you for sharing the analysis’ key finding with your readers

Please feel free to contact me directly if there are any questions, and thank you for your interest in the “2008 Hospital Professional Liability and Physician Liability Benchmark Analysis.”

Best regards,
Kelly Drinkwine
312.755.3537
cmps, on October 6th, 2008 at 1:14 PM Said:

Economic Crisis Management for Physicians

The physician who remains in practice long enough is sure to undergo some adverse situation that may negatively affect his economic life. Perhaps that is what happened to the doctor, above.

And so, when it occurs, you must have a crisis management plan in place to deal successfully with the matter. We wish him well.

The Management
Dr. Marcinko, on October 7th, 2008 at 10:36 PM Said:

Oh Henry!

Henry Blodget recently pointed out that Google shares are down 50% from their high, closing today at $346.01. What will the impact of this deterioration be? Blodget has a few guesses:

1. Shareholders will want more explanation for Google’s massive spending on research and capital projects.
2. Google might feel pressured to lay off employees or cut spending in other ways.
3. Declining share price could hurt employee morale and shift compensation focus to cash instead of options.
4. Employees will continue to jump ship.
5. Google will lose some of its luster.

Please subscribe and contribute your own thoughts, experiences, questions, knowledge and comments to this story for the benefit of all our Executive-Post readers.

Dr. David Edward Marcinko; MBA
Publisher-in-Chief
Christy Lodwick, on October 8th, 2008 at 1:50 PM Said:

Dr. Marcinko,

Do you have any information on the average salaries of Emergency Room Physicians? I am doing some research on this sector. Any help or direction you could give would be greatly appreciated.

Thanks.
Christy Lodwick, MHA
Impact Health Care Solutions
Ann Miller; RN, on October 8th, 2008 at 5:10 PM Said:

Chrsity,

You may begin your info search by contacting the American College of Emergency Room Physicians. They have been most complimentary of our work.

Link: http://certifiedmedicalplanner.com/MDs.aspx

Best.
Ann Miller; RN, MHA
Jackson, on October 9th, 2008 at 12:18 AM Said:

RAC

Did you know that CMS announced four new contractors to administer its Recovery Audit Contractor (RAC) program? The contractors, responsible for auditing provider reimbursement requests, are:

1. Diversified Collection Services of Livermore, CA
2. CGI Technologies and Solutions of Fairfax, VA
3. Connolly Consulting Assoc. of Wilton, CT, and
4. Health Data Insights of Las Vegas.

So, expect more contentious debate in the future.

Jackson
Mike, on October 9th, 2008 at 7:16 PM Said:

The Conflicted AUM Fee-Corollary

The Assets Under Management [AUM] fee system of charging clients based on the amount of assets under management is flawed for the financial advisor.

Why; because it often forces clients with simple lives to pay more for services, than those with more complex financial affairs.

The Assets Under Management [AUM] fee system of charging clients assets on the amount of assets under management is also flawed for the client.

Why; because advisors often take more risks than necessary in order to maintain income levels, with a risk-reward ratio heavily against the client as they are “decidedly-not on the same-side-of-the-table.”

And so, what is the answer to this opposing situation; client versus advisor? Your comments are appreciated.

-Michael
cmps, on October 10th, 2008 at 12:44 PM Said:

Future CM Doctors Beware

Physicians who intend to accept annual access fees for concierge medicine should make sure they’ve cancelled all of their contracts with third-party and governmental payers; checked the by-laws of facilities where they have privileges, consult state laws, and know that some patients may receive no reimbursement even if they do file their own claims.

Dr. Marcinko
Hope, on October 11th, 2008 at 1:21 AM Said:

Sample Balance Billing Contract Clause

Physician to Seek Payment from MCO Only For those health services determined by MCO to be Covered Services, Physician agrees that in no event, including but not limited to nonpayment by MCO, MCO insolvency, and breach of this Agreement, shall Physician bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against subscriber, enrollee or persons other than MCO acting on their behalf for services provided pursuant to this Agreement. This provision shall not prohibit collection of supplemental charges or co-payments on MCO’s behalf made in accordance with the terms of applicable Agreement between MCO and Members.

Physician further agrees that (a) this provision shall survive the termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members and (b) this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between Physician and Member or persons acting on their behalf.

Any modification, addition, or deletion to the provisions of this section shall become effective on a date no earlier than fifteen (15) days after the Commissioner of Insurance has received written notice of such proposed changes.

-Hope
Darrell, on October 11th, 2008 at 4:27 PM Said:

DDS versus MBA,

On October 18, two days before HHS Secretary Michael Leavitt was to address the ADA House of Delegates at the 2006 national convention in Las Vegas, I posted “Careful with that electronic health record, Mr. Leavitt” as a guest column on WTN.

http://wistechnology.com/articles/3407/

By the time he stood up to the podium, my column came up as his first news hit when one googlesearched his name. It remained so for several days following the convention. Perfect timing, don’t you think?

-Darrell K. Pruitt; DDS

The WTN column is still the most popular piece I have ever posted. It was even translated into Chinese (somewhere on the Internet).

I like to think I am the reason that the Cabinet Secretary was especially pissed at dentists when he threatened to sick MBAs on us. (“Health standard setting: ‘”If the DDSs don’t do it, the MBAs will’” – ADA News, October 20, 2006)

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2177

-Darrell K. Pruitt; DDS
Mark, on October 14th, 2008 at 12:59 AM Said:

More on Ayn Rand and Heathcare Politics

In this time of economic crisis, remember that Alan Greenspan’s moral mentor was Ayn Rand.

The above comment was released by the Ayn Rand Institute in 1993 as a comment on the Clinton Health Plan. In that speech, Rand denies that healthcare is either a right or an entitlement:

“Under the American system you have a right to health care if you can pay for it, i.e., if you can earn it by your own action and effort. But nobody has the right to the services of any professional individual or group simply because he wants them and desperately needs them. The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them.”

“You have a right to work,” she continues, “not to rob others of the fruits of their work, not to turn others into sacrificial, right-less animals laboring to fulfill your needs.”

Additional thoughts are appreciated.

Mark
cmps, on October 16th, 2008 at 12:15 AM Said:

MPT and Healthcare Management

This was a terrific article. As a physician-investor, I was aware of MPT, diversification and asset allocation principles, etc. But, this was the first time that MPT was ever described in a way that related to healthcare management and administration.

Now, I can see how personal financial planning issues, and health economics, do translate into better medical practice management; for me!

Thanks
A Doctor
Ann Miller; RN, MHA, on October 16th, 2008 at 1:38 AM Said:

About http://www.DialogMedical.com

Dialog Medical features an industry-leading application that enhances the education, discussion and documentation associated with the informed consent process for physicians, ambulatory surgery centers and hospitals.

Its iMedConsent™ application is trusted by more than 15,000 physicians. This novel solution is integral to healthcare organizations’ efforts to standardize communication across the enterprise, manage risk, comply with regulatory requirements and better document informed consent encounters.

Ann Miller, RN, MHA
Hope, on October 16th, 2008 at 1:44 AM Said:

About http://www.ePodiatryConsentForms.com

e-Podiatry Consent Forms™ is an innovative new suite of software programs from the Institute of Medical Business Advisors [iMBA, Inc]. Their products solve your informed consent problems and enhance the education, discussion and documentation of the informed consent process for all podiatrists performing foot, ankle and leg reconstructive surgical procedures.

The Problem

All podiatrists are being pressured by the Centers for Medicare and Medicaid Services [CMS], the Joint Commission on Accreditation of Healthcare Organizations [JCAHO], liability carriers and private insurance payers to make their consent process more patient-friendly, informed and easily understood. And, the pressure to standardize and comply is great.

The Solution

One answer to this modern risk-management problem may be e-Podiatry Consent Forms™ The company licenses two core surgical products, with related concepts in development:

1. Forefoot, Mid-Foot and Simple Rear-Foot Version
2. Complex Rear-Foot, Ankle and Lower Leg Version

Each e-Podiatry Consent Forms™ CD-ROM is increasingly trusted as the simple solution to standardize communications across the entire office-enterprise; from managing-risk, informing-patients and complying with modern regulatory requirements through enhanced patient-centric informed consent encounters.

Thus, by improving the consistency, details, documentation and effectiveness of the informed consent process, e-Podiatry Consent Forms™ equips all podiatric surgeons with the tools needed to augment quality standards, reduce litigation potential and improve patient outcomes and safety.

Hope Hetico; RN, MHA, CMP™
Chief Operating Officer
Hope Hetico; RN, MHA, on October 16th, 2008 at 1:49 AM Said:

About http://www.ePodiatryConsentForms.com

e-Podiatry Consent Forms™ is an innovative new suite of software programs from the Institute of Medical Business Advisors [iMBA, Inc]. Their products solve your informed consent problems and enhance the education, discussion and documentation of the informed consent process for all podiatrists performing foot, ankle and leg reconstructive surgical procedures.

The Problem

All podiatrists are being pressured by the Centers for Medicare and Medicaid Services [CMS], the Joint Commission on Accreditation of Healthcare Organizations [JCAHO], liability carriers and private insurance payers to make their consent process more patient-friendly, informed and easily understood. And, the pressure to standardize and comply is great.

The Solution

One answer to this modern risk-management problem may be e-Podiatry Consent Forms™ The company licenses two core surgical products, with related concepts in development:

1. Forefoot, Mid-Foot and Simple Rear-Foot Version
2. Complex Rear-Foot, Ankle and Lower Leg Version

Each e-Podiatry Consent Forms™ CD-ROM is increasingly trusted as the simple solution to standardize communications across the entire office-enterprise; from managing-risk, informing-patients and complying with modern regulatory requirements through enhanced patient-centric informed consent encounters.

Thus, by improving the consistency, details, documentation and effectiveness of the informed consent process, e-Podiatry Consent Forms™ equips all podiatric surgeons with the tools needed to augment quality standards, reduce litigation potential and improve patient outcomes and safety.

Hope Hetico; RN, MHA, CMP™
Chief Operating Officer
cmps, on October 16th, 2008 at 5:25 PM Said:

Palin versus Biden

In none of the debates or presentations has there been a discussion to decrease the cost of health care. All presentations have been in shifting the cost from one organization to another. There are two components to health care today that do not aid in the delivery of health care, lawyers and the insurance industry.

Tort reform must be a priority as if affects all aspects of our lives with no beneficial aspects. The insurance industry needs to be regulated by the federal government if in the brokerage of health care; or completely removed. Only after these two items are addressed can one actually begin to address health care costs.

Dr. Philip McKinney
Darrell, on October 19th, 2008 at 11:12 PM Said:

Government Run Health Care

I posted this on the Houston Chronicle website today in response to an article titled, “Setting the health care record straight – Candidates’ plans spur need to separate fact from fiction,” written by Dr. Arthur Garson. He is clueless about dentistry.

http://www.chron.com/disp/discuss.mpl/editorial/outlook/6065747.html
Setting Dr. Garson Straight

“Any candidate’s plan gives us ‘government run health care.’ This is simply not so.” – Dr. Arthur Garson Jr.

Oh, but it is so, Dr. Garson. It snuck up on everyone. For example, most people have no idea that American dentists and their patients have been sold out.

Last week, Dr. John S. Findley was sworn in as the new president of the ADA. Here is what he said in an interview posted in the ADA News Online on October 7. “We need to position dentistry correctly for the future, working to maintain as much control for dentists as government will allow.”

http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp

The interview is understandably for members only.

Anyone can see that ethics and the Hippocratic Oath are taking a beating for the common good, and dental patients will suffer because of it. As dentists, we obviously can no longer depend on organized dentistry to represent our patients’ interests 100%.

Dr. Findley admits it. I am afraid that this will be remembered as a shameful period for the American Dental Association.

Darrell K. Pruitt; DDS
Darrell, on October 19th, 2008 at 11:17 PM Said:

ADA Transparency

I demand transparency from the ADA. I (or anyone) can do that these days, you know.

I submitted the following comment to a website associated with the San Antonio Express-News called my SA health.

http://www.mysanantonio.com/health/31239029.html

Dr. Mark Feldman, the ADA President for the past year, was interviewed by Don Finley for the Express-News. Comments were invited following the article, and someone who calls him or herself “nyscoff” beat me to the first comment. That is why you see me sweep her aside before I take on Dr. Feldman.

Did you know that in his installation address to the ADA House of Delegates on October 2, 2007 Dr. Feldman actually said that we may have to “redefine common sense”?

http://www.ada.org/members/ada/governance/hod/07_speech_feldman.pdf

If Dr. Feldman will cooperate, we may just get a long-awaited peak at his ambitious plans for all of us.

Darrell K. Pruitt; DDS

———————————————-

Whoa there, nyscoff, if that is your real name.

Goodness! That is quite a heap of dung you’ve collected, nyscoff. Is that why you hide? I think your shyness is because you simply lack the confidence it takes to invest your real name into your ideas. After skip reading your cheap comment, I find it easy to confirm that your fear is justified. You hold no value in what you write, so why should we? Forget about you, Myrtle.

There is a far better use for this impromptu forum. In fact, this could become an unprecedented open conversation directly with the leaders of the American Dental Association. Dr. Mark Feldman sounds like he hopes that dentistry is given proper consideration in the new administration (it is far too late for the election). I say that if he wishes to better serve dentistry, he must meet consumers half-way, and why not here and now? Leaders can no longer hold themselves apart from Internet conversation where spin falls flat. Let us hope that he will respond to my invitation soon. What a milestone that would be for dentistry – An ADA President who is not afraid to talk with anyone about the direction of the profession. Like signing one’s real name, it shows investment in one’s character. I can think of no better way to prove that you are a sincere person, Dr. Feldman.

Here is my question for you: How will electronic health records improve dental care in the US? Hardly anyone, including dentists, knows of the benefits of digital records in dentistry.

My follow-up question is on everyone’s mind, especially with the economy in a tailspin: How much do you expect electronic dental records to decrease dental fees? Let us not forget that lowering the cost, while at the same time, increasing quality, is the entire purpose of healthcare reform.

Please reply, Dr. Feldman. Join me in celebrating unprecedented transparency in dentistry. As you can see from Myrtle’s comment, institutional, committee-approved silence has never worked well as a PR tool. Let’s you and I open up with each other and clear things up right now in front of everyone. The future of dentistry depends on your courage. Your move.

——————————————-

I wish to thank the San Antonio Express News for hosting this forum. I actually graduated from dental school in San Antonio in 1982, and have fond memories of the city. I was sorry to hear that Dr. Earl Feldman (no relation) recently died. He was one of my favorite prosthodontics instructors. I know he will be missed.

Darrell K. Pruitt; DDS
Fort Worth, Texas
Darrell, on October 21st, 2008 at 8:21 PM Said:

What difference does it make?

I posted this on PennWell today.

—————————————

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14763

Will electronic health records save money in dental care? And does that even matter? I have assembled for you the official word from the leaders of the American Dental Association:

- On the Advocacy section of the ADA website, it states that health information technology will be the organization’s primary tool for reducing the cost of dental care in the future.

http://www.ada.org/prof/advocacy/agenda.asp

- Dr. Robert Ahlstrom, a healthcare IT hobbyist and part-time stakeholder who represents the interests of the ADA as well as all dentists in the nation, praised the HIPAA Rule in testimony to a the National Committee on Vital and Health Statistics (NCVHS), a government advisory panel that reports to HHS. Ahlstrom boasted that because of HIPAA, “Provider and plan cost savings will translate to less costly health care.” HHS liked his other nine rationalizations as well.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2641

- When past president of the ADA, Dr. Mark Feldman, was asked if EHRs will save money in dentistry, he refused to answer the question.

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14736

I found Dr. Feldman’s reticence particularly confounding because less than a week ago, in his address to the ADA House of Delegates, he praised Dr. Dr. Bob Brandjord, a well-respected past ADA President, and one of my personal favorites. Here is one of Dr. Brandjord’s quotes that I am particularly fond of: “When we see something change that doesn’t make sense, we have to identify it and let the ADA know about it. Don’t roll over and take it if something doesn’t seem right. Your interpretation might not be accurate every time, but nobody who administrates or interprets the laws will be aware there are any issues to resolve if they’re never brought up.”
From ADA News, 12/20/06

Yet Dr. Feldman chooses silence.
But then, what difference would it make anyway?

- Dr. John Findley, the brand new ADA president says that regardless of whether dentists want them or not (and regardless of how much harm slippery patient records cause patients, I assume), it is a done deal: “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’”

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14303

Regardless of the ADA’s committee-approved spin, the historic surrender of the Hippocratic Oath, and Dr. Feldman’s suspicious silence, being a covered entity will become even more expensive for dentists on November 1. That is when the Federal Trade Commission’s (FTC) “Red Flag Rules” go into effect. Unless you are a cash-only dentist, the FTC can now also reach out and touch you if you have a data breach.

The way it looks from here, if one reports a loss of patient identifiers, such as from a stolen hard drive backup that many dentists carelessly transport to and from the office every day, inspectors from numerous sectors of government will line up at your door. However, if you don’t report a fumble, an FBI agent could be the first in line.

Here’s the problem: Hackers and dishonest employees leave no trail. So if the FBI agent unexpectedly surprises a dentist with a search warrant in regards to a rash of identity thefts, the dentist will be the first to be suspected of selling patients’ identities. I wonder if Dr. Findley will have the courage to warn the members about that horrible possibility.

Anyway, what difference would it make?
Darrell K. Pruitt DDS
cmps, on October 22nd, 2008 at 4:26 PM Said:

DCA

Dollar-Cost-Averaging is mind balm. It doesn’t actually reduce risk, and it doesn’t increase returns.

In fact, there’s evidence that investors should approach the market more aggressively. Over short periods as well as long, investing lump sums is the equal of dollar-cost averaging, except in those rare times when the market is going straight up, when lump-sum investing does better.

Very nice post.
-Financial Advisor
Darrell, on October 22nd, 2008 at 11:03 PM Said:

e Doctors – Not!

I posted this on PennWell.

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14795

EHR salesman Ryan Levacy’s big mistake.
“This nonsense that electronic health records will save money must stop!”
- Mark Scioli, M.D.

Even though it is obvious that EHRs will never save money in dentistry, despite Dr. Robert Ahlstrom’s glowing testimony to the NCVHS (see “What difference would it make?”), one would think that physicians would be easy marks for pushy healthcare IT salesmen. One might be wrong.

On October 10, Mark Scioli, M.D., who practices at the Center for Orthopedic Surgery in Lubbock, Texas, posted a comment on ModernHealthcare.com titled, “EHRs don’t save Texas doc time, money or paper.”

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20081010/REG/310109987

Dr. Scioli writes: “My God, who are the idiots who have convinced our legislators that these systems will somehow save money? Improve patient safety? Hogwash! Try to update a longstanding patient’s profile in your computer … see how long it takes you, how slowed down your office will be.”

Yea! Who are those idiots?

Dr. Scioli is my hero. However, an EHR salesman named Ryan Levacy from Austin read the doc’s comment and has a different opinion. He posted a reply on ModernHealthcare.com titled “Doc who eschews EHRs ’stuck in Stone Age.’”

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20081014/REG/310149990

Starting with the title, I have never before seen such authoritarian boldness coming from someone who is trying to sell a product to anyone. It took courage for Mr. Levacy to publicly blame doctors like Scioli for the failure of his EHRs, which he thinks are just swell. “To be honest, [Dr. Scioli] is one of the reasons for the slow adoption rate of electronic health records. Frankly, his attitude is the major problem. He states that the EHR did not save him time, money, paper, etc.”

If that was not enough belittling of countless potential customers, CEO Ryan Levacy ends his lecture with this blistering remark for Dr. Scioli: “Next time, he should save the hyperbole and re-examine his decisions, or just go back to what he is comfortable with-the pen and paper-and enjoy his vacation while he undercodes and loses 5% to 15% of what he could be making.”

Wow. And I thought I was nasty.

Yesterday, Dr. Scioli responded in an article titled “EHR salesmen, politicians won’t change doc’s mind.”

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20081021/REG/310219964

“How stuck in the past can I be? When I said these systems don’t save time, money, or paper, I speak from experience. Likewise, I say whomever thinks these systems will save money is nuts.”
- Dr. Scioli.

That’s telling him, Doc. I wish someone would have a heart-to-heart conversation with a few healthcare IT hobbyists in the American Dental Association.

-Darrell K. Pruitt; DDS
Ann, on October 23rd, 2008 at 10:31 AM Said:

Risky Business

“The root of this financial crisis is the tension between wanting to spread risk and not understanding its consequences”.

Read more from:
http://www.guardian.co.uk/commentisfree/cifamerica/2008/oct/15/kenneth-arrow-economy-crisis

By Kenneth Arrow; PhD
Darrell, on October 24th, 2008 at 4:20 PM Said:

Let’s see what I can do from here. I’m coming across new ideas in entertainment every day.

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14854

Can the ADA handle members’ questions?

“I think dentists are becoming more aware the Association is representing their interests on regulatory issues. The people behind our Public Affairs Initiative in our governmental affairs area are always equipped to handle questions.”

-Dr. John S. Findley
October 2008 interview published in the ADA News.

http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp

QUESTION

What happens if an ADA member wants information about the NPI number that the ADA once encouraged dentists to quickly apply for?

INVESTIGATION

Contrary to Dr. John Findley’s promises, when I sought out people equipped to handle my questions, I ran into dead ends at ADA Headquarters. Nobody at all would talk to me about the NPI number. So I moved my investigation, which I hoped would become a pilot study, to the state associations. Below is the Texas Dental Association’s copy of an email that I sent to 42 of the 50 associations on 3/18/08. Some of the questionnaires were sent to the executive directors of the state associations, such as Mary Kay Linn of the TDA. Most were sent to non-specific contact links. (List follows in “DATA”).

Of the remaining 8 states that did not receive a questionnaire, 6 of the state websites required registration to leave a message. I did not bother with those. Of the remaining two, Washington State Dental Association had a bad email address, as did Arkansas State Dental Association.

I could not determine what the problem was with Washington’s address, but I have an idea about the cause of the failure of modern communication in Arkansas. To this day, if one visits the “contact” page of the Arkansas State Dental Association’s website http://www.dental-asda.org/asda1_018.htm, and click on the email link, your next outgoing email will be futilely rushed to “your@address.here” .

Arkansas is but one of the unforeseen challenges facing our nation’s effort to achieve interoperable electronic health records.

From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
Sent: Tuesday, March 18, 2008 7:39 PM
To: ‘marykay@tda.org’
Subject: National EHR survey – pilot study

Dear Mary Kay Linn:

My name is Darrell Pruitt. I practice dentistry full-time in Fort Worth, Texas. I am performing independent research on the progress of Electronic Health Record (EHR) adoption in dentistry – state by state. I request a little of your time to help me with this pilot study, consisting of only a few questions.

In August of 2007, President Bush issued an executive order calling for the nation’s healthcare providers, including dentists, to adopt interoperable EHRs by 2014. Since the progress of adoption is not being monitored in dentistry, one has to agree that it is urgently important that our profession obtain and report the progress. That is why I am requesting your help. If precise information is available, please note source. If not, please give an estimate.

1) What percentage of dentists in your state are HIPAA-covered entities?
2) What percentage have NPI numbers?
3) What percentage currently have “paperless practices,” including electronic dental records?
4) What percentage use computers for front office duties? (checking out patients, filing insurance)
5) What percentage file insurance claims electronically?

Thank you for your time. If I receive a response, I will let you know the results of this study.

Sincerely,
Darrell Pruitt DDS
RESULTS

I received only one response, and it was not even from my own state association. A kind representative from California replied that the CDA does not have the information I requested, and suggested that I try the CMS.

I discovered that CMS is not allowed to release that information. It is a national secret.

DISCUSSION

One of the duties of the ADA Department of Informatics is to promote the adoption of NPI numbers. Up until the NPI deadline was delayed a couple of times, the ADA vigorously promoted the number on the ADA News Online.

What follows is a list of the articles about the NPI that have appeared in the ADA News over the last four and a half years.

http://www.ada.org/prof/resources/topics/npi.asp

It is interesting to note how the titles changed from optimism to despair, with the final article from over a year ago revealing a dark warning about the voluntary number. It has been a year since the ADA has mentioned anything at all:

Feds set sights on national identifier system for health care providers (Feb. 16, 2004)
National Provider Identifier application process begins May 23 (May 17, 2005)
Association launches NPI information campaign (May 23, 2005)
Doctor, who are you? (June 6, 2005)
It’s time to apply for a national provider identifier (May 9, 2006)
The national provider identifier (July 11, 2006)
No need to buy NPI kits (Aug. 7, 2006)
It’s time to get your NPI (Mar. 5, 2007)
NPI deadline delay (April 17, 2007)
National provider identifier posting doesn’t make personal data accessible (June 20, 2007)
Check NPI data before it’s posted on Web (Aug. 17, 2007)

If the numbers of US dentists who have applied for NPI numbers is a national secret as I was told, it does not make sense that the ADA Department of Dental Informatics would spend enormous efforts in recruiting dentists without being held accountable for the progress of the effort.

CONCLUSION

1. Dr. John Findley is mistaken.
2. The ADA Department of Dental Informatics is not transparent with membership about its activities.
3. Some states may need special help.

Respectfully,
Darrell K. Pruitt; DDS

DATA:

Here are the addresses I sent the questionnaire to. The asterisks note the states I was not able to reach on the Internet:

Alabama dradental@bellsouth.net

*Alaska http://www.akdental.org/contact.asp

*Arizona http://www.azda.org/email/index.asp?P=10

*Arkansas your@address.here

California contactcda@cda.org

Colorado info@cdaonline.org

Connecticut cdingeldey@csda.com Carol Dingeldey

*Delaware http://www.delawarestatedentalsociety.org/contactus.html

Florida nwa@ij.net Dr. Nolan W. Allen

Georgia phillips@gadental.org Martha S. Phillips, Executive Director

Hawaii hda@hawaiidentalassociation.net

Idaho info@isdaweb.com

Illinois info@isds.org

Indiana doug@indental.org Douglas M. Bush Ex.dir

Iowa info@iowadental.org

Kansas kevin@ksdental.org Kevin J. Robertson, CAE, Executive Director

Kentucky info@kyda.org

Louisiana info@ladental.org

Maine info@medental.org

Maryland mddent@msda.com

Massachusetts rboose@massdental.org Robert E. Boose, EdD Executive dir.

*Michigan http://public.smilemichigan.com/site/293/default.aspx

Minnesota info@mndental.org

Mississippi office@msdental.org

Missouri vicki@modental.org Vicki Wilbers Ex.dir.

Montana mda@mt.net

Nebraska nda@alltel.net

Nevada nda@lasvegas.net Robert H. Talley, D.D.S. Ex.dir.

New Hampshire info@nhds.org

New Jersey ameisel@njda.org Arthur Meisel, Esq Ex. Dir.

New Mexico mmoores@nmdental.org Mark D. Moores, Executive Director

*New York http://nysdental.org/nysda_contacts/index.cfm

North Carolina aparker@ncdental.org M. Alec Parker, Executive Director

North Dakota ndda@midconetwork.com JOSEPH J. CICHY Executive Director

Ohio david@oda.org David Owsiany, JD – Executive Director

Oklahoma ddavis@okda.org Dana Davis Executive Director

Oregon info@oregondental.org

Pennsylvania rvn@padental.org Rebecca Von Nieda Director of Meetings & Ad

Rhode Island info@ridental.com

South Carolina lathamp@scda.org Phil Latham, Ex. dir

South Dakota info@sddental.org

Tennessee tda@tenndental.org

Texas marykay@tda.org Mary Kay Linn Executive Director

*Utah uda@uda.org X bad address

Vermont ptaylorvt@aol.com

Virginia info@vadental.org

*Washington rutha@wsda.org X bad address

West Virginia wvrds@aol.com Richard D. Stevens Executive Director

*Wisconsin http://www.wda.org/feedbacks/new

Wyoming WYODENTAL@bresnan.net Ms. Diane O’Keefe, Executive Director
Dr. Amarantos, on October 24th, 2008 at 11:32 PM Said:

Dr. Marcinko,

You are absolutely, right on target. Although, I believe a small practice can share from each venue and survive quite nicely.

Gregory T. Amarantos, DPM, FACFAS
Cell 847-207-5678
Office 773-334-2299
Ann Miller; RN, MHA, on October 25th, 2008 at 2:35 AM Said:

Center for Excellence in Health Care Journalism

The Center for Excellence in Health Care Journalism is classified as a supporting 501(c)(3) for AHCJ, Inc. The purpose of the Center for Excellence in Health Care Journalism is to ensure that journalists are properly trained to cover news events, trends, and issues in all aspects of health care journalism, including the business of health care, public policy, medical research, medical practice, consumer health issues, public health, health law, and ethics.

Perhaps the folks mentioned in the post above should consider joining The Association of Healthcare Journalists: http://www.healthjournalism.org

-Ann
cmps, on October 26th, 2008 at 12:03 AM Said:

Pulling the Plug on Some Sectors,

Some sectors funds are too narrow. For example, the offerings of HealthShares Dermatology & Wound Care ETF, had roughly only $2 million in assets when the plug was pulled and it expired.

Ann
Editors, on October 26th, 2008 at 1:00 PM Said:

By Christopher Lee
Washington Post Staff Writer
washingtonpost.com | Wednesday, July 9, 2008

Medicare has paid as much as $92 million since 2000 to medical suppliers who billed the government for wheelchairs and other home equipment purportedly prescribed by physicians who, according to records, were dead at the time, congressional investigators said yesterday.

The Centers for Medicare and Medicaid Services (CMS) honored about 500,000 such claims despite pledging six years ago to correct the problem, which was identified by the Health and Human Services Department’s inspector general in 2001.

In more than half the cases studied, the doctor listed as having ordered the equipment had died more than five years earlier, said a report by the Senate Homeland Security and Governmental Affairs Committee’s permanent subcommittee on investigations.

“We discovered that some medical equipment suppliers have scammed the Medicare system — and the American taxpayers — out of massive amounts of money,” Sen. Norm Coleman (Minn.), the panel’s top Republican, said in a statement. “Using the ID numbers of dead doctors, these scam artists have treated Medicare like an ATM machine, drawing money out of the government’s account with little fear of getting caught.”

The report is part of the committee’s ongoing investigations into waste, fraud and abuse in the fast-growing federal health program, which serves more than 43 million elderly and disabled Americans. Medicare pays annually more than $400 billion in benefits and is a fixture on the Government Accountability Office’s “high-risk” list of troubled programs.

Last year, the government established a Medicare Fraud Strike Force to crack down on a problem that officials estimate costs taxpayers tens of billions of dollars annually. The program’s durable medical equipment component, in particular, has been a frequent target of companies seeking to bilk the government. The subcommittee has scheduled a hearing on the problem today. When the system works properly, a physician writes a prescription for home medical equipment for a Medicare beneficiary. He takes the order to a supplier, who sells or rents the equipment to him. The supplier, in turn, submits a claim for payment to a Medicare contractor for processing. The claim includes a number issued by Medicare that identifies the prescribing physician.

Senate investigators obtained from the American Medical Association a computer file of physicians who had died between 1992 and 2002. They selected 1,500 at random and asked Medicare officials to turn over medical-equipment claims filed with those doctors’ Medicare ID numbers between 2000 and 2007.

During that time, the review said, ID numbers for 734 deceased doctors were used to file 21,458 claims that totaled $3.4 million. Investigators counted the claims only if the equipment was bought more than a year after the doctor’s death.

Extrapolating from the sample, investigators estimate that 384,730 to 572,238 such fraudulent claims were submitted during that period, and Medicare paid an estimated $60 million to $92 million. There are still active ID numbers in Medicare’s system for as many as 2,895 dead physicians, investigators said.

They examined separate data for Florida, home to many retirees and a perennial leader in Medicare fraud. They found that more than a quarter of deceased Medicare doctors there still have active ID numbers in Medicare’s system.

The ID for one doctor, who died in 1999, appeared on 83 claims submitted by Professional Gluco Services Inc., a Miami company, between November 2005 and September 2006. A federal grand jury indicted two of the company’s owners last year on charges of defrauding the government of $1.3 million for equipment that had never been ordered or delivered. Both men pleaded guilty.

Medicare officials had promised to do a better job screening claims after the 2001 inspector general’s report found that the agency had paid $91 million for medical supply claims with invalid or inactive physician ID numbers in 1999.

Medicare officials said several new steps should help, including a plan to match monthly Social Security Administration data about U.S. deaths against a revamped Medicare provider-identification system. They also pointed to new accreditation requirements for suppliers under a new program, opposed by the industry, that sets some equipment prices through competitive bidding.

“Fraud and abuse in the context of Medicare-covered durable medical equipment has been a focal point of ours in recent years,” said CMS spokesman Jeff Nelligan. “Before this program, anyone could become a supplier, but now they must be fully accredited based on strict financial and quality standards.”

Reader Submitted
cmps, on October 27th, 2008 at 12:24 AM Said:

Competitive Analysis

More thoughts on competitive healthcare analysis can be found in the premium print journal: http://www.HealthcareFinancials.com by Robert James Cimasi, of Health Capital Consultants, LLC.

Ann
Ray, on October 27th, 2008 at 10:22 AM Said:

It’s about the Fees,
The real purpose of the above aged aphorisms is to continue the income stream for fee-based “financial advisors.”

If you don’t stay in the marekt; they don’t make any money.

-Ray
ladyartist, on October 30th, 2008 at 10:45 AM Said:

Hello,

I am thrilled that you made this post as I have a story that can be repeated thousands of times. First, these doctor rating services are invaluable. I went to WebMD’s forums to share my story and received many replies asking to which doctor I was referring because they wanted to steer clear of them.

My story:

A month ago I went to a “Pain Management” doctor because of two herniated discs in my neck and spinal stenosis.

After paying $200 cash (I have no health insurance) for a “consultation” the doctor comes into the room, has me push my arms around a bit and tells me that I need surgery. Then she leaves the room without saying another word. She never came back, never said “good luck” or “nice to meet you.” Nothing.

We paid $200 for a “consultation” with her and we saw her for three minutes. This doctor:

* Said I need surgery, but when asked to recommend a surgeon, she could not because she didn’t know any (I did not believe her. I feel she didn’t recommend anyone because I don’t have insurance.)
* Fails to explain what a herniated disc is.
* Fails to discuss my options.
* Fails to even ask me a single question.
* Never even looked at my MRI. I know because they were in my possession the whole time.

This “pain management doctor” sent me back to my WALK IN CLINIC for pain management for two herniated disks and spinal stenosis. She said they can’t prescribe pain meds because I saw a different doctor “two weeks ago” for the pain. Big huge surprise – I’m in excruciating pain.

I shared this story on WebMD and offered to release the name of the doctor; and I had many people write to me. I enthusiastically shared her name. I went to every doctor rating service I could find and shared my story.

Thank you SO MUCH for offering to hear her story. Anyone can write to me at naturalone@ymail.com and I will release her name to them as well.

LadyArtist
cmps, on October 30th, 2008 at 6:05 PM Said:

News Update

HHS’ inspector general’s office has issued a report criticizing the CMS for its failure to protect patient information by lax enforcement of the Health Insurance Portability and Accountability Act’s security rule, saying in an accompanying letter that the inspector general’s own audits of hospital security systems show “numerous, significant vulnerabilities” that put patient data “at high risk.”

So, perhaps our friend Dr. Pruitt is more correct, than not!
Ann
Gale Wilson-Steele, on October 30th, 2008 at 6:54 PM Said:

Patients do look to others for personal recommendations and reviews of doctors, and by posting them online, their opinions can be shared globally.

LadyArtist has given us insight on her doctor based on her real personal experience, which may save others from an equally unsatisfying visit. Ideally such comments would provide important customer feedback and help doctors in question to use this information to improve their own practices. It also would be helpful to hear back from the reviewed doctor … I’m sure LadyArtist would be happy to know that her feedback was constructive and being heeded.

-Gale
ASC, on November 3rd, 2008 at 12:47 PM Said:

Loss of Chance,

I would have to agree with medical malpractice lawyers who suggest that the “Loss of Chance” doctrine, accepted by States, would invite frivolous lawsuits.

Currently, Florida has not adopted this rule. In the event it did, the following considerations should be reviewed.

How would this affect the doctor’s decision on handling marginal cases; attorney’s ability to file suits; and familiy emotions to Cash-in-On opportunity?

I don’t oppose the public right to hire an attorney and file suit when necessary. I also do not agree on capping settlements. Both the Congressional Budget Office [CBO] and the General Accounting Office [GAO] review of the Kessler-McClellan study showed that the evidence was not conclusive enough to support the claim that caps on damages could hold down overall medical cost.

However, I do have a claim against attorneys who file suits with the only possibility to cash in on a marginal situation. Even though the opinion of some is that the frivolous law suits do not make it through the system, I would have to point out that it still costs money. The doctors have to hire an attorney, answer legal complaints as well as spending hours preparing for the possibility of a trial.

A report issued by Towers Perrin, 2006 – Update on U.S. Tort Cost Trends - showed that since 1975 medical malpractice cost has increases at an annual rate of 11.4%.

* Furthermore, would doctors request second and third opinions when treating a marginal case?
* Could insurance companies increase premiums to handle addition protocols to protect against this doctrine?
* Who would pay, the doctors, patients or insurance carriers for these items?

In addition, percentages do not tell the whole truth on the survival of the patient. What expert can really testify that a certain procedure or early detection would guarantee 100% survival? I believe in accountability for doctors’ actions. They should be held responsible for real negligence as proven by the current law.

The focus should not be on whom to blame and who should pay; instead, we should focus on what would improve our system. Medicine is not an exact science.

-A Certifed Financial Planner
Amaury S. Cifuentes, on November 3rd, 2008 at 1:02 PM Said:

Non-Competition Clauses in Medical Agreements

The basic non-competition agreement is one that precludes one party from engaging in competition with another. Since non-compete contracts interfere with a person’s ability to make a living, courts may refrain from enforcing the agreement. A properly drafted noncompete agreement should be limited in its breadth and scope. To be enforceable, a noncompete clause should specifically address what activities are prohibited, define a narrow geographic area, and define a limited time period.

Recently, a Kansas court of appeals upheld a noncompete contract restricting Michell M. Louis, DO from practicing for three years in the same county as Wichita Clinic PA, unless the physician paid 25% from her earnings during those three years.

In another instance the trial courts questioned the noncompete of two Evansville cardiologists who worked for Ohio Healthcare Inc. The 17 page decision from the court noted the AMA opposition of non-compete agreements. They wrote:

“The implications that flow from the disruption caused by enforcing covenants include increased costs of care, decreased quality of care and decreased patient satisfaction.”

In addition, in the case of New Castle Orthopedic Associates v. Burns, the Supreme Court of Pennsylvania held that a noncompete agreement between an orthopedic practice and its former physician employee would not be enforced. The court based its decision largely on the fact that there was a shortage of orthopedic specialists in the geographic area encompassed by the noncompete agreement, as evidenced by referring physicians who testified that it took anywhere from four weeks to four months to obtain appointments for their patients.

Non-compete agreements are used to protect the employers from allowing a high profile employee from leaving and retaining some clients. In addition, it helps protect the good will of the firm and its financial stability. And, recent regulations enacted by the Stark Laws will also call into question the enforceability of physician’s non-compete agreements in certain situations.

Therefore, do we protect the medical provider and provide protection for them to create value in their medical practices; or do we protect the publics’ consideration, right to freedom of choice and the right to continue current relationship with their physicians?

-Amaury Cifuentes; CFP®
cmps, on November 4th, 2008 at 11:20 AM Said:

Inflated ER Wait Times

Did you know that inflating estimated emergency room wait-time makes patients happier, according to a study presented at the American College of Emergency Physicians [ACEP] meeting in Chicago.

As reported by the Wall Street Journal, October 30, researchers calculated the mean time it took to get through the ER for a given test or procedure, then added 20 percent when they told patients what to expect.

In a standard patient satisfaction survey, all nine variables related to wait times improved after the ER adopted this policy, while the improvement was statistically significant for five of the variables.

Isn’t this same ploy used by restaurants?
-Ann
Katie, on November 10th, 2008 at 2:09 PM Said:

I know that many doctor rating sites irritate doctors, but I see them as a good thing – and think that doctors should even encourage their patients to go online and rate them.

The reason for this is that most doctors are good at what they do, and liked by their patients. However, most people won’t think of recommending their doctor unless they’re asked for it (standard word of mouth principle). If my doctor asked, I would happily go online to fill out a positive review.

It would be even better if the doctor’s office itself sent out a survey to patients after their appointments asking them to rate their experience, or even offered a rating function on their own site. Then they could verify that someone was a patient – while still giving the patient the opportunity to be heard. (Which reduces lawsuits, I’ve read.)
Also, the main complaints that irk patients are frequently things doctors could easily change: less waiting time, being nicer, etc. I think doctors should view that as an opportunity to see how they can improve their service to their patients.

If doctor rating sites could give doctors a chance to respond and show improvements (e.g. “Hi, this is Dr X. I noticed on here that patients are upset about the long waiting times. Here are the steps we are taking to address that”); and that would be even better.

Many companies have found that having a rating function on their website or encouraging ratings has made their customers view them more positively. I think doctors could benefit from this, as most are not bad doctors. The more ratings they get; the better.

-Katie
Stu, on November 10th, 2008 at 4:45 PM Said:

Defining the Health Cloud

How about health Platform-as-a-Service [PaaS], as one definition of health cloud or grid computing? And, the leading corporate proponents to provide same would be: EMC, IBM, Oracle, MSFT and Alfresco, etc.

-Stewart
cmps, on November 11th, 2008 at 1:06 AM Said:

Mental Health Quotation

“Do we want two types of accounts about human behavior – one to explain the conduct of sane or mentally healthy persons, and another to explain the conduct of insane or mentally ill persons? I maintain that we do not need, and should not try, to account for normal behavior one way (motivationally), and for abnormal behavior another way (causally). Specifically, I suggest that the principle, ‘Actions speak louder than words’ can be used to explain the conduct of mentally-ill persons; just as well as it can the behavior of mentally healthy persons”.

By Thomas Szasz
Insanity [The Idea and Its Consequences]
1997, p.352
Joseph, on November 12th, 2008 at 6:34 PM Said:

Un-Insured ER Patients?

According to Tracey Walker, writing in the Nov 4th edition of Managed Healthcare News, despite common perceptions that uninsured adults are primarily responsible for overcrowding in emergency rooms (ERs) – or are using ERs to seek treatment for minor illnesses – a recent study by Robert Wood Johnson Foundation Clinical Scholar Manya Newton MD – of the University of Michigan – finds that this opinion lacks evidence.

-Joseph
cmps, on November 13th, 2008 at 12:53 AM Said:

MSFT and the Cloud

According to the Dow Jones Newswires, 04:12 PM ET 11/12/2008, Microsoft Corp. (MSFT) is staking its place in cloud computing, trying both to grab a share of the fast-growing market for off-premise computing and protect its franchise packaged software products.

Last month, the world’s biggest software company unveiled Windows Azure, a platform that allows developers to write Microsoft-compatible software that is stored on and accessed from its servers. Azure also lets user’s access online versions of Microsoft applications, like databases and email servers. Azure underscores Microsoft’s intention to shake up the world of cloud computing, the growing trend towards hosting applications and data on off-site servers, rather than on individual computers’ hard drives.

The Redmond, Wash. Company is trying to tempt its core customers – the world’s biggest companies and most consumers – to stay with familiar products but access them in a new way, rather than switch to alternative services offered by cloud-computing pioneers like Google Inc.

-Ann
Jaris, on November 13th, 2008 at 11:06 PM Said:

Hello,

I found & used a site called mdnationwide.org to research a specific doctor. Though they did charge a fee, I found it had more detailed information than any other site, including those free sites who have doctor’s credential information.

Hopefully this helps.

Good Luck!
Jaris
cmps, on November 25th, 2008 at 1:16 AM Said:

Hospital in Financial Crisis,

In the AHA’s survey, Report on the Economic Crisis: [Initial Impact on Hospitals], it’s clear that hospitals are already experiencing the effects of the economic downturn.

For example, CEOs are considering several cost-cutting tactics in dealing with this financial crisis:

- 56% of CEOs are postponing renovations or plans to increase capacity
- 45% are delaying purchase of clinical technology or equipment
– 39% are postponing investments in new information technology.

And so, what else can be done; a government bailout like AIG or CitiCorp?

-Richard
cmps, on November 25th, 2008 at 1:22 AM Said:

The Domestic Healthcare Myths

Zeke Emanuel and Shannon Brownlee wrote an op-ed piece in Sunday’s Washington Post that should be required reading for anyone interested in health care reform. The title is, “5 Myths About Our Ailing Health Care System.” In the article, they suggest the “5 Myths” are:

1. America has the best health care in the world.
2. Somebody else is paying for your health insurance.
3. We would save by cutting administrative waste in private insurance.
4. Health-care reform is going to cost a bundle.
5. Americans aren’t ready for a major overhaul of the health–care system.

Read more: http://www.washingtonpost.com/wp-dyn/content/article/2008/11/20/AR2008112002420.html

So, true or false; please opine?
-Ann
Executive-Post, on November 26th, 2008 at 1:14 AM Said:

Shared Savings Program

CMS delayed finalizing an exception for shared savings programs in the 2009 Medicare Physician Fee Schedule Final Rule issued on Oct. 30, 2008, because CMS believed it had received too few comments to craft an appropriate exception for shared savings programs that would not risk fraud to the Medicare program. CMS will accept additional comments on ways to appropriately structure such an exception until mid-February 2009.

-Stewart
Executive-Post, on November 28th, 2008 at 12:44 AM Said:

The Encryption Fallacy
http://www.modernhealthcare.com/article/20081125/REG/311259958

Dental, Health Streams’ Should Unite Despite Hurdles

“In response to reader commentary on Joseph Conn’s “CCHIT awaits word on fate in Obama administration”

Response

Darrell Pruitt’s concerns are important. As for liability—would a dental provider in private practice face liability under the Health Insurance Portability and Accountability Act if her/his electronic health-record data was stolen? Would the procedures for dealing with such a theft interfere with her/his practice? Although if we suddenly had eHRs in every dentist’s office in the U.S., I doubt there would be a crime wave of eHR thefts across the country, clearly there is a risk. Any dental provider should take the same steps as any provider, namely, encrypt the hard disk.

High Cost-Open Source

The high cost is because of proprietary systems of great expense. The Veterans Affairs Department and the Indian Health Service have had integrated (medical-dental) systems in place for years. While the VA dental package is not open-source, the VistA system per se is open-source, and is available, sponsored by the CMS. The IHS dental package is open-source and can be used together with the VistA database. And so, when it comes to loss of records, please note that not one veteran’s EHR in VistA was lost during the Katrina disaster in Louisiana.

Optimized Care

The reason for integral communication among medical and dental providers is to optimize and support chronic care, the source of over 70% of costs of healthcare in the U.S., to optimally support prenatal care affecting the unborn, to optimally support pediatric care and to address the urgent multidisciplinary needs of patients at risk of osteo-radionecrosis.

Assessment

Dental-provider concerns are important and must be addressed. It is reasonable that dentists are alarmed, reading about thefts of computers and hard drives and problems of HIPAA compliance. Pruitt suggested in a phone conversation that two-way fax relationships with an alternative method of IDing providers and patients might solve the HIPAA liability problem. I suspect the best solution is a best-practice approach to electronic data security and backups. Practical solutions must be found so that routine, appropriate and necessary communication between medical and dental providers can safeguard the health (oral and systemic) of individual patients. Patient safety and quality of care are foremost. It is neither safe nor supportive of quality of care to have two less-than-adequately coordinated “streams” of care administering and prescribing medications and performing surgeries on patients receiving care in both “streams.”

Valerie Powell, Ph.D.
Professor: Computer/information systems
Robert Morris University
Chairwoman: Education/training
WorldVistA
Moon Township, Pa.
Executive-Post, on November 28th, 2008 at 12:58 AM Said:

Side-Stepping Insurmountable Obstacles

“The reason for integral communication among medical and dental providers is to optimize and support chronic care, the source of over 70% of costs of healthcare in the U.S., to optimally support prenatal care affecting the unborn, to optimally support pediatric care and to address the urgent multidisciplinary needs of patients at risk of osteoradionecrosis.” Valerie Powell, PhD

Even though I have to wonder why Valerie Powell picked the rare “osteoradionecrosis” to highlight from so many more common diseases like diabetes and heart disease, I agree that better communication between physicians and dentists is needed now more than ever before. It would save lives. But we simply cannot get there from here.

Even if I am the only dentist in the entire nation to notice, as a confident scout who knows the terrain better than most, I will report again and again that I have seen what lies ahead. I am giving fair warning to all concerned that it makes no difference how many are already in the dental IT convoy, and it does not matter how many letters trail the leaders’ names. I am telling you that the bridge is out, and the greater the momentum – the more spectacular the crash. The wreckage will justifiably crush the careers of careless HIPAA stakeholders who know far too little about dentistry. Those who ride indefensible absurdity the longest will suffer the most. Fair is fair.

Unfortunately, it will also destroy patients’ trust in eDRs for the rest of their lives and dentistry may never see Open Source Evidence-Based Dentistry and the miracles that would have helped my grandchildren. If stakeholders are allowed to drive interoperability off a cliff, one can forget about real-time data-mined dental research. If either dentists or dental patients do not trust their welfare to digital records, the records will be worse than inadequate. They will be dangerous.

Did I mention in a previous part of this thread that 330,000 active and former dental patients lost their identities to a hacker at a University of Florida dental school recently? How would you like to be known as a high tech paperless dentist in that college town? If you were a dental patient in the community, and you had a choice, why would you pick a dentist with digital records over a dentist who has paper records that are impossible to hack?

Even though hundreds of thousand of years ago, even the slowest-thinking Neanderthals undoubtedly noticed that infections of the mouth can make one feel bad all over, there is abundant recent research which proves the connection between chronic diseases of the body and diseases of the mouth. Enthusiastic IT stakeholders who often confuse rationalizations with reasons would have us believe that it takes interoperable computers to communicate between dentists and other healthcare providers. I say if we wait on that to happen before establishing universally-accepted alternate safe lines of communication, millions of people will die needlessly.

“We may need to solve problems not by removing the cause but by designing the way forward even if the cause remains in place.” Edward de Bono – Pioneer of Lateral Thinking (Wikiquote).

Dentists indeed need to be better connected with physicians. But it does not require that dentists endanger their patients’ welfare by having to maintain Personal Identification Information (PII) on their computers, and most of all, it does not require a dentist to be a HIPAA-covered entity. This means that entrenched government officials and politicians will not like my idea at all. But face it. Their reckless ambition made HIPAA insurmountable.

Here is a lateral idea that I have not completely worked out, but how about this: Make eDRs and eMRs compatible with common fax machines as a requirement for CCHIT accreditation. Commonly, common sense simply provides simple solutions. Now look at how simple that was.

Darrell Pruitt DDS
Fort Worth, Texas
Dr. Darrell, on November 28th, 2008 at 12:45 PM Said:

Reply to Valerie Powell, PhD
The fallacy of encryption

Valerie Powell writes, “Although if we suddenly had eHRs in every dentist’s office in the U.S., I doubt there would be a crime wave of eHR thefts across the country, clearly there is a risk. Any dental provider should take the same steps as any provider, namely, encrypt the hard disk. “

Without security, theft is impossible to prevent. Let’s just say identity theft is a growing problem in our nation that we will naturally discover was relatively small today, and hardly noticed by even professional health organizations whose mission is to do no harm.

Did you know medical records of over 160 million patients have already been lost in the last few years? And those are only the ones we know about. That is equivalent to more than half of the US population. In addition, according to a study released a year ago by the Ponemon Institute and Deloitte and Touche, 85 percent of the security or privacy executives surveyed – around 800 individuals – claimed at least one reportable security incident in the preceding 12 months. What is more, 63 percent of the professionals surveyed had multiple reportable privacy breaches – between 6 and 20 – in the previous year.
http://www.deloitte.com/dtt/article/0%2C1002%2Ccid%25253D182733%2C00.html

Even though one may not hear about patient privacy breaches occurring in dental offices, does not mean dental patients’ records are any more secure than the 26.5 million medical records that were lost by the Veterans Affairs Department in 2006 because of a stolen computer. Breaches of dental patients’ identities are simply going unreported. How good is that?

By the way, the 26.5 million records were part of the VA’s VistA database that Valerie Powell mentioned as being a good open-source interoperable system; very open-source.

Pushed by ambitious public and private healthcare IT stakeholders, the nation simply pursued eHRs with reckless abandon, particularly since the HIPAA mandate was amended in 2003 to favor stakeholders over patients. The results of egregious errors in judgment are fast becoming painfully evident to consumers, whose trust is absolutely required if we are to have trustworthy medical records. We are losing our patients’ confidence, friends.

The loss of trust is not limited to medical records. At the first of October, 330,000 dental records were lost to a hacker from a Florida dental school. This was avoidable.

As a member, I hold my American Dental Association partly to blame. The ADA, which advises the US Department of Health and Human Services about healthcare IT matters on behalf of the nation’s dental patients, has been transparently negligent because of institutional investment in digital records. The leaders of my profession should have warned both dentists and lawmakers about the danger of identity theft at least three years ago, when I brought it to their attention. Alas, I am but one dentist – brushed off by many as a trouble-maker.

I find it incredible that Valerie Powell assumes that broader adoption of today’s notoriously insecure eHRs will not create more opportunities for thieves.

So will encryption solve this problem? No; encryption will not be trusted by patients. Here is a simple test to support my claim: If your doctor fumbles the identities of you and your loved ones, would you want to know – regardless of encryption? I would.

As far as I can tell, it is only the stakeholders who can’t handle the truth.

Darrell K. Pruitt; DDS
Fort Worth, Texas
Amaury, on December 1st, 2008 at 4:05 PM Said:

Health Insurance Companies:

The CMBX indices which tracks commercial mortgage back securities are reporting widening yields, an indication that more defaults are eminent due to expectation of worsen U.S. market conditions. The exposure of these commercial mortgages back securities is affecting differently life insurance companies and health insurance companies.

Even though commercial loan underwriting fundamentally are sound by using debt service ratios calculations, which help determine the cash flow of the commercial property and its ability to repay the loan. Requirements of higher down payments; typically 20 – 25 percent down which improves the equity position; in addition to personal guarantees from borrowers with less then five years history and substantial assets and reserves. All which could abate some of the meltdown of valuations.

However, fundamentals in the commercial mortgage back securities do not guarantee the success of individual firms like Hartford (HIG), Met Life (MET) and Pacific Life (PL) which own these assets and could face additional problems from the exposure (Barr & Morcroft, 2008)

Health insurers like United Health Care (UNH), Aetna (AET) and Well Point (WEP) by comparison do not face the same problems. Even though their investments in fixed income have decreased current revenues, overall core business continue to grow and their outlook are better than most life insurers.

Health insurer core business which offers health benefits offered through commercial and government programs should continue to grow. With a potential market of the 46 million Americans without health insurance (US Census 2005) and with projected 76 million baby boomers turning 65 in 2011 (Novelli, 2002), health insures still are poised to add growth. Furthermore, health insures are not subject to loss of revenues due to asset management like most life insurance companies.

In conclusion, physicians should not have the same concerns with the health insurers’ default due to the commercial mortgage back securities, but should review policies issued by any life insurers and review the limits of coverage offered by their specific states insurance departments to determine what protection are offered in case of bankruptcy.

-Amaury S. Cifuentes; CFP

Citations:
Barr and Morcroft: “Insurerer’s slump on concerns about commercial mortgage exposure”

19 November 2008, MarketWatch.
http://www.insurancenewsnet.com/article.asp?n=1&innID=886958624
http://www.census.gov/Press-Release/www/releases/archives/income_wealth/007419.html

William Novelli: “2011 in America: A New Vision” 16 November 2002
http://www.aarp.org/about_aarp/aarp_leadership/on_issues/a_new_vision/new_vision.html
Darrell, on December 1st, 2008 at 5:54 PM Said:

PROGRESS REPORT – ADA/IDM

“Can your clients find out about you online? – What Intelligent Dental Marketing [IDM] will soon learn about search engines”?

Ten days after I made this promise, I successfully helped IDM embarrass itself an article titled “Time is up, Intelligent Dental Marketing.” It appears as the number 5 hit when one googlesearches “Intelligent Dental Marketing.”

Here is a teaser for the next topic of this lesson about using Google strategically.

- When a scout bee finds a good source of nectar, he returns to the hive and does a dance to describe the location for others to follow…. Well, now that I think about it, sweet nectar is not quite the analogy I am trying for. Maybe it is more like fire ants swarming an intruder, or even a hyena rolling in the decaying carcass of a wildebeest and retuning to the pack with the odor of their next meal.
Yea! That’s the ticket.

-D. Kellus Pruitt; DDS

Want to make a difference with a click?

Unconventional PR is even more fun when friends join in. It is very simple, costs nothing, and it is incredibly effective for grabbing the attention of good ol’ boys who think silence is professionalism and image is everything. You know the type. They’re superficial.

Are you acquiring a taste for the sport yet, grasshoppers? Feel like going out and picking your own fight? If not, you can always pile on to any that I started just by clicking on its hyperlink. If you don’t like what I have said in one place or another, whatever you do, do not click the link. Even though the game is incredibly simple, don’t assume the stakes are meaningless. Watch what happens to ADA/IDM.

This is the power of individuals within social networks. This is the power it will take to effect meaningful change not only in dentistry, but in the nation. And as serious as it is, we must have some fun. Nothing says that conversation in the marketplace has to be somber and controlled. That’s bland. That’s archaic.

I am pleased we have reached this part of the course. It has truly been an exciting adventure for me. Now we come to a point when real-time discoveries become truly exciting. It is time to throw in a “SEO power multiplier” — or something like that. I don’t know what to call it. The platform I am using is new, as far as I know. It is almost like Web 3.0 democracy or something. It is supported by the argument: If an entity cannot defend itself on the Internet, it is defenseless. And it probably has a committee for a central nervous system.

TEST

We have a real-time experiment in progress. “Time is up, Intelligent Dental Marketing” turned out to be a popular post. Today it fell to the number 8 hit from the number 3, when one googlesearches “Intelligent Dental Marketing.” The number 1 and 2 hits were advertisements for IDM posted like news articles on the ADA News Online.

HOMEWORK

Here is the link:
http://community.pennwelldentalgroup.com/forum/topics/time-is-up-intelligent-dental?page=1&commentId=2013420%3AComment%3A20574&x=1#2013420Comment20574

As someone once said in my kind of town; vote early and vote often.
-D. Kellus Pruitt; DDS
Executive-Post, on December 1st, 2008 at 7:24 PM Said:

Costliness of eHRs

According to Jeremy Engdahl-Johnson, Managing Editor at Milliman, we can’t know for sure whether electronic records will increase or decrease costs. As a purely cost-based argument, the debate can go on indefinitely. Ultimately, the quality argument may win out for a reason independent of cost—because it is deemed the right thing to do.

The idea that healthcare has grown too complicated, becoming “too much airplane for one man to fly,” is often invoked as justification for surgeons’ checklists and better use of tools built on evidence-based medicine. It’s not that our doctors aren’t good; it’s that there are too many details and too many scientific improvements to keep track of.

The quality imperative—now emboldened by an administration that claims to be intent on change—may clear the way for other changes, generating the will to make a pervasive electronic health environment a reality.

Find out more at http://www.healthcaretownhall.com
-Ann
Executive-Post, on December 2nd, 2008 at 1:17 PM Said:

The Misplaced eMRs and HIT Movement

According to David C. Kibbe MD, from this external post, http://www.thehealthcareblog.com/the_health_care_blog/2008/12/index.html

“I confess” my own misplaced hope in the EMR movement, and that I’m finally embracing the reality that most investments in health IT have not met expectations. My broad message is that the key lesson of this failure has been that adoption of health IT without understanding the fundamental interactions between people, business process, and technology wastes both human and economic capital.”

Think about this informed opinion in light of the frequent posts of Dr. Darrell Pruitt; DDS.

-Ann
Darrell, on December 2nd, 2008 at 9:28 PM Said:

About Hybrid eHRs,

Take a look at what I copied from MedicalNewsToday.com. A hybrid won’t do it alone, but it will help.
http://www.medicalnewstoday.com/articles/130977.php

-D. Kellus Pruitt; DDS
Darrell, on December 3rd, 2008 at 5:15 PM Said:

Intelligent Dental Marketing Disappoints ADA Member

http://community.pennwelldentalgroup.com/forum/topics/intelligent-dental-marketing

You know what I think happened to the world economy; Good ol’ boys in high places.

It is my opinion that there are far too many quietly arranged sweetheart deals in the nation that favor good ol’ boys. Though the agreements are not technically illegal, they are arguably unethical, and would never survive modern transparency. I think it is a tradition that crosses all borders and permeates modern society from small businesspeople to the highest government officials.

From what I have seen in my own niche microcosm of dentistry, it is easy to imagine how traditional habits quietly influence entities like, say, lawmakers and pork barrel pushers, or Freddie Mac and mortgage lenders. Or even, Intelligent Dental Marketing and the ADA. At the risk of hurting feelings, I have to confess that in-your-face unresponsiveness from both organizations arouses my suspicions.

I am disappointed in ADA/IDM. Almost three weeks ago I openly asked three straightforward questions in an email to Intelligent Dental Marketing, and there still has been no public response.

http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=1&commentId=2013420%3AComment%3A19917&x=1#2013420Comment19917

I repeat the three questions directed to IDM, here on the PennWell forum. (I no longer send emails to IDM because I no longer have to; they are watching intently and I assume are too scared to squeal).

1. What is the financial arrangement between IDM and the ADA? How is the profit split?

2. How is marketing of your advertisement business handled when it is performed by the ADA? For example, on November 13, an article with no byline appeared on the ADA News Online with the title “Can your patients find you online? – What you need to know about search engine marketing”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?

Who paid for your advertisement on my professional organization’s website?

3. If two ADA members are the only dentists in a small town, will the dentist that spends the most for your services get the best representation?

If anyone else has a question for IDM, be my guest. The line is open. Intelligent Dental Marketing is defenseless.

D. Kellus Pruitt; DDS
Jeff, on December 4th, 2008 at 11:32 AM Said:

Are Financial Advisors Still Needed?

Does all this information obviate the need for financial advisors? For many smaller or DIY physician-investors, it certainly has reduced the need by outsourcing these functions to the doctor himself.

However, the experience and knowledge of a trusted, educated, degreed and fiduciary financial advisor is still heavily relied upon for anyone requiring “professional” assistance, complex trading, disciplined integration or higher-end services. They haven’t gone away; they just have to adapt what they do, how they provide their services, and who their physician-clients are. The entire financial planning process is in; the product sales process is out. Most importantly, the nomenclature obfuscation and verbal word parsing, for enhanced perceived credibility, must be exposed.

In essence, financial advisors have to re-engineer themselves and move up the value chain. Those who do re-educate will flourish; those who can or do-not, will die. It is no longer a business-as-usual ecosystem.

-Jeff
Jeff, on December 4th, 2008 at 1:18 PM Said:

Primary Care Fiasco

“Let us not forget the looming physician shortage at the primary care entry level of patients into the system. Universal coverage without primary is access is meaningless. Just ask Massachusetts citizens. And if Congress follows its formula for cutting Medicare by 21% in June 2009, we will have a political donnybrook of unimaginable dimensions on our hands. If that cut occurs, it is likely 1/3 of physicians will no longer accept new Medicare or Medicaid patients. The outcry from the disenfranchised but entitlement-minded populace will be thunderous”

Richard Reece; MD
From: Who will speak for independent physicians at the reform table?
Link: http://www.thehealthcareblog.com/the_health_care_blog/2008/12/index.html.

-Jeff
Darrell, on December 6th, 2008 at 2:15 AM Said:

I’ve been a bad boy!

Allow me to share with you the latest discoveries coming out of the PennWell Community College course “Social Networking – Advanced Studies” [not for credit].
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced

I am aware that not everyone in my sphere is interested in Search Engine Optimization (SEO), and its bastard, tactless, unshaven cousin, Unconventional PR Warfare (UPRW). However, I just know that some of my readers are just like me – fed up with bureaucratic lies and intensely interested in learning how to send unaccountable door-to-door salespeople on down the road – not only to improve the neighborhood, but just for grins.

If that is what interests you, then you probably will not find the following investigation tedious at all. I try my best to keep it as interesting as possible. You can bet that a handful of officials from the ADA as well as IDM are following it very closely – each high-ranked and shy individual quietly hoping that I won’t post something with their name on it. Which brings me to this question: I wonder who in the ADA was responsible for spearheading the drive to get members in bed with an insensitive advertisement firm called IDM. (Did I hear a groan from Chicago?)

The investigative thread that I present below is still in progress. It begins with a comment I posted on December 3 titled “A real-time puzzler.”
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=2&commentId=2013420%3AComment%3A20858&x=1#2013420Comment20858

For those who have a freakish interest in this kind of thing, you can catch the background there. For those with merely abnormal flaws in their personalities that cause them to want to watch things like train wrecks, it is not difficult to pick up the story from this morning’s continuation.

One additional note: There are links to several of my jagged posts that chafe good ol’ boys badly. Even if you don’t read the links, please do our neighborhood a civic favor and at least click on them. That would be really swell.

Update: Test A (7 AM Central, 12.5.08)

Thought-provoking stuff; the unusual occurrences – Is what we are seeing state-of-the-art PR defense, or is it a normal quirk of google search? Science is fun!

RESULTS

The critical comment concerning the ADA’s business relationship with Intelligent Dental Marketing from Search Engine Marketing (SEM) competitor, The Visible Dentist, has hardly moved at all.
http://www.thewealthydentist.com/blog/493/dentists-quitting-ada-due-to-political-differences/

Yesterday, the comment was IDM’s 22nd hit in a googlesearch – just ahead of my “Want to make a difference with a click?” at number 23. Since then, the Visible Dentist comment only moved to hit number 20 – an insignificant random jitter. However, my comment “Want to make a difference with a click” completely disappeared from the first ten pages (100 hits).
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=2&commentId=2013420%3AComment%3A20678&x=1#2013420Comment20678

Now, only one of my initial three hits remains, and it is hidden on page 4 (number 32) when anyone, including a potential ADA/IDM customer, performs a google search of Intelligent Dental Marketing. And something strange happened to it as well.

When one clicks the link titled “Social Networking-Advanced Studies,” it directs the reader to “BCBSTX Test Results” – one of my posts that does not mention Intelligent Dental Marketing at all.
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=1&commentId=2013420%3AComment%3A19972&x=1#2013420Comment19972

Something else that puzzles me is the mixed-up meta description under the BCBSTX link: “Good luck, Intelligent Dental Marketing … Intelligent Dental Marketing (IDM) has not yet responded to my three questions – even”.

The first part; “Good luck, Intelligent Dental Marketing” is content from Lesson four, “Trapping a slow-moving beast” – a very critical open email to IDM.
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=1&commentId=2013420%3AComment%3A19917&x=1#2013420Comment19917

The second part of the meta, “Intelligent Dental Marketing (IDM) has not yet responded to my three questions – even …” is from Lesson five, “Using Google Strategically.”
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=2&commentId=2013420%3AComment%3A20107&x=1#2013420Comment20107

The keywords in the hit did not correspond to the link. Instead, the link re-directs the reader to my criticism of BCBSTX, as described in a comment I posted on the Executive Post titled, “The NPI and One DDS’s Opinion.”
http://healthcarefinancials.wordpress.com/2008/08/25/the-npi-and-one-dds%e2%80%99s-opinion/#comment-2075

DISCUSSION

I imagine that BCBSTX is not too happy about this circumstance, regardless of the cause. They would rather keep my Executive Post comment hidden as much as Intelligent Dental Marketing would like to keep “Cutting and branding a trapped beast” buried. (That is the one that I ended with: “I happened to learn about branding as a youngster decades before I learned about metaphors. Branding is an additional way to keep newly-formed steers in their place.
http://community.pennwelldentalgroup.com/forum/topics/time-is-up-intelligent-dental?page=1&commentId=2013420%3AComment%3A20574&x=1#2013420Comment20574

ADDITIONAL RESEARCH

I became curious about what lies between Intelligent Dental Marketing’s number one google search hit and their first critical comment – the one from The Visible Dentist at number 20. Here is what I found:

- The first three hits are advertisements sponsored by the ADA. There are two other deeper ADA hits, which brings the ADA-sponsored ads to 5.

- Not counting the ADA’s ads, there are 10 various Internet ads for Intelligent Dental Marketing, including 3 specifically for SEM.

- There is 1 link to a Columbia University Dental Associates website which is a legal disclosure to protect Intelligent Marketing from lawsuits arising from misunderstandings of what IDM can and cannot do for dentists.

- There are 2 hits for booksellers – both on the first page. They are Amazon.com and America’s Dental Bookstore links which advertise Intelligent Dental Marketing founder, Joel Harris’ book on dental marketing. I wonder if he discusses “Search Engine Optimization” in his books.

-There is 1 link to a dental blogger named Gregory (Flap) Cole; DDS, who approves of the ADA – IDM business partnership.

PROJECT PROPOSAL

It would be interesting to get Dr. Flap Cole’s opinion, which is 180 degrees counter to mine, posted on the PennWell forum.

Update: Test A (9 AM, 12.5.08)

RESULTS

Thanks to help from readers, my comment from two days ago, “Intelligent Dental Marketing disappoints ADA member Darrell Pruitt DDS” showed up on IDM’s first page this morning around nine o’clock.
http://community.pennwelldentalgroup.com/forum/topics/intelligent-dental-marketing

I imagine if IDM SEO geniuses are somehow fighting against my unconventional PR, they won’t have time to ski this weekend because they will be working overtime.

PROPOSAL

I’ll watch what happens to it.

- Will the popularity of my devastating comment suddenly drop two or three pages like my other comments did?

- Will the meta-description somehow end up with a link to BCBSTX again?

- Will anyone at BCBSTX get really pissed if the popularity of “The NPI and One DDS’s Opinion” that is posted on the Executive Post again increases because of readers hitting its link?
http://healthcarefinancials.wordpress.com/2008/08/25/the-npi-and-one-dds%e2%80%99s-opinion/#comment-2075

This is getting more and more interesting the deeper I plow.

Update: Test B (3 PM, 12.5.08)

The rank of my comment mentioning Trajan King has not moved from the number nine hit more than 24 hours after I posted a link to “Time’s up,” in which I offered the CEO of Intelligent Dental Marketing, that I (we) could help increase his fame.
http://community.pennwelldentalgroup.com/forum/topics/social-networking-advanced?page=1&commentId=2013420%3AComment%3A20549&x=1#2013420Comment20549

-Darrell K. Pruitt; DDS
Darrell, on December 7th, 2008 at 6:55 PM Said:

SEARCH RESULTS

In a previous post, I mentioned the September 19 Executive Post comment titled “Such a ‘Sleazy’ Company.”
http://healthcarefinancials.wordpress.com/2008/09/19/%e2%80%9csuch-a-sleazy-company%e2%80%9d/

It is the comment that is highly critical of Delta Dental.

This morning, Sleazy floated up to the twelve most popular posts, just like “The NPI and One DDS’s Opinion” did the day before – which is critical of BCBSTX’s use of the NPI number.
http://healthcarefinancials.wordpress.com/2008/08/25/the-npi-and-one-dds%e2%80%99s-opinion/

DISCUSSION

The report cards are out, and everyone passed. I am proud to declare that the first class has reached an “aha!” moment in understanding the mechanics of Unconventional PR Warfare and strategic use of search engines. Now we simply need more content creators who can ignite marketplace conversations about neighborhood issues that I cannot possibly reach. These techniques are not limited to dentistry, and it will soon be the rage.

Preview of Lesson 6: I am working on Section II, which I think will move from the mechanics of social networking into advanced theory of marketplace conversations. I can’t think of anything more current and relevant for this PennWell Community College course: Our nation will soon accept a fresh administration during the worst economic times in 30 years. Even silence is bankrupt.

Over a year ago, I started following Barack Obama’s plans for transparency. In the last week I monitored his efforts towards change described on the “American Moment” section of his blog, Change.gov.
http://change.gov/newsroom/blog/

From what it appears, it looks like the change will be chaotic – at least at first. The new administration is trying to take a manageable sip from a fire hose of comments.

Regardless of one’s opinion concerning his plans for healthcare, President-elect Obama courageously promises transparency that McCain would have never been capable of delivering. Government from the ground-up may be our only way out of this mess, friends. Democracy is a participatory sport.

ONE MORE THING

Leaders of the American Dental Association, take heed. If the next President of the United States honors citizens’ concerns with transparent conversation, ADA President Dr. John S. Findley must show similar respect to dues-paying ADA members. “Findley for the Future” was his campaign motto. Now it is a brand he chose that he will forever wear – regardless if he turns it cynical.

This is simply not a good time in history to be an unresponsive, command-and-control dinosaur. Dr. Findley’s reputation is classically vulnerable. Only a month or so into his term, he already risks being re-defined as irrelevant and sidelined as a leader, even if he gets a nice plaque at the end of the year.

Let me give an example: I recall an article that appeared in the ADA News Online on October 21 titled “Staying true to the Association’s values is key: Dr. Findley“. It was written by James Berry.
http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3272

Berry writes that when addressing the ADA House of Delegates, Findley said that “Transparency is essential if you expect and demand accountability, and you should.” Exactly.

Here is a critical response that I posted on the Executive Post on October 30 titled “ADA ‘Transparency’ in Health IT [Part 1] – It all Depends on the Meaning of the Word.” http://healthcarefinancials.wordpress.com/2008/10/30/ada-%e2%80%9ctransparency%e2%80%9d-in-health-it-part-i/

Please come visit my neighborhood, Dr. John S. Findley – lest your brand, “Findley for our Future” be grossly misunderstood.

D. Kellus Pruitt; DDS

Editors Note: Dr. Pruitt blogs at PenWell, and others sites, where these posts and comments first appeared.
physicians foundation, on December 8th, 2008 at 9:33 AM Said:

BOSTON, Nov. 18 (UPI) —

Nearly half of all U.S. primary care physicians want to stop practicing or reduce their patient loads, a survey of primary care physicians indicates.

See more surveys on doctor discontent:
http://www.newsandweb.com/physicians+foundation.html
Kathy, on December 9th, 2008 at 1:52 AM Said:

According to the Associated Press, December 1, 2008, Federal health officials estimate that the struggling economy will speed up by one to three years the exhaustion of the Medicare trust fund covering hospital and nursing home care.

Trustees for the Social Security and Medicare programs warned last March that the trust fund for Medicare Part A would become insolvent in 2019, but the chief actuary for Medicare said Monday the economy will likely generate less revenue through payroll taxes than the trustees had projected. Once the trust fund is exhausted, the federal government will continue to pay for hospital care and other services, but it initially would only have enough money coming in to cover 78 percent of estimated costs.

-Kathy
Kathy, on December 9th, 2008 at 11:35 AM Said:

New Book Review

In the just released book, “The Best Practice,” Charles Kenney chronicles the long march toward a culture within American health care that demands continuous quality improvement [CQI].

Recall, it was twenty years ago – “today” – that it was almost heretical to question the quality of American health care. The common refrain being that it was unarguably the best in the world.

Decades of work by Berwick and others, however, have dispelled that myth, and the underlying belief that medical errors and hospital acquired infections are simply an artifact of the business. These quality champions deem it unacceptable that as many as 98,000 Americans die annually from preventable medical errors, and that most Americans receive the recommended care only half the time.

They’ve spent years building their case, and in turn created a social movement around their cause. And, the case deserves a read!

-Kathy
Darrell, on December 9th, 2008 at 6:07 PM Said:

Electronic Health Records and Tyranny

I posted this on PennWell in response to the below.
By Darrell K. Pruitt; DDS

Electronic Health Records and Tyranny
http://community.pennwelldentalgroup.com/forum/topics/electronic-health-records-and

An article written by Alex Nussbaum was posted on Bloomberg.com this morning titled “Insurers, Costs Spurring Faster Rise in Online Medical Records.”
http://www.bloomberg.com/apps/news?pid=20601109&sid=aX4cYX.5J0pg&refer=home

Note: Dr. Pruitt blogs at PenWell, and others sites, where this post first appeared.
Amaury, on December 9th, 2008 at 7:40 PM Said:

My Response,

In the new-era, physician-investors should consider reviewing their advisors’ investment strategy and financial planning advice. Although the above post does provide some food for thought; I think all of the statements are not completely accurate.

Using an advisor to assist you in choosing your investments and financial planning strategies can save you time and money. This of course, makes the assumption that you need to delegate the work.

Example, let’s look at the analogy of fees vs. commissions. Yes it’s true that a fee based financial advisor will earn more over time versus just buying one fund family and taking advantage of break even points. However, if the need arises to rebalance the account, and the choices are inadequate, you might incur new sales charges to buy a new fund.

Also, it may be time consuming to review all the funds available. Not all mutual funds are created equal and each provides different approach to investing. DFA or American Funds are two good examples of different fund families.

Furthermore, if you decide to buy individual stocks and bonds, the research can be time consuming. What is your time worth? What would you pay for someone to provide you the research? The recommendation of the stocks and bonds do not come from computer software, but from real analysis.

Also, it is not accurate to say that all advisors will take more risk since they get compensated less for cash and bonds. If you believe in the concept of asset allocation models, then offering these asset classes are going to define themselves based on your desired portfolio risk.

In addition, what if you have a question related to another financial planning issue? You will not be able to call that mutual fund company for advice.

In conclusion, physician-investors that decide to hire and advisor, should trust but verify the information provided to them. Hire an advisor who understands your specific needs and is willing to provide multiple solutions and fee structure.

Think New-Wave, think for yourself, and use the resource available to make informed decisions. But, is this really new or just forgotten with the good times?

-Amaury S Cifuentes, CFP®
Darrell, on December 9th, 2008 at 11:54 PM Said:

Attention Allscripts,

I posted this follow-up to my last comment “Electronic Health Records and Tyranny.”
http://community.pennwelldentalgroup.com/forum/topics/electronic-health-records-and?page=1&commentId=2013420%3AComment%3A21533&x=1#2013420Comment21533

I could say that stimulating discussion on this forum is like pulling teeth – except that I am good at pulling teeth.

Maybe another quote or two from the inflammatory article by Bloomberg reporter Alex Nussbaum will start a fire somewhere. Glen Tullman, CEO of Allscripts, is a real piece of work. I think he is a typical vulnerable lightweight who shuns transparency in traditional ways. I also think that together, we can easily trap this slow-moving dinosaur. It will be fun trying, and after all, it’s the American thing to do.

According to Bloomberg reporter Alex Nussbaum, Tullman thinks Obama should expand on reforms passed this year in Congress. “Those changes give doctors a 2 percent increase in Medicare and Medicaid reimbursements if they use electronic prescriptions. A 2 percent penalty will kick in within two years for doctors who don’t follow suit.”

Even though the rest of the nation’s economy is in the drink, Tullman boasted that Allscripts has seen a fivefold increase in the number of U.S. doctors using its electronic prescribing software. His company is the largest U.S. provider of software to doctors. I think that makes him royalty or something.

Nussbaum reports that Tullman says he thinks that future federal spending should be tied to physicians’ use of the system, and perhaps come in the form of loans, “to ensure doctors have some skin in the game.”

This is worth repeating: Glen Tullman thinks that providers should have to take out loans to buy his product “to ensure that doctors have some skin in the game.”

Are you feeling the itch yet?

Remember, Glen Tullman is the CEO of Allscripts, and was addressing a forum sponsored by Nasdaq OMX Group Inc. and Leerink Swann & Co. This won’t make you feel any better: Shortly after Tillman pronounced his vision of our future, Allscripts stocks rose 35 cents (almost 5 percent).

Seriously, just how does Tullman make you feel?
You can tell me.
I’m a doctor.
D. Kellus Pruitt; DDS
Jackie, on December 12th, 2008 at 8:28 PM Said:

More on SearchAmerica,

According to the Wall Street Journal, December 10, 2008, credit-reporting bureau Experian PLC agreed to acquire SearchAmerica Inc., a closely held company in the business of mining patients’ financial data to help hospitals determine how likely patients are to pay their medical bills.

With the $90 million purchase, Experian is getting heavily involved in health care at a time when hospitals are struggling to collect from both the uninsured and underinsured, while Equifax Inc. and TransUnion LLC, credit-reporting bureaus based in the U.S., also offer services that help hospitals get a sense of patients’ incomes and payment likelihood.

-Jackie
Nigel, on December 13th, 2008 at 4:04 PM Said:

“New-Wave Thoughts on Investing

After reading about the Bernard L. Madoff Wall Street scandal, I like my new-wave idea the best.

Link: http://blogs.moneycentral.msn.com/topstocks/archive/2008/12/12/how-does-a-scammer-lose-50-billion.aspx

TRUST NO ONE WITH YOUR MONEY. Sorry, if you lost any.

Cheers.
-Nigel
Debra, on December 13th, 2008 at 4:28 PM Said:

The hope of firms like 23andMe, Navigenics, DeCodeMe, and others, that are aimed at promoting cures and treatments – like CollabRx and Cure Together – is that the body of knowledge from both genomics and overall patient experiences will advance fast enough so that the current situation of “more diagnosis with less ability to change the outcome” will slowly change to one where knowing your likely health future will help you avert some of the worse consequences.

-Debra
Darrell, on December 13th, 2008 at 4:45 PM Said:

More on Allscripts,

I sent an email to Glen Tullman which features the response I submitted concerning his October 15 live chat on HIStalk. I then posted the open email on PennWell. Almost immediately HIStalk posted my comment on their website. That is why I followed my PennWell comment with this reply:

“Within minutes HIStalk posted my harsh assessment of Glen Tullman. I am pleasantly surprised. Even though it is unlikely that anyone from Allscripts will respond to the challenge, maybe it will draw some irate and unprepared IT hobbyists or Tullman hangers-on into the open. Then we’ll have us some real fun.”

I intend to burn Glen Tullman as an example for other unresponsive stakeholders who might have their sights on politics.

-Darrell K. Prutt; DDS

Note: Dr. Pruitt blogs at PenWell, and others sites, where this post first appeared.
http://community.pennwelldentalgroup.com/forum/topics/glen-tullman-ceo-of-allscripts
Darrell, on December 14th, 2008 at 7:38 PM Said:

Trapping Scott Serota – CEO of BCBS
By D. Kellus Pruitt; DDS

I posted this on PennWell, as well as on Anne Zieger’s FierceHealthIT blog in response to her comment about BCBS.
http://www.fiercehealthit.com/story/spotlight-bcbs-association-plans-healthcare-it-reforms/2008-12-08#comment-565

The title of Anne Zieger’s lead, which describes an article on Healthcare IT News, is “SPOTLIGHT: BCBS Association plans healthcare IT reforms.”

Should BCBS plans cause doctors and patients concern – Judge for your self?

I read the article written by Dana Manos a couple of times. It is obvious that Scott Serota, president and CEO of BCBS of America, is scared. His insensitive arrogance reminds me a lot of another struggling CEO, Glen Tullman of Allscripts.
http://community.pennwelldentalgroup.com/forum/topics/glen-tullman-ceo-of-allscripts

Like Tullman, Scott Serota’s timing and sense of urgency betrays to attentive and active analysts like me that the government is not moving fast enough to suit Blues’ business plan to cut out a nice profit from patients’ healthcare dollars and call it “reform.” To understand their quiet crises better, here is some background information about semantics. The nature of the noun “reform” is different than the noun “transparency.” “Reform” can be used as a buzzword.

Of course, one could argue that Serota is very transparent in his plans to use the immense size of BCBS to force change. One should not confuse transparency with common Bush-league intimidation. Surely by now everyone recognizes that BCBS cannot tolerate accountability to doctors and patients – and transparency is exactly what Obama brings. If you have not done so yet, visit Obama’s website Change.gov.
http://change.gov/newsroom/blog/

Now imagine how obsolete traditional silence will look when sleazy tactics from BCBS are openly discussed on future HHS Secretary Tom Daschle’s blog – by thousands of angry providers and patients. There is already a long backlog.

Serota is running scared all right. BCBS’s business model matured in obscurity and is classically soft. It is just one more fat, slow-moving and unresponsive dinosaur on the verge of extinction. I’ll prove it. It may take a week or so. I got a head start working on the monster’s tender spots a while back in an article titled “The NPI and One DDS’s Opinion” that is posted on the Medical Executive-Post blog. It has proven to be very popular.
http://healthcarefinancials.wordpress.com/2008/08/25/the-npi-and-one-dds%e2%80%99s-opinion/#comment-2075

Not unexpectedly, nobody from BCBSTX has yet found the courage to defend their employer. I think that means Scott Serota is also vulnerable. He is defenseless by association. Transparency to BCBS is like water to the Wicked Witch of the West.

For the immediate future, not one person in the whole organization can be held accountable to providers, yet “Pay for Performance” – an substitute for our free-market system – is one of the five initiatives stressed by Scott Serota to attendees at the e-Health Initiative’s annual conference earlier this month – an enthusiastic collection of healthcare IT stakeholders and hobbyists.

Here is my open challenge: Scott Serota, please come defend yourself right here on Anne Zieger’s website. I’m sure she won’t mind, and it would improve your reputation with doctors.

Unless you haven’t heard, it stinks and will get exponentially worse very soon.

Note: Dr. Pruitt blogs at PenWell, and others sites, where this post first appeared.
John, on December 14th, 2008 at 10:32 PM Said:

I read that according to a recent Harvard study, over 80 percent of all hospital bills have at least one error. Is that accurate? Incredible.

Does this software help with billing accuracy, or is it just operational efficiency, capacity and scheduling?

Thanks
-John
Ann, on December 16th, 2008 at 12:27 AM Said:

More on Daschle,

According to writer Maggie Mahar, the problem with domestic healthcare today is that: “too many proposals for health care reform focus solely on universal access and run the risk of sending good money after bad”. The question we need to ask is: “access to what”?

And, as healthcare journalist Merrill Goozner often points-out “while the lack of insurance leads to an estimated 22,000 unnecessary deaths each year, medical errors kill nearly 100,000—and most of those people were undoubtedly well insured.”

How can this be? As regular readers of the Medical Executive-Post know, while uninsured patients are undertreated, in our money-driven health care system, well-insured patients often are over-treated. And overtreatment can be dangerous. Unnecessary hospitalizations lead to hospital-acquired infections, wrong side surgery and medication mix-ups. Unneeded tests lead to false positives, false negatives, and treatments that can expose patients to risk without benefit.

And so, we trust the new doubly appointed healthcare czar, Tom Daschle, takes the above into consideration has he begins his efforts.

-Ann
Jim, on December 16th, 2008 at 1:32 PM Said:

Brutal as the 2000-02 bear market was, at least big chunks of the market were in the black. Value-oriented funds (particularly ones investing in small companies) and bond funds earned decent returns for most of the period.

-Jim
Amaury, on December 17th, 2008 at 11:13 AM Said:

More on ARs,

To enhance the collection of accounts receivable, physicians should consider increasing the number of accounts that their staff can handle. The following suggestions will help increase the number of accounts, per staff member, and increase the possibility of collecting prior to referring the account to an outside collection agency.

Standardize your collection policies and procedures and allow the staff and management to offer the same terms to the patients. Be willing to accept the same terms that a collection agency would accept on your behalf. This will reduce the number of patients contacted by your staff.

Use your technology effectively. Standardize your letters sent to your patients. Include in your letter not only the balance due, and net payable amount, but options to pay over longer periods. Offer solutions for payments, not just demand of payments.

Establish routine orders to review the accounts, not just those over 120 days old. In addition to separating accounts by size, you should separate accounts by possibility of collecting or the possibility of not collecting.

For example, accounts that have moved out of the geographic area will be more difficult to collect since it is unlikely that the patient will use your services again. Also, if the client has minimum assets or the assets are protected, like a homestead property in Florida, heavy collection or judgments will be ineffective. This will help you establish a policy for charging off accounts or referring the account out to a third party earlier and reduce staff time in working accounts that are uncollectible.

Establish an efficient system for collecting small balances by automating your collection letters for those small balances to reduce labor cost and to increase staff effectiveness.

Since collections can become very time consuming, and expensive using an outside agency for those improbable accounts, one should be considered immediately. However, choosing an
out-side collection agency requires some due diligence.

Consider using an agency that is local in the area. Check with your State to see if there are excess complaints against the collection agency. Review the payment structure they offer to the collectors and the monitoring system they use. What policy do they set for charges?

The above will assist you in increasing the number of accounts your staff can handle which should increase your collection attempt on your accounts receivable.

-Amaury S. CiFuentes; CFP
Dr. Bill, on December 31st, 2008 at 1:14 PM Said:

The Madoff Tax Problem,

Since the taxes paid in this case were on “phantom profits” as a result of the Ponzie scheme; what might be some of the tax implications for investors who paid based on CG, IN and DIVs that never really were there?

How can the IRS be reigned in? Any thoughts?

-Dr. Bill
Amaury Cifuentes, on December 31st, 2008 at 6:42 PM Said:

Charitable Donations

During the year, many of us make donations to our favorite charities. Typically, the donations are made in cash or property. Property or non cash items are deductible up to their fair market value. The tax deductions for charitable contributions are limited to 50% of your adjusted gross income or 30% for appreciated property. However, if you volunteer your time you can deduct the mileage driving to the charity, which can be either 14 cents per mile for use of your automobile or the actual expense like your gas. Furthermore, you can deduct 100% of your out of pocket expenses, but not your actual time. It is recommended that you receive a receipt from the charity or be able to provide proof by bank check for deduction purpose.

Paying Expenses and Delaying Receivables

Paying expenses and depositing receivables is done on a routine basis. However, December is an excellent time to pay those expenses normally be paid in early January, in addition to buying items that can be deductible immediately. Also, you can delay posting receivables the last two weeks of December. This net effect will increase expenses and lower revenues for the current year.

-Amaury Cifuentes; CFP
Darrell, on December 31st, 2008 at 7:08 PM Said:

You started booming about the time I joined. I did the same thing to PennWell. Now I’m going to work on DrBicuspid .com. My pleasure.

-Darrell K. Pruitt; DDS
Bill Winterberg, on January 1st, 2009 at 6:30 PM Said:

The SEC also provides a website to evaluate the basic characteristics of investment advisers and their firms.

http://www.adviserinfo.sec.gov/IAPD/Content/Search/iapd_OrgSearch.aspx

The site reveals Part I of the Form ADV, but not Part II which has much more specific information. Prospective clients can always request to view a firm’s ADV Part II before becoming a client. Lots of disclosure information is included in the ADV Part II. Some advisers include the form on their website for easy access while others only deliver it upon request.

Bill Winterberg; CFP
Portland, OR
Barton, on January 2nd, 2009 at 8:33 PM Said:

ADVERTISEMENT

For help on choosing the best practice management software, check out this free white paper located at http://www.nuesoft.com/news/white_papers/medical_software_vendor_integration.html

Barton J. David
NueMD.com
Amaury, on January 3rd, 2009 at 8:51 PM Said:

Pantom Profits

Unfortunately, the investors are going to have an uphill battle to recoup some of the taxes paid on “phantom profits”. However, investors do have some options under the current I.R.S. code.

First, investors will in some situations have the ability to amend their tax returns and recoup some of the taxes paid. This currently is limited to the last three years and is subject to limitations. It must also be completed by April 15, 2009 to be able to file amended returns back to 2005.

Second, investors may be able to claim “Theft of Loss”. The I.R.S definition of loss:
1.165–9 26 CFR Ch. I (4–1–07 Edition)

(d) Definition: For purpose of this section the term “theft” shall be deemed to include, but shall not necessarily be limited to, larceny, embezzlement, and robbery”

No doubt investors will find this issue to be more complicated than just filing a return including the theft of loss. Investors that wish to take losses will have to prove when the losses were realized (current year or previous years), what the amount of funds was stolen (initial amount and what was received back), and what was done with the proceeds (who got paid, investors, advisor, hedge funds, etc).

This will be difficult and time consuming and discrepancy between the investors and I.R.S. opinions of these facts will vary.

Sadly, dealing with “Ponzi” schemes are not new to the I.R.S and investors may face extreme challenges in recouping some of the funds. It is extremely important that investors work closely with their tax advisor in determining the best course of action for their unique situation.

Furthermore, the magnitude of this case will prove to be different in my opinion due to the large dollar amount and so many high profile investors. It will be without a doubt many years before all issues are settled, but changes from the I.R.S, Wall Street and Investors requirements might be forthcoming. One possible change might be a broad settlement with the I.R.S and Trustee for the investors involved in “Ponzi” schemes.

-Amaury S. Cifuentes; CFP
Ann, on January 4th, 2009 at 2:50 PM Said:

Welcome Fiduciaries … Seriously?

New CFP board standards could make suing insurance agents, and carriers easier.

According to Darla Mercado, on June 16, 2008, InvestmentNews, the “leading news source for financial advisors”, new rules require CFP certificants to act as fiduciaries.

CMP charter-holders from iMBA, Inc., have been fiduciaries since inception.
http://www.MedicalBusinessAdvisors.com

Yet, the the new CFP board requirements did not commence until January 1, 2009. What gives? Why so long? Why not disclose conflicts-of-interest, commissions and payments to potential clients?

And, can CFPs “opt-out” as was originally proposed?

Read More: “The new CFP standards could make suing agents, carriers easier” – http://www.InvestmentNews.com

-Ann
http://www.CertifiedMedicalPlanner.com
Jack, on January 4th, 2009 at 3:35 PM Said:

On the SEC

“Way to go Brownie!”
Er-ah! Chris Cox of the SEC.

-Jack
Dr. Pruitt, on January 4th, 2009 at 5:39 PM Said:

More on Inter-operable Electronic Dental Records

In addition to posting an announcement on PennWell, I posted this comment on a surrogate blog I have used in the past to drum up attention.
http://www.topix.net/forum/med/dentistry/T0GLLJEPSJAJJDBCJ/p5#lastPost

Hope the New Year is going well for all my sports fans who don’t mind watching truth uncovered – hair and all.

For anyone interested in seeing what I stepped in, I am involved in a couple of threads with both Dr. Marty Jablow and Dr. Valerie Powell on DrBicuspid.
http://www.drbicuspid.com/forum/tt.aspx?forumid=2

The subject is interoperable electronic dental records – good or bad. I think what we hear about them is just hype, and I am holding Jablow and Powell accountable for what they are telling other dentists on the Internet. I think it is incredible that neither one of them acknowledges even a single problem to going digital.

Marty doesn’t seem to believe breaches occur at all from dental offices and they both see huge problems with paper, fax machines and telephone calls. To hear them talk about how bad paper records are, it is a wonder that the profession has survived for several decades with such remarkable safety. I think these two stakeholders are capable of world-class cognitive dissonance.

It is my opinion that Dr. Marty Jablow and Dr. Valerie Powell are running out of wriggle room. I am considering presenting the unanswered questions from the abandoned debate on PennWell soon – just to tighten the squeeze chute another notch. (see “EHR / PACS – The Great Debate”)
http://community.pennwelldentalgroup.com/forum/topics/2013420:Topic:14859

I bet it will cause either excitement or silence. Either way, my patients win. Please come visit us.

D. Kellus Pruitt; DDS
Darrell, on January 4th, 2009 at 5:48 PM Said:

On eDRs [Dentists are Different]

I haven’t sent you anything since the opening combinations I hailed down on Dr. Marty Jablow regarding the difference in eDRs from whole body medicine and eHRs. If you haven’t been following my exchange with him on DrBicuspid, let me say it got weird. I left him bleeding. Marty just would not take a dive like most do.

Then I tangled again with Valerie Powell PhD. She is currently trying to dodge me, but I have her penned against her own buzzwords and I won’t let her squirm free. If you are interested, these little skirmishes are occurring on DrBicuspid.
http://www.drbicuspid.com/forum/tt.aspx?forumid=2

Seriously now!

I posted the following on both DrBicuspid and PennWell. It’s an important one.

The “Conscience Rule” and eDRs

David Templeton, a reporter for the Pittsburgh Post-Gazette, posted an article on their website this morning titled “Conscience can now be guide for reproductive health workers.”
http://www.post-gazette.com/pg/09003/939386-85.stm

He describes the last-minute push by the U.S. Department of Health and Human Services [DHHS] to support healthcare providers in their decision to withhold treatments from patients if doing so is against a provider’s conscience. Specifically, it is about abortion.

“The proposed regulations will reinforce and reaffirm existing federal laws which prohibit recipients of certain federal funds from coercing individuals in the health care field into participating in actions they find religiously or morally objectionable,” said John M. Haas, president of the National Catholic Bioethics Center in Philadelphia. “If you do not believe in performing an abortion, you want to be protected from being forced to do that. Others may disagree with us, but we are not forcing them to violate their conscience.”

Since this “conscience rule” will go into effect the day before Barack Obama is sworn in as our next president, do you think a dentist say in Fort Worth might stretch the envelope of the law and declare he or she morally objects to forcing dangerous and expensive electronic dental records on his or her patients?

I smell a fight. Maybe this Rule will eventually mean that the NPI number will no longer be required for a dentist to participate in CHIP in Texas – treating the poor. CHIP, of course, receives federal funds. This could get exciting.

Facing overwhelming odds, ADA President Dr. John S. Findley and others gave up the fight for moral sovereignty long ago. In September, Dr. Findley stated in an interview that “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’”
http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp

Wanna bet on it, John?

D. Kellus Pruitt; DDS
Amaury, on January 5th, 2009 at 3:34 PM Said:

Linda,

Based on the information you provided it appears that you might be able to claim a loss on your tax returns. I am assuming the following:

* Initial Investment: $50,000.00
* Surrender: $2,300.00 (approximately)
* Surrender Value $38,333.50 (approx $38,333.50 x 6% penalty = $2,300.01)

Annuities have a ten percent penalty on early withdraw before the age of 591/2; however, this only applies to gains. You cannot deduct your penalty paid on the annuity of $2,300.00 as a realized loss. Your accountant may have you deduct the loss of $11,666.50 (approx) since you completely surrendered the annuity.

First, your accountant may include the loss as a miscellaneous item by itemizing the deduction on your schedule A of your tax return. The loss will be subject to 2% of your adjusted gross income and may be subject to Alternative Minimum Tax.

Second, your accountant may have the loss considered an ordinary loss during the current year while entering into a transaction for profit. This full loss could be deducted without AMT issues.

However, please be advised that the IRS Ruling 61-201 provides minimal amount of authority regarding the losses of the annuity to be acceptable as ordinary loss. It is strongly recommended that you seek the advice of your tax consultant since this can be questioned by the IRS. Unfortunately, the IRS has not provided proper guidance on how to deduct losses from annuities.

Good luck!
-Amaury Cifuentes, CFP®
Dr. Darrell, on January 6th, 2009 at 12:36 AM Said:

You’ve treated me wonderfully. Best wishes for ‘09.
-Darrell Pruitt; DDS
Dave, on January 6th, 2009 at 10:59 AM Said:

Telescopic Philanthropy

Considering the financial mismanagement and extreme revenue seeking tactics of many not-for-profit hospitals today, much like Mrs. Jellyby the misguided do-gooder in Charles Dickens’s “Bleak House”, some practice a form of “telescopic philanthropy” [first termed by Richard Oastler; in 1727].

You recall, she was the character who neglected her chaotic family to devote time to improving conditions in distant Borrioboola-Gha, Africa. This is akin to some charitable CEOs showing a tendency to neglect the crying needs of those patients around them.

In other words, charity should begin at home.

-Dr. Marcinko
Dr. Mary, on January 7th, 2009 at 12:57 PM Said:

More Federal Debt?

If consumer debt got us into the current financial mess; how can more Federal debt via the bailout, be helpful?

In the last decade the federal deficit has ballooned from 2.0 to 3.5 trillion dollars!
So, how many generations will it take for our kids and grandkids, to pay this off?

When you get into a hole; maybe it’s time to stop digging?
-Dr. Mary
Richard, on January 7th, 2009 at 11:03 PM Said:

Institutional Pro-Bono Medical Care Takes A Fall!

Did you know that a new study suggests that with the economy still limping, charitable giving is likely to fall off this year?

Yep, it’s true according to Ann Zieger of Fierce Health Finance on January 7, 2009. About half of non-profit hospitals and healthcare institutions expect to see a slowdown in giving, averaging about 17 percent overall, according to the survey from the Association for Healthcare Philanthropy.

-Richard
Dr. Marcinko, on January 8th, 2009 at 12:46 AM Said:

And, the Real Question Is?

Are health-policies, medial licenses, DEA numbers and CEU credits, etc., designed to provide security for doctors and medical practices? OR, is it to actually assist patients. The rise of health 2.0 web-enabled initiatives seems to suggest a competitive barrier to entry, rather than real patient protection.

And, while licensure protections may have indeed been needed back-in-the day, they are less needed this-day. But, we’d love to hear some opinions. Agree or not!

-Dr. David Edward Marcinko
Dr. Pruitt, on January 8th, 2009 at 7:36 PM Said:

Oh yea!

Speaking of the new administration, I was quoted today in an article written by Kathy Kincade, Editor-in-Chief of DrBicuspid titled “Electronic health records: Part II Patient privacy and ROI.”
http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=301344&wf=34

Of Insecurity

“The many benefits that are possible from data mining interoperable eHRs will never be attained if patients or doctors don’t trust the security,”

Said Darrell Pruitt, D.D.S., of Fort Worth, TX, and a prolific online commentator about eHRs told DrBicuspid.com in an e-mail.

“If the stakeholders roll out a product that disrespects patients’ rights to privacy, Americans will never trust EHRs, and all the magic that could benefit our grandchildren will never be realized.”

-Darrell K. Pruitt; DDS
Darrell, on January 8th, 2009 at 7:50 PM Said:

A Follow-Up,

Today, President-elect Barack Obama posted this on his website:

“To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. But it just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.”

Link: http://change.gov/newsroom/blog/

Note that Obama did not say “except for dentistry.”
Won’t he be surprised!

-Darrell K. Pruitt; DDS
Dr. Darrell, on January 8th, 2009 at 7:59 PM Said:

More on the Reply to Dr. Valerie Powell
http://www.drbicuspid.com/forum/tm.aspx?m=542

Dr. Powell, I have said this before to many people publicly and privately. I have gained great respect for you. I sincerely admire you for your compassion, your drive, your knowledge of chronic diseases and your toughness in the face of adversity. Wherever you and I go from here, I consider you my friend who I sometimes disagree with 180 degrees. I truly feel honored with your presence. What we are accomplishing here is good. The nation is watching.

“You made it clear to me what your concerns were/are about privacy and EHRs and about costs and EHRs and I sent you verification that my EHR integration agenda now includes the concerns you identified, so obviously I agree that those points need to be addressed.”

When you mentioned to me that you inserted my concerns about privacy and cost into your agenda, I was flattered. I wish you would have run your ideas by me sooner, though. I would have told you not to waste your time. Your concession is simply not enough.

Even if a dentist is shielded from lawsuits following a breach of his or her patients’ personal information – soon to include complete digital medical histories as well as PII – lawsuits are just part of the problem.

- Immediately the patients involved in the breach must be notified and the dentist must assume responsibility for helping them to monitor their credit for a couple of years. Of course, an attorney will have to be hired, and agreements signed with each patient, so it could get really expensive. A couple of years ago, the Ponemon Institute estimated that it costs around 80 dollars per client when breaches occur. The institute also predicted that 20% of the clients will never return to a place of business that fumbles their identity.

In other words, even if a dentist does the right thing following a breach, his or her practice could easily be ruined. Lawsuits make no difference at all. The dentist could be bankrupt even before the HIPAA fines are assessed.

Which brings us to …

- Authorities must be notified. This ultimately means a visit to the dental practice by PriceWaterhouseCoopers employees who are contracted by the HHS to perform HIPAA inspections. I assume they are paid on commission for the violations they uncover. I would also assume that the office computers could be confiscated for investigation if the breach involves crimes committed using the dental patients’ IDs to steal money or healthcare. And as I have previously mentioned, if one’s health history is altered, someone could be seriously injured or killed because of the breach. Am I wrong to want to shield my patients from this danger?

“So why don’t you approach your concerns as seriously as I approach mine? You could contact your congressman/woman to pursue improvement of health information technology.”

I’m not serious? Do you really question my seriousness just because I don’t contact my Congressperson?

Long ago I discovered that going through the accepted traditional channels to get things accomplished was impotent and frustrating. However, going after the sources of problems – such as your plans for my practice, Dr. Powell – is much more effective and fun.

“I incorporated the points you brought to my attention and moved forward, but, I’m sorry to say, you’re repeating the same things as when I first met you online.”

I’m funny that way about being stubborn, but you cannot sell me your product without satisfying those concerns. You have simply failed to do so. No sale.

Since you brought up seriousness, I want to share with you my favorite quote. It is from the master of aphorisms, philosopher Friedrich Nietzsche:

„Reife: Das heißt, den Ernst wiedergefunden den man als Kind hat, beim Spiel.“

“Maturity: That is, to rediscover the seriousness that one had as a child – at play. “

One should assume I am serious.

And now, nore about the hybrid solution:

“At the same time I know a hybrid fax technology that you hint at is not sufficient for patient care and others writing to DrBicuspid have already explained to you why it won’t suffice.”

Dr. Powell, this is the second time you have immediately dismissed my idea, only this time, you claim that “others” have already told me why it won’t work. What did I miss? Why, exactly will it not work? I don’t think you and Dr. Franklin Din truly considered it.

Remember, all we are talking about is simple exchange of information between machines. What difference does it make if one end terminates with paper? Where is the problem?

Once again, if you are waiting on interoperability, that could take decades, if it happens at all. On the other hand, I think if a simple universal format could be agreed upon – perhaps a one-page form highlighting significant medical/dental changes dentists/physicians should be made aware of – an interoperable hybrid system could be established within six months. You must agree that this solution offers a simple, super-cheap and safe way to exchange admittedly important health information.

All that is needed is a format, a collection of interested healthcare providers and someone with the connections to get this rolling. I can think of nobody better equipped to succeed than you, Dr. Powell.

Concerning the research stating that dental health histories are inaccurate, what makes you think digital health histories will be accurate if patients are overly concerned about their privacy?

But let us return to your early statement that 44,000 and 98,000 Americans die each year due to medical errors. I asked how many of those were connected to dental offices. I assume nobody knows.

Before dentists are asked to spend at least 20,000 dollars for a dangerous system that may be obsolete in three years, shouldn’t we base our decisions on evidence of need and not just guesses and unrealistic promises?

Once again, you are reaching for weak rationalizations for dentists to adopt paperless practices. I can confidently tell you that dentists recognize this immediately, which makes it a lousy, but nevertheless, entertaining sales pitch. Deaths of dental patients have never been a significant national concern until stakeholders needed it to be. Besides, where is the proof that reading information on an LCD screen is better than reading it on paper?

We sometimes have power outages from ice storms here in North Texas. Which records are easier to see with a flashlight – digital or paper?

-Darrell Kellus Pruitt; DDS
Dr. Pruitt, on January 8th, 2009 at 10:04 PM Said:

More HIPAA,

I posted this on Business Report.com in response to an article written by Anna Thibodeaux that was not truthful, in my opinion.

http://www.businessreport.com/news/2008/dec/29/not-your-fathers-dentist-tchn1/#comments

Fact or Ad?

Was the article “Not your father’s dentist” by Anna Thibodeaux a news item or a PR piece dressed up to look like news? It is difficult to tell. For the sake of accuracy in the marketplace, let’s figure it out.

Dr. Johnnie Hunt, a pediatric dental specialist in Louisiana has only had a paperless practice a month, yet she already claims that digital patient records are more accurate than her paper records were. It is simply amazing that she could discover that so quickly. Were there not any foul-ups in the transition from paper to digital? Not one? All I can say is that her paper records must have been incredibly sloppy.

Unfortunately, she will learn that computers don’t fix sloppy. They enhance sloppy in surprisingly sudden ways.

She also says that digital health records increase dental patients’ privacy. What if her computer is stolen from the office? What if the computer is hacked? In the last few years at least 160 million digital health records have been fumbled. How many paper records have been fumbled in the last 2000? That is also an amazing claim, Dr. Hunt.
She says digitalization preserves records in a disaster. What about a North Texas ice storm rather than a Louisiana hurricane? Which is easier to read with a flashlight – paper or digital?

What if one’s computers are suddenly confiscated by a federal agent who is investigating a massive ID theft which leads to one dentist’s practice? A Louisiana dentist can tell a hurricane is coming days in advance.

Pediatric dentist Dr. Johnnie Hunt says digital records cut costs. Everyone knows there is little hope of return on investment for physicians’ eMRs, and they have much more need for digitalization than dentists. That is why HHS Secretary Michael Leavitt had to bribe 1,200 physicians just to try eMRs.

Now, instead of producing digital records that doctors will buy, healthcare IT stakeholders are asking for GM-style bailouts from Congress. Don’t you know those will be special works of art. Think of the quality of a 1975 East German Trabant automobile. That is another sweet product of a captive market.

How can Dr. Hunt possibly say that digital records somehow lowered costs for her?

In his testimony to the Department of Health and Human Services over a year ago, ADA representative Dr. Robert H. Ahlstrom said:

“One dentist contacted the ADA recently and said that their current vendor was not going to update the current version in use today and instead the dental office would be forced to purchase a new system for $30,000-$40,000 dollars or return to submitting paper claims.”

http://www.ncvhs.hhs.gov/070731p08.pdf

Just how much was she paying her office help, and how many staff was she able to lay off?

Here is my favorite line in Anna Thibodeaux’s PR piece. Dr. Johnnie Hunt says:

“Computerized records also increase patient privacy, which is especially important to comply with the federal Health Insurance Portability and Accountability Act [HIPAA].”

Once one realizes that if a pediatric dentist has no digital records, HIPAA is irrelevant to the practice – it makes this argument cute in a childish way.

In dentistry, digital is a dangerous and expensive compromise; hardly an improvement. Let’s tell the truth.

-D. Kellus Pruitt; DDS
Ann, on January 10th, 2009 at 6:05 PM Said:

For 2009,

The IRS has announced the 2009 mileage rates to be 55 cents per mile for business, 24 cents per mile for medical and moving and 14 cents for charitable mileage.

This marks a decrease in the amount from the 2nd half of 2008 rate of 58.5 cents per mile for business, 27 cents per mile for medical and moving and 14 cents per mile for charitable mileage.

-Ann
Don, on January 10th, 2009 at 8:19 PM Said:

The Surgeon General?

Why does the Surgeon “General” wear a Navy-looking uniform? Shouldn’t he be called the Surgeon “Admiral”, instead?

-Donald
Scott, on January 10th, 2009 at 11:37 PM Said:

Moving-up-the Value Chain

The experience and knowledge of a trusted financial advisor may still be relied upon for those requiring professional assistance, complex trading, and/or needing deeper insight or higher end services.

They [FAs] haven’t gone away; but they’ve had to adapt what they do, how they charge and provide their services, and who their customers really are.

In essence, financial advisors must move up the “value-chain”.

-S. Shreeve; MD
Barbara, on January 11th, 2009 at 8:08 PM Said:

Absolute Minimum

Steven Podnos; an MD, MBA, and CFP™ certificant in Merritt Island, Fla., says requiring NAPFA members to hold the CFP™ designation should be the “absolute minimum” requirement. “I come from the medical profession which has very rigid licensing requirements,” says the former full-time doctor. “I think this space needs minimum certification standards, and CFP™ is the bare minimum.”

“It’s not the end-all, though,” he adds. “I think the industry needs to develop higher levels of education and certification, along with some level of board exams so the public knows financial advisors have a certain level of certification standards.”

From a recent e-trade magazine post.
-Barbara
James C. Pyles, on January 12th, 2009 at 12:28 AM Said:

Darrell and Executive-Post Readers,

Thanks for bringing me up to date. It appears that President-elect Obama is well-intended but people have been filling his head with nonsense about HIT saving money and saving lives. The cynicism of those who make the cost saving argument is revealed in the fact that they are trying to get funding in the stimulus package because nothing in that package is designed to save money but rather to put Americans to work. The Congressional Budget Office released its report in December finding that a nationwide HIT system will cost $500 billion over ten years and is unlikely to produce any net savings. “Evidence of savings in the health care sector as a whole is limited.” CBO Key Issues in Analyzing Major Health Insurance Proposals, p. 149 (Dec. 2008).

I am attaching an Open Letter to President-elect Obama which you may use as you see fit. You will note that every statement in the letter sets forth a fact that is corroborated in footnotes.

Keep up the good work.

James C. Pyles, Principal
POWERS PYLES SUTTER & VERVILLE PC
1501 M Street NW, Seventh Floor | Washington, DC 20005-1700
tel 202.466.6550 | fax 202.785.1756
jim.pyles@ppsv.com | http://www.ppsv.com
Darrell, on January 12th, 2009 at 12:34 AM Said:

Jim,

I hope the New Year is going well for you and your family.

This is a private email and/or blog post, but you are welcome to share it with friends you trust … or not.

It centers on the private conversation I am having with Valerie Powell PhD concerning the future of dentistry. Valerie already confided to me that she is also sharing our conversation with close associates.

I’m putting some things together and thought you might be interested in following the thread.

I don’t think I am stretching the truth when I claim that I have already set the pace for the future official negotiations over dentistry and electronic health records in front of the US Senate (mid-July?).

I’ll also tell you that the official plans of the ADA House of Delegates’ – whatever they may be – matter squat to me. If the House tune is not my tune, the House is out of tune. It is my opinion that regardless of what I personally do, it would be a really bad idea for the ADA to risk getting caught lobbying for IT bailout money. That would reliably erode any remaining credibility that the ADA has with Congress – following Ahlstrom’s controversial HIPAA testimony.

http://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry

That is just my opinion.

My counterpart at this point in my adventure is Dr. Powell, who knows everything about chronic diseases and healthcare IT, but she knows nothing about the business of dentistry – which I have discovered is typical for those who would manage our practices with swell and expensive ideas.

I look at the situation, and it occurs to me that I am the only dentist in the nation saying anything at all about electronic health records in public. You have to agree that this is not a favorable verdict for ADA representation. That is how bad the information vacuum has become in our profession. Valerie wants to fill it with her stuff based on academic fantasy, and I want to fill it with my stuff based on 26 years of dentistry. Forget about the ADA.

From all outward signs, the ADA organization is in a coma. I don’t mind filling the vacuum … for now!

-Darrell K. Pruitt; DDS
Valerie, on January 12th, 2009 at 12:42 AM Said:

Dear Darrell,

Well, Happy New Year! I think I have found my own way of causing trouble. There are lots of medical folks who just can’t seem to adjust to the research results that make it clear that they must regard their dentist colleagues as full-fledged and valuable members of the primary care team.

So, Frank Din and I have plenty to keep us busy. It looks like we’ll be getting some help from Dr. Marjorie Jeffcoat, a well-known periodontist who is now Dean Emeritus in the dental school at the Univ. Penn. She co-authored IOM Report on Dental Education at the Crossroads, in 1995.

One non-eHR approach that would be useful would be to encourage co-location of primary care physicians and general dentists in a joint practice (and correspondingly pediatricians and pediatric dentists). That would go a long way toward building the kind of chronic care I envision. That might be more effective than faxes.

BTWSince you like mysteries, have you ever looked at the acknowledgement list in Frank’s and my position paper at the very last entry in that list? What do you think that is about?

-Valerie
Darrell, on January 12th, 2009 at 12:46 AM Said:

Dear Valerie

Many thanks for the reply.

“One non-EHR approach that would be useful would be to encourage co-location of primary care physicians and general dentists in a joint practice (and correspondingly pediatricians and pediatric dentists). That would go a long way toward building the kind of chronic care I envision. That might be more effective than faxes.”

Wow! If you thought interoperability is tough, you have no idea how difficult and expensive it would be to pair up dentists with physicians in the same location. I agree, that would be utopia for integrated care of patients, but outside of academia and institutional settings, it is simply not a realistic possibility. It will never fly, Valerie. As a friend, I would suggest you avoid the embarrassment of losing credibility, and keep that idea in your pocket; seriously.

I’m glad I had the chance to once again review your paper, Valerie. I looked closer at the one-page “Wisconsin Diabetes Guidelines Diabetes Referral Form,” and it occurred to me that this would be a good place to start on our common goals – using the hybrid solution of a computer-fax interface to better handle chronic diseases instead of interoperable dreams.

I know you and Frank have a lot invested in the idea of a digital platform for communications, but you are too far ahead of your time. In addition, it is my opinion that you cannot get there from here. Let’s be sensible instead of accomplishing nothing.

And, it so happens that the fax machine is safer, cheaper and already in place in virtually all dental and physician offices. Consider the hybrid solution as not only an inexpensive stepping-stone to the (almost) universal digital interoperability that we both seek (on our own diverging terms), but also as a proving ground for your theories about the benefits of better communications between physicians and dentists. Do you have any better ideas for the research you desperately need at a better price?

If you wanted to set up a pilot study using a limited amount of dental/medical patients, I would not only personally volunteer to participate, but I would help spread the word about your efforts. Now how can you possibly beat that offer?

Now, imagine the influence you would win if you could exhibit hard data which irrefutably supports your contention that dentists and physicians need better communication. That works much better than educated guesses and hopeful fantasies.

Once PII is removed from dental patients’ dental records, allowing progress at last towards interoperable eDRs, you will hit the ground running with the support of dentists in private practice instead of skepticism mixed with mistrust.

Remember, information is the product -the computer a tool – and not the other way around.

This is progress, Valerie.

-Darrell
Dr. Pruitt, on January 12th, 2009 at 12:49 AM Said:

Dear Valerie,

I am proud that you let me know that I am one of the four who you acknowledge anonymously. You recognized my desire, yet you still let me know that my input mattered. I am honored.

Regarding causing neighborhood fire-fights between physicians and dentists; I assume the co-location is voluntary and not mandatory. However, California has a penchant for doing cutting-edge-stupid.

Do you realize that 85% of dentists in private practice are solo (ADA News)? Do you also realize that all but three dentists in the nation like it that way (Darrell’s guess)?

In today’s climate, I cannot imagine getting doctors and dentists in the same auditorium, much less a small office.

Go for it, Valerie. But remember that I warned you against it.

-Darrell K. Pruitt; DDS
Frank, on January 12th, 2009 at 2:13 PM Said:

Digital Health Records?

Implementing eHRs will be tough, and many hurdles stand in the way.

For example, only about 8% of the nation’s 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation.

-Frank
Amaury, on January 12th, 2009 at 3:52 PM Said:

My thoughts,

No doubt that in these tumultuous times the need for professional financial advice is reviewed by many investors. However, the answer to your questions is not as easy as a yes or no answer. Instead you must review the required information and complexity of the problem that you are seeking advice for and determine if you need a professional to assist you.

Information from the internet:

The internet has millions of websites and it is estimated we can only access one forth of the information. Anybody can publish information on the internet so before accepting the information provided from the internet you should consider the following;

Authorship, publish body, point of view, referral to other sources, verifiability, currency and determine if the information is misinformation or propaganda. A source to help you with more details on how to verify the information can be found in The Sheridan Libraries, John Hopkins University.

Example, an article in the BMJ Accuracy of information on apparently credible websites: survey of five common health topics (Kunst, Groot, Latthe 2002) concluded that the information are moderately accurate and show that even creditable website might not provide higher level of accuracy.

Also, Google and related search engines provides a large number of hits providing the same information. Don’t make the mistake to accept the information as valid since the erroneous information is often duplicated. In addition, information that is reviewed, verified and published is not typically free.

Software:

Advances in technology have allowed individuals the ability to prepare their own tax returns, legal documents and financial plans. Programs like Turbo Tax, QuickBooks, Home and Business Lawyer, Morningstar Principia and Financial Logix are easy to use and relatively inexpensive. However, the input of information determines the outcome. In addition, these programs are not very helpful when you have complicated or specific questions.

Consider:

Home and Business Lawyer provides you information on preparing a basic lease or Will but this is no replacement for proper legal advice.

Turbo Tax provides you the ability to prepare your federal income tax, but it cannot answer very complex tax issues. Also, Turbo Tax has limitations in representation of your defense in case of an IRS audit.

Morningstar can help you determine your retirement plan and can assist you in analyzing investments ratings and financial information. Again, it does not answer specific question or provide you information on all strategies available for any specific needs you might need during your retirement and investments plans. (Morningstar ratings are not a guarantee of future performance)

Programs are lacking the human factor or experience (art) that an individual can provide.

Consider the information impact and the medical field. The internet provides information on symptoms and remedies for many illnesses, however individual should consider seeking medical advice when needed.

In these two cases should individuals ignore professional medical help when needed?

1. Individuals today can access information regarding high blood pressure and provide home remedies to try to regulate their blood pressure.

2. Women have the ability to determine their pregnancy and even have non medical home care and delivery without the assistance of a physician.

The examples above are simplistic and in conclusion the answer to your question in my opinion is NO. As information becomes more accurate and available you should not obviate your advisor, attorney or tax professional. Instead, you should consider advice from your advisors in more complicated and personalized issues and use other resources for more simplistic questions.

Furthermore, consider the progression of information availability in all fields. As the information availability expands, professional in all fields will have to extend their knowledge and provide more specific advice or services to compete for business.

Finally, minimum education (the science) and experience (the art) are two more reason to consider using a financial advisor in certain situations. Example, advisors that have earned the CFP® or CMP® designations have demonstrated a minimum level of education and understanding of financial planning concepts. Also consider using an advisor that has experience in working with individuals in your field. As you probably recall, your formal education although very valuable was only enhanced with your experience.

Regards
-Amaury Cifuentes, CFP®
Jeremy Engdahl-Johnson, on January 12th, 2009 at 4:15 PM Said:

Video on Quality eHRs

President-elect Obama is right to emphasize quality in his vision for electronic health records. Electronic health records may help us solve the healthcare quality problem, but if they are implemented solely as a technology initiative and we fail to fix the larger quality problem we will have an even higher cost but still broken system.

Also, the privacy issue is indeed a key one. It is my understanding that the plan is not so much to build some uber-database with everyone’s medical records, but rather to make the records interoperable so that care providers can reach across the healthcare infrastructure to access the information they need. With multiple IT heavyweights creating their own personal health record products, and with different EMR systems in place, the distributed approach is also more practical.

I hope all these different solutions can play together.
See video discussions:
http://www.healthcaretownhall.com

-Jeremy
Firefly, on January 13th, 2009 at 5:25 AM Said:

Your industry information guide

This is definitely a good idea. This will not just enable sharing of important medical information easier for medical professionals all over the world but will also make it possible for them to reach out to people and understand their problems.

Shine
Hope, on January 13th, 2009 at 12:52 PM Said:

More Advisory Selection Considerations

Experience counts, of course, so find out how long your advisor has been in business or how long his company has been in business before making any purchases … either the individual or the company that he works for has a reputation to protect [yet experience only goes so far … there are good and bad, types].

Far too many of those who hold “professional” designations offer a product or service for sale. It is fair for you to ask your financial professional what they do, and how they get paid, by whom, how much and on what terms. Understand their areas of specialization. Some may specialize in just life insurance or annuities or health insurance or long term care insurance products.

Meet with them, face to face and if possible at their office … brick and mortar add a lot to credibility Ask about registration or licenses. Anyone who sells a financial or insurance product must be registered in the state in which he/she does business. Is the license current? Have there been any disciplinary actions? Check their CRD background, and ADV Part I and ADV Part II.

It is important to understand how advisors will be paid. If you engage their services, will you pay an hourly fee or a flat fee? If they manage your investment assets, do they earn a commission or do they charge a percentage fee for the assets that they manage? For planning services, do they charge you by the hour, by the project or by the plan? If they sell products, do they get paid commission on the sale of a product? Do they earn bonuses, trips or awards for sales of certain products or during a certain time of the year? While it is understandable that a manufacturer would offer incentives to a sales person, it would certainly not be in your interest if your financial or insurance portfolio were built so that a salesperson could qualify for a bonus trip to an exotic location.

Finally, do not sign a client arbitration agreement, and do retain your ability to sue. Arbitration is settled, on behalf of the advisor, 99% of the time. So, the deck is stacked against you from the start. Also, ask if the advisor is a fiduciary … will inform you of conflicts of interest at all times, will not-opt out of this responsibility to work on your behalf, and will sign a document attesting same. Remember the parole evidence rule … if it is not in writing, it does not exist.

There are good guys and gals out there, but you may have to dig to find them.

-Hope Rachel Hetico; RN, MHA, CMP
Dr. Pruitt, on January 14th, 2009 at 5:17 PM Said:

An unanswered invitation to Obama

A little over a year ago, I invited Sen. Barack Obama to a discussion on the Texas Dental Association Free Forum. I was hopeful for a response of some kind from someone on his Internet-connected staff but I imagine that the entire team was too busy back then to consider dental care. That’s nothing new.

Let’s see if anyone is paying attention yet. I think there is a 50:50 chance that we might get a response in a day or so; that would be swell.

Don’t tell anyone, but HIPAA failed long ago and the nation’s politicians who are aware of the failure, in both government and dentistry, are trying to keep it a secret until at least after the next presidential election. I am afraid the bad news won’t wait. I think Senator Barack Obama will help me spill the news for the first time on TDAFF by responding to this essay. It is worth a try. From what his campaign website says, he is a fan of modern communication and TDAFF is revolutionary in healthcare – as well as consistent with Obama’s ideas for government. Keep reading. I’ll show you the event horizon, friend.

All presidential candidates, including Obama, still have no clue about the absurdity of HIPAA because politicians never consider dentistry. That is an unfortunate failure of our ADA leadership. It is nothing new. For a long time now, ADA leaders have been telling politicians what they think Washington wants to hear, rather than telling the truth. In addition, they willfully mislead membership as well, while trying to keep from telling them much at all. That is also nothing new.

While searching for a presidential candidate to invite to participate in open discussion about the future of dentistry in Texas, I came across Barack Obama’s campaign website. http://www.barackobama.com/issues/technology/#solve-problems

Under his stated commitment to invest in healthcare information technology, his campaign reveals that “A key feature of Barack Obama’s health care plan is the use of technology to lower the cost of health care.” He certainly was not considering dentistry when he wrote that statement. He also was not considering dentistry when he wrote that paper records are inferior to electronic records when coordinating care, measuring quality and reducing errors.

Senator Obama claims that he will develop healthcare IT in coordination with providers and frontline workers. Once again, I think we can be certain that he was not thinking about dentists. Healthcare IT is going nowhere in dentistry.

He does, however, make a valid point that paper claims cost twice as much to process than electronic. That makes digitalization of dental claims a wonderful opportunity for the insurance industry to increase their profits as well as executive bonuses. But it falls far short of a dentistry concern, nor is reducing insurance overhead at all consistent with the mission of the ADA. If insurers want to save money using digitalized data, they deserve to. This is America. They will just have to convert paper dental claims themselves. For every dollar they require dentists to invest in their IT infrastructure, someone goes to bed with a toothache. Accessibility to dental care is not only consistent with the mission of the ADA, but it is always more important than CEO stock options.

The virtually complete rejection of eHRs in dentistry proves that dentists do not want the expense and liabilities that come with paperless practices, regardless of what naïve and ambitious leaders in the ADA say. Besides, even after being heavily pushed by entrepreneurial and governmental stakeholders, fewer than 5% of physicians have adopted eHRs.

Because physicians must maintain four to five times the number of patients’ records as dentists, and because medical histories can be as thick as telephone books, as well as the constant need for lab results and consultations with others that is almost non-existent in dentistry, physicians’ patients might actually benefit from eHRs some day. However, the Department of Health and Human Services has to finally resort to paying 1,200 physicians across the nation just to get them to try eHRs. How much will taxpayers have to pay dentists to try them, considering they offer no tangible benefits for dental patients, while the expenses and liabilities of being HIPAA compliant continue to increase because there is nothing holding down the cost? Taxpayers cannot afford any more mandate fantasy.

Now that the truth is out, and HIPAA is inescapably dead in dentistry, where do we go from here? Before the ADA can go forward with any meaningful political representation following this PR disaster, the failure of leadership in the effort must be accepted and HIPAA has to be officially sidelined if not abandoned completely. Organized dentistry must separate itself from the rule because actions allowed and even encouraged by the act directly harm dental patients. The HIPAA rule is unethical, not only because it methodically takes control of treatment decisions from dentists and patients, but because it is a complete failure at protecting patient privacy as well. HIPAA clearly disregards the Hippocratic Oath in many painful ways.

So how could the failure of interoperable eHRs in dentistry affect the election if someone like Barack Obama were paying attention? Many politicians as well as ADA leaders who also know little about dentistry promise higher quality (fillings) at lower prices. Any dentist who has ever done a filling has to wonder how eHRs can possibly cause that to happen. Will Barack Obama really listen to reason, or will he ignore dentists just like the Bush administration does? Let us see for ourselves. I will send the invitation to his website http://my.barackobama.com/page/s/mypolicy

I hope it will handle 1,700 words.

I chose candidate Barack Obama to highlight, not because I particularly support him, but because of my interest in another promise he posted under the topic: “Create a Transparent and Connected Democracy – Open up Government to Citizens.”

His campaign literature claims that an Obama presidency will use cutting-edge technology, creating a new level of transparency, accountability and participation. Furthermore, his campaign promises that it has a vision of how technology can help connect government to its citizens and better engage them in democracy. It already sounds a lot like TDAFF, doesn’t it? Hmmm! Who is copying whom? Maybe Obama and I both sense society’s desire of better, more inclusive democratic governance.

In his list of ways to integrate citizens into the actual business of government, he includes making government data available online. Perhaps if Obama were president, I could find out how many dentists in Texas have NPI numbers. Neither the Department of Health and Human Services nor the ADA Department of Dental Informatics will let go of that information. I assume they keep it a national secret for my own good.

Without even one mention of “2.0,” there are plenty of web 2.0 characteristics in the fresh ideas Obama offers in his campaign. Not only does he promote blogs, wikis and social networking, but he wants to open up government decision-making and involve the public in the work of agencies by tapping into the vast expertise of citizenry to help make more informed decisions. This represents “architecture of participation” – the classic characteristic of web 2.0. Today, this is also called using the Internet as a “platform.” Today’s ADA is reluctant to allow such control from membership, even though it is an organization composed of trusted and highly educated professionals, dedicated to the welfare of others, who each one pay dues to the non-profit organization. Go figure.

Get this. Whereas TDA officials are staying away from this free forum in droves, Obama would require his appointees to employ all the technological tools available including blogs, wikis and social networking. He pledges to modernize information sharing in order to improve governance and to allow citizens to be heard. ADA officials still use letters to the editor -“Talk to the hand, doctor.” No kidding. That is not all. If a dentist wishes to discuss a serious and possibly embarrassing policy issue with ADA leaders, some regress to the security that the tactile sense of paper provides. I think that in tricky times they prefer the accountability that the US Post Office delivers no faster than a postman can walk. But by far, the usual response over the Internet is the official silence we are witnessing on this free forum right now.

I think it is now appropriate that I notify everyone that I hold no official position within the ADA or any other professional organization. I represent only myself and I hold myself accountable for everything I say. I am merely a garden-variety member with no rank and I have a life-long immunity to embarrassment through trial and error desensitization… lots of errors in countless trials.

Here is the reason that I think Obama just might listen, even though he has misconceptions about eHRs. He says he wants to restore the basic principle that government decisions should be based on the best-available, scientifically-valid evidence and not on the ideological predispositions of agency officials. Wow. That could cost some people their jobs in the ADA.

Now if I can only get Barack Obama to understand that HIPAA does not help dental patients, he will be the first ever enlightened politician in ADA history, inside or out.

-Darrell K. Pruitt; DDS
Nel, on January 15th, 2009 at 12:05 AM Said:

Great Query

This is a great question, especially coming from a doctor. In your own practice, you surely see the value of a trusted medical opinion versus information available on the internet.

Consider losing weight and quitting smoking. Everyone knows they should do this. Some will do it on their own, while others need GUIDANCE and a PLAN. Same with a simple, diversified portfolio and more than enough retirement savings.

However, a layperson wouldn’t perform surgery on themselves. Neither should you design your own estate plan, hedge a concentrated stock position, set up a trust for your children, or hundreds of other important financial goals.

My company has a free website which matches people to financial advisors who specialize in areas like healthcare professionals. There are also advisors who wrote articles in our Article Library specifically for doctors.

-Nel
An Ex-FA, on January 15th, 2009 at 12:43 AM Said:

Nel,

You make an extremely poor analogy comparing doctors to financial advisors. There is no universal definition of FAs [usually retail salesmen] who too often are company shills with little [mere weeks] training. Have you even reviewed this website?

I was a successful FA, after a few weeks of training, but couldn’t stomach it. This is the polar opposite of doctors and those in healthcare who require years of education.

And, you need only read the other posts and whitepapers on this site to discern the difference. Sorry; your example is faux. We all know better. Stick to goading the laymen. Stay away from the docs.

-The Happy Ex-FA
Jack, on January 15th, 2009 at 4:03 PM Said:

Financial Advisor Marcus Schrenker’s Sad Saga,

Did you know that Marcus Schrenker, a 38-year old financial advisor and insurance agent who ran a registered investment advisory [RIA] called Heritage Wealth Management in Indianapolis, was taken into custody recently by US Marshalls who found him hiding in a northern Florida camp ground?

Schrenker, shocked the industry and his clients, by just landing on cover of the New York Post because of his sad shenanigans. To elude the Feds, Schrenker apparently attempted to fake his own death in an airplane crash to escape authorities and regulators.

Apparently, the FA, had a lengthy history of shady dealings—from bankruptcies to receipt of stolen property, securities lawsuits on behalf of individuals and lawsuits from insurance companies claiming he booked hundreds of thousands of dollars in exorbitant annuity commissions.

Many of those he sold annuities to were current and former Delta pilots whose retirement accounts he managed, according to a New York Post story.

His world appeared to have caved in when Indiana’s Secretary of State raided his $4 million home on New Year’s Eve, seizing computers, cash and the rest. That same day his wife filed for divorce.

What a guy!

-Jack
Diane, on January 15th, 2009 at 7:35 PM Said:

College Savings Plans

College Section 529 savings plans, like the rest of the market, have taken a beating lately and have provoked the concern and ire of many parents.

Why:

1. Investors in 529 plans pay at least two or three layers of fees [plan, college, broker].

2. Section 529 plans still offer a limited range of investment choices.

3. You can change investment choices, only once a year, with often confusing options.

4. Colleges consider a 529 account a parental asset for purposes of financial aid. You escape federal taxes only on the account’s growth.

And so, you might want to avoid a 529 plan if:

1. You qualify for a Roth individual retirement account.

2. You haven’t fully funded your own retirement.

3. Your child is close to college age.

4. You are low or middle-income and might qualify for financial aid.

Unfortunately, some medical professionals are finding themselves in this very situation.

-Mary
Jeff, on January 16th, 2009 at 7:17 PM Said:

Amaury Cifuentes CFP,

So, basically your argument and main [primary] reason to hire a financial consultant is lack of time?

Geezz! If I don’t have time to watch out for my own money; perhaps I don’t deserve to have it. Think Bernie Madoff; his big name clients were time compressed, too!

Absolutely no one – no one – will look out for me; better than me! Sorry.
-Jeff
Patty, on January 16th, 2009 at 7:30 PM Said:

Trust the FINRA and the SEC? – Think Again!

Isn’t attorney Mary Schapiro, tapped to chair the SEC, facing questioning in conjunction with a pair of lawsuits over her candor and truthfulness in statements she made in connection with the merger that created the Financial Industry Regulatory Authority [FINRA] – formerly the NASD - which she now heads?

Any insider scoop is appreciated? If you trust the SEC and FINRA, you’d better think again. After all, it’s your money!

-Patty
Dr. Barremore, on January 17th, 2009 at 7:08 AM Said:

Dear Dr. Pruitt,

It has come to my attention that you are attempting to engage the dental community at large in an all-out war of sorts against the impropriety of the ADA/IDM business partnership. You even went so far as to mention yours truly and my website in your assaults.

How dare you sir work to expose such malfeasance on your own! Have you lost leave of your senses? What makes you think dentists in general even care what the ADA does with their dues, or that the IDA may be scamming them?

Apparently sir you are watching far too little TV these days and thus you seem to have adopted some odd sense of responsibility and honor which frankly, is in direct opposition to the country’s epidemic corruption.

Unless you prefer people remember you as moral, just and altruistic, I suggest you give up this campaign important to so many people and indulge in something less idealistic. Try pursuing some shallow, self-serving interests. Millions do these days and it serves them quite well.

Stand down from this insanity; quit at once; you cannot hope to win against the overpowering forces of pure evil. Just forget about it and move on; there’s nothing more you can do to make a difference.

Wait a second…

On second thought — give ‘em hell Pruitt — give ‘em goddamn hell!!!

John Barremore
http://www.thevisibledentist.com
Dr. Pruitt, on January 17th, 2009 at 6:09 PM Said:

Dear John,

Thanks; we both agree. I am having far too much fun for a professional.

It is easy to see that it is transparently wrong for my non-profit ADA organization to be in business with an entity which shares profits derived from membership – even if it lowers members’ dues … especially if it lowers dues. Even now I cannot engage ADA leaders in open, real-time discussion of important and urgent issues. Imagine how unresponsive the bureaucracy will be when it doesn’t need membership dues at all.

We suffer from a creeping malignancy in the ADA that has overtaken the mission of my once proud organization. I intend to excise this lesion radically, no matter how deep I have to cut, and no matter how long as it takes.

Hurt feelings don’t concern me much. The self-perpetuating bureaucracy has been too fat for too long. It is time to downsize the American Dental Association and squeeze it back into the confines of its mission as a lean, hungry, responsive voice for dentists and patients. Silence is obsolete defense these days for fat dinosaurs, and I will prove it.

ADA/IDM should already know that each time an ad dressed up as an article with no byline appears in my ADA News, I will bring it to the attention of everyone I can, including commentary and strategic links. Count on it.

In addition, just for grins, I will incessantly repeat asking my three unanswered questions to IDM until silence from a huge advertising firm becomes a well-known industry joke.

And of course there is the perpetual SEO (Search Engine Optimization) lesson I am teaching IDM CEO Trajan King.

I promised Trajan that I would make him famous for bothering me at work with a phone call instead of responding to my three questions online. Apart from the obvious entertainment, I am doing this as a community service to deter further rudeness in my neighborhood from other good ol’ boys.

I just googlesearched “Trajan King.” The CEO’s second hit behind his LinkedIn site is “Trajan King, Intelligent Dental Marketing and SEO Tricks.”

http://community.pennwelldentalgroup.com/forum/topics/trajan-king-intelligent-dental

I can only imagine that my caustic thread infuriates Mr. King, but there is simply nothing he can do about it – other than to surrender to accountability and respond online. As it turns out, I am far better at SEO than Intelligent Dental Marketing.

Thanks for the comments on this Medical Executive-Post, John Barremore.

The Visible Dentist is my kind of vendor.

-D. Kellus Pruitt DDS
Ann, on January 18th, 2009 at 4:27 PM Said:

Reimbursement Update,

Legislation enacted in July 2008 reversed a 10.6% cut – while stating in January 2009 that a 1.1% increase would replace same – that would have gone into effect if lawmakers had not acted.

-Ann
Hope, on January 18th, 2009 at 4:31 PM Said:

Wachter Speaks on Medical Tourism,

According to blogger and quality guru Robert Wachter MD;

“ … in the end, the flattening of healthcare is inevitable. And, while it will be controversial, it may also represent the kind of shakeup our system requires if it is ever to deliver the value Americans need and deserve …”

-Hope Hetico; RN, MHA
http://www.CertifiedMedicalPlanner.com
Dr. Marcinko, on January 18th, 2009 at 4:41 PM Said:

Marcinko Speaks,

As a former insurance agent, RIA, RR, financial advisor, certified financial planner and quality medical review practitioner, as well as Founding Editor-in-Chief of this blog and companion print journal: Healthcare Organizations: [Financial Management Strategies].

Link: http://www.HealthcareFinancials.com

“ … in the end, the flattening of the financial services industry is inevitable. And, while it will be controversial, it may also represent the kind of shakeup our system requires if it is ever to deliver the fiduciary value American investors need and deserve …”

Fraternally,
-Dr. David Edward Marcinko; MBA, CMP™
http://www.CertifiedMedicalPlanner.com

Editor: Financial Planning for Physicians and Advisors.
Editor: Insurance Strategies and Risk Management for Physicians and Advisors.

http://www.MedicalBusinessAdvisors.com
Rachel, on January 18th, 2009 at 8:02 PM Said:

Medical Quality Gurus … Giants,

I couldn’t agree with Hope, Ann, Dr. Bob Wachter and Dr. Dave Marcinko more.

John Wennberg’s disciples at Dartmouth are coming out with so many uncomfortable facts for the healthcare industrial complex, that it’s hard to keep count.

Medical tourism, CDHPs, fee and complication rate transparency, and market competition, etc., are all just the beginning.

And, Wennberg started it all by introducing the notion of practice variation 30 years ago. His group is now turbo-charging its research production, and basically all of it is bad news for anyone pretending that “American health care is the best in the world”.

To paraphrase Uwe Reinhardt PhD, of Princeton, how can the American healthcare – not be as good as American health care?

Rachel Pentin-Maki; RN, MHA
http://www.HealthcareFinancials.com
http://www.CertifiedMedicalPlanner.com
http://www.HealthDictionarySeries.com
Ann, on January 19th, 2009 at 12:55 AM Said:

About the CMP™ Designation,

The Certified Medical Planner™ designation confirms fiduciary responsibility on all its charter-holders; at all times. There are no opt-out provisions. Our goal is to raise the bar on fiduciary accountability for all financial advisors serving the healthcare space.

In other words, we embrace the “F” bomb.

As a physician-client, why would you want it any other way?

Ann Miller; RN, MHA
http://www.CertifiedMedicalPlanner.com
Nigel, on January 19th, 2009 at 3:54 PM Said:

Schnepper’s Solution,

Was Bernie Madoff an investment supermarket? Although I don’t really care since I lost nothing with him, you doctor-types may have? Now, for me, the market is another thing…!

Nevertheless, according to Jeff Schnepper of MSN Money Talk, rather than deduct a Madoff loss as a short-term capital loss, it may be possible to claim a theft loss.

Financial fraud is included in the US Tax Code’s definition of a theft loss. Madoff confessed to his sons that his investment business was “just one big lie” and “basically a giant Ponzi scheme.” And there’s talk he may soon plead guilty to fraud.

And so, with a theft, the full amount of a Madoff loss would be deductible in the year of the discovery – 2008 in this case – reduced by $100 and 10% of your adjusted gross income. So if your adjusted gross income was $200,000 and you lost $200,000 with Madoff, you might be able to claim a deduction of $179,900.

This is complicated. So, as always, talk it over with your tax adviser. Good luck!

-Nigel
Darrell, on January 19th, 2009 at 9:01 PM Said:

Will Pawlenty Drive Dentistry Out of Minnesota?

Imagine you are a dentist who owns a solo dental practice in Minnesota – and that due to the poor economy you are barely hanging on financially. I assume there are a few.

Suppose your governor said, “Nowhere is the need for improvement more evident—or more essential—than in our dental care system. Spiraling dental costs must be contained, even as we strive to improve the quality of dental care and improve the oral health of our populations.”

Would you move to Iowa? Could you afford to move if you wanted to?

Although the governor never once specifically mentioned dentists – they never do – Tim Pawlenty proclaimed today that because of the imminent and extensive budget shortfall, dentists in the state must not only do more for less pay, but they will also have to purchase whatever is necessary for them to become paperless by 2015 – so that their quality of care can be assessed and pay scales assigned according to cost-effectiveness for the state of Minnesota.

It is called Pay-for-Performance and it requires only dental claims history and an NPI number from the provider. Satisfied patients’ opinions and free-market forces matter little, if any at all. Pawlenty’s artificial market, which smells like hocus-pocus socialism, is a product of data-mining using mysterious algorithms that favor stakeholders more than principles.

(For an example, googlesearch “Ingenix, NY State attorney general”)

Governor Tim Pawlenty’s guest editorial is posted on ModernHealthcare.com, and is titled “The Minnesota way – Blueprint can help nation achieve cost, quality goals.”

http://www.modernhealthcare.com/article/20090119/REG/901169981

A national blueprint? That’s national scary. Any dentists from Minnesota care to comment?

Are you still allowed to comment? Just tap once for yes and twice for no.

-D. Kellus Pruitt; DDS
Stu, on January 20th, 2009 at 1:46 PM Said:

RIP the Financial Supermarkets,

According to Jim Jubak, of MSN Money, Bank of America CEO Ken Lewis is betting his company that he can take hundreds of billions in government money and avoid the kind of government-engineered breakup now humbling Citigroup [too bad for shareholder].

Could he be right? The big banks are clearly on the edge of crisis that it seems unlikely the government will use the power that comes with being the lender of last resort to break up Bank of America. That leaves BoA with a good shot at coming out of this crisis as the industry’s next, and only, “financial supermarket.”

Again, too bad! I mean is this a goal shareholders seek? The 10-year Citigroup experiment suggests not. Size economies just don’t seem to bring enough of the expected benefits to offset the lack of control that has turned Citigroup into a lesson in the failures of risk management.

The “one-stop-shop” business model has proven a failure again, and again, both on Wall Street and in healthcare. “Best-of-breed”, on the other hand, fosters innovation, competition and deep subject matter knowledge. Of course, allow me to mention service quality, which in my experience through correspondence with Ken Lewis, is abysmal and condescending at BoA.

PS: Dito for most of the so-called financial services sector.

-Stu
Ben, on January 20th, 2009 at 2:29 PM Said:

Medtronic Pays … Very Well !

Did you know that according to the Wall Street Journal, January 16, 2009, a prominent spine surgeon and researcher at the University of Wisconsin received $19 million in payment over five years from Medtronic Inc., one of the country’s largest makers of spinal devices?

The alleged, Thomas Zdeblick, allegedly received the payments while helping Medtronic develop and promote a number of spinal products. Medtronic’s $19 million in payments to Dr. Zdeblick from 2003 to 2007 went “greatly” beyond what was evident in disclosures he made to the university.

The University of Wisconsin, like other academic centers that conduct federal research, is required by the government to monitor its researchers’ financial conflicts. In each of the five years cited in the letter, Dr. Zdeblick told the university that he received $20,000 or more from Medtronic, and in one year, he reported getting $40,000 or more. The disclosures conform to school policies, which currently don’t require researchers to specify amounts received above $20,000.

Talk about DME healthcare 2.0 transparencies; NOT!

-Benjamin
Bill, on January 20th, 2009 at 9:41 PM Said:

What’s realistic for health-care reform?

A Video by Morningstar Analysts

Link:
http://video.msn.com/?vid=4ad027e7-a16f-47f0-9212-285eae04495b&mkt=en-us&brand=money&from=MSNmoney_dispatches&fg=Widget_dispatch

Enjoy.
-Bill
Frank, on January 20th, 2009 at 11:24 PM Said:

More Madoff Solutions,

Remember, some investors might be able to recover up to $500,000 each through the Securities Investor Protection Corp., which acts essentially as an insurance fund.

-Frank
Chuck, on January 21st, 2009 at 3:03 AM Said:

About Heartland Payment Systems,

Did you know that the Associated Press just reported that payments processor Heartland Payment Systems Inc, said its system used to process Visa, MasterCard, American Express and Discover Card transactions was breached last year, but asserted that merchant and customer data were not affected.

And so; what about that healthcare eHR privacy and IT security? Fact or fiction? Think about it!

-Charles
Paul, on January 21st, 2009 at 11:53 AM Said:

Studies and Surveys,

Did you know that a survey by Lincoln Financial Group of 1,000 people aged over 45 showed that 79% are seriously concerned about the amount of Inheritance Tax (IHT) their estates will bear when they die and the resulting effect on what their children will inherit? The, now several years-old, study is often cited by those in the industry.

At least, this is the company line for the financial services sector whose goal is to sell products; like annuities and insurance policies.

But, after the recent market meltdown, new Obama Administration, and “sun-downing” of the current estate tax laws; is the validity of this survey still accurate?

-Paul
Dr. Elena Katazkos, on January 21st, 2009 at 1:58 PM Said:

On CRNAs,

I firmly believe that as a CRNA with a PhD in biology, the vast majority of CRNA’s who carry the direct burden of being unsupervised should benefit from the CMS bonuses.

Most of the time I am unsupervised due to my education and continuing training. It should be an incentive because more of us are needed. 80% of CRNA fail the first year of school because it is a demanding career.

Why shouldn’t we be compensated for our hard work?

-Elena Katazkos; CRNA, PhD
Dr. Pruitt, on January 21st, 2009 at 2:59 PM Said:

Dear Leaders of Advance for Health Information Professionals:

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?CC=86545&zz=0#AnchorPostComment

Now that I have you under my digital thumb, I should tell you that Medical Executive-Post picked up a version of my comment “Predictable Behavior…” that you quite understandably rejected yesterday.

Link: http://www.HealthcareFinancials.com

http://healthcarefinancials.wordpress.com/2009/01/21/predictable-him-behavior/

The Medical Executive-Post @ HealthcareFinancials.com is a unique website in the healthcare industry.

It is courageous. Dr. David Edward Marcinko, Publisher-in-Chief, embraces transparency in the business and finance of healthcare consulting – even if truth happens to be politically incorrect and very unpopular with stakeholders. But, one would expect that from one of the leading health economists.

Dr. Marcinko is also a fair person if you care to defend yourself, Advance.

As always, you are free to respond to my comments wherever you find them – just like everyone else is.

The difference is; I don’t think there is a single thing you can say, other than “We were stupid.” Yep. It’s an uphill climb from here.

This is not over. I’ll be watching what you post.

-D. Kellus Pruitt; DDS
Hope, on January 21st, 2009 at 3:12 PM Said:

Ben,

Are your folks [AIF/AIFA] allowed to use a brokerage arbitration agreement; or not? Please advise?

Thanks.
Hope
Hope Hetico; RN, MHA, CMP
http://www.CertifiedMedicalPlanner.com
Hope, on January 21st, 2009 at 3:18 PM Said:

Hi Ben,

Many thanks for your private, cogent, focused and thoughtful response [regarding AIF].
In follow-up, we have one request, and one invitation:

First, we would like permission to re-print your response on our blog:
http://www.HealthcareFinancials.wordpress.com

Second, we invite you in all candor, intelligence and goodwill to comment and post on the same blog. The issue of fiduciary responsibility, and related corollaries, is a popular one with our readers and subscribers.

Many thanks again for your input.

Hope
http://www.CertifiedMedicalPlanner.com
http://www.HealthcareFinancials.com
http://www.HealthDictionarySeries.com
Jack, on January 21st, 2009 at 3:26 PM Said:

The UBS Settlement,

This is not an “F” bomb, but:

Did you know that an Alabama court just approved a settlement under which HealthSouth Corp. will receive a $100 million payout from UBS; settling allegations that the investment bank helped former HealthSouth executives fraudulently boost the rehab provider’s bottom line?

The $100 million includes $25 million in attorneys’ fees and about $1.2 million in expenses.

-Jack
Economist, on January 21st, 2009 at 3:39 PM Said:

CRNAs, Oh Please!

According to a January 2009 Salary.com report, a Certified Registered Nurse Anesthetist received an average annual base salary of $175,319.00. And, that’s just 76% of total income. The other benefits include the following:

(1) Bonuses: $50.00
(2) Social Security: $9,164.00
(3) 401k/403b: $6,313.00
(4) Disability: $1,754.00
(5) Healthcare: $5,722.00
(6) Pension: $8,067.00
(7) Time Off: $22,933-00.

So, this is a total package, benefits and salary, amounting to about $ 229,334.00. Isn’t it amazing?

Of course, the salary.com figures are not statistically correct. Nevertheless, compare this with an average general practitioner [MD/DO] salary of less than $150,00.00?

And so, I suggest that all CRNAs rejoice, instead of complain; PhD or not. Everyone has salary issues. If you are unhappy; quit and start your own business; then you can pay yourself … what you [think] you are really worth.

-A Health Economist
Dr. Tim, on January 21st, 2009 at 4:45 PM Said:

On Being Timothy Geithner,

My namesake, Treasury Secretary-designate Timothy Geithner, just said he was careless in failing to pay $34,000 in Social Security and Medicare taxes earlier this decade and has apologized to Congress.

Sorry Tim; but get a clue; you lost all credibility. So, here is my letter to Uncle Sam.

Dear Uncle Sam, and the IRS,

“I am very sorry for failing to pay my taxes. Please hire me to run the Treasury Department.”

Thank you.
Dr. Tim M.
Ann, on January 21st, 2009 at 5:34 PM Said:

More info;

For further reading on this topic, see these two articles co-authored by Grena Porto, published in Patient Safety & Quality Healthcare:

http://www.psqh.com/julaug06/disruptive.html
http://www.psqh.com/novdec08/drawing.html

As well as this one:

http://www.thehealthcareblog.com/the_health_care_blog/2009/01/disruptive-phys.html

-Ann
Ben, on January 21st, 2009 at 7:41 PM Said:

Hello Hope,

Designees are not prohibited from signing such an agreement and there are some important points to understand the reasoning.

First, by definition, if you are entering into such an agreement, you are entering into a non-fiduciary relationship. So, any fiduciary requirement wouldn’t apply in this scenario.

Second, if this same question were applied into a scenario of a fiduciary relationship, such as with an RIA, this would be a method of dispute resolution, not a practice method. So, in the event of dispute, the advisor and investor would be free to agree to the method of resolution of their choosing. In this scenario, however, typically the method would not be discussed until the dispute itself arose.

Finally, it is important to know that AIF/AIFA designees are not required to be a fiduciary. It is symbolic of the individuals training, knowledge and ongoing development in fiduciary processes, but does not mean they will always be acting as a fiduciary.

I hope this answer helps. Please feel free to contact me or anyone else at fi360 if you have any more questions.

Thanks,
Ben Aikin; AIF®
Bennett, on January 21st, 2009 at 7:46 PM Said:

Hello,

Tthis message is in response to a comment left by Hope on our blog. You may reprint the comments from our blog discussion. We will begin to monitor your blog as well and comment appropriately.

Thank you for your interest.
Ben
Bennett Aikin, AIF®
Communications Coordinator

Fiduciary360
438 Division Street
Sewickley, PA 15143
(412)741-8140×226
(412)741-8142
http://www.fi360.com

fi360 – your guide to global fiduciary insights
World-class training, tools, and resources for investment fiduciaries.
Cindy, on January 22nd, 2009 at 12:43 AM Said:

More on CRNA Salary,

A commentator CRNA-PhD asks above: “Why shouldn’t we be compensated for our hard work?”

The answer, of course, is because it adds no-value to the task at hand. Look, we have doctors who are also JDs, CPAs, MBAs and PhDs etc, on our hospital staff and elsewhere. Should these degrees also mandate increased salary for medical practitioner holders? Currently, they do not – and should not.

CRNAs already earn more than biology PhDs – for a reason. A PhD is a degree; not a job or license, so don’t forget the legal implications, as well. How many unemployed PhDs exist, versus unemployed CRNAs?

Of course, the numerous online PhD and other programs of nebulous worth, only add to the conundrum [regardless of “accreditation” designations]. Such gratuitous “degree seeking behavior” was attempted in Georgian public education a few years ago, to no avail; just as the degree mills ramped into high gear for the teachers – coincidental?

Finally – an aging domestic population, medical advancements, health information technology needs, new drugs and the many conditions-treatments now being approved for MC payment – all work against third party reimbursement increases. In fact, one should think that third-party [government] reimbursement will only decrease going forward; not increase. The country just can’t afford it.

So; always think “added-value” in order to avoid the faux salary-education trap. It’s an employee/union mentality; not at all a professional one. The relationship between degree and salary is not always a direct one; and never will be. “You eat what you kill.”

Recall, Bill Gates received an honorary college degree from Harvard; but had only a HS diploma before then. So, shall we [read the “marketplace”] reduce his salary, too!

Think about it, and good luck.

-Cindy; RN, MBA
Judith, on January 22nd, 2009 at 2:01 AM Said:

POMRs,

Did you know that according to blogger Tim Elwell, Dr. Larry Weed introduced the first eMR in 1966?

Back then, it was on paper, and was called the “Problem Oriented Medical Record” or POMR. This innovation, out of the University of Vermont, held great promise.

Now, over 40 years later, eMR adoption is between 12-15%, or even less in the small provider office setting. Of course, the paper POMR is more secure, private, inexpensive and not easily hacked.

-Judy
Adam, on January 22nd, 2009 at 12:01 PM Said:

CRNA and the Monetarists,

The domestic unemployment rate is now more than 7.2%. We are all free to seek other employment opportunities if we don’t like our current salary.

Many biology PhDs, and “doctors” of all types are waiting tables! Go compete outside of the healthcare sector. Better still; be grateful.

Adam Smith [of sorts]
Ken Powers, on January 22nd, 2009 at 7:05 PM Said:

Dr. Marcinko,

Your January 22 post on defining Sentinel Events does not mention that Joint Commission hospital accreditation is recognized by CMS as meeting the Medicare’s Conditions of Participation. The Joint Commission has held this federal “deeming authority” since 1965. Hospitals with Joint Commission accreditation are deemed to meet the federal Conditions of Participation for the Medicare and Medicaid programs.

The organization is now formally referred to as The Joint Commission and the acronym is no longer used.

Thank you for your attention to this matter.

Kenneth A. Powers
Media Relations Manager
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
phone: (630) 792-5175
fax: (630) 792-4175
email: kpowers@jointcommission.org
Website: http://www.jointcommission.org
Donald, on January 23rd, 2009 at 12:35 AM Said:

Hello,

Ths was a very informative article. It was well put together and provided for a great read. I’m going to forward this blog to my hospital work study-group so that they can also read and review it all.

You’ve got a new subscriber to this free blog, and your print-journal, too!

-Dr. Donald Mega
Dr. Marcinko, on January 23rd, 2009 at 1:11 AM Said:

[Un] Predictable Results,

I read with astonishment the above post by Dr. Darrell K. Pruitt. As regular readers of this Medical Executive-Post know, Dr. Pruitt, a dentist from Ft. Worth Texas, is an avid blogger here and elsewhere. And, although we may not agree with him on every point, his arguments are cogent and practical for the grass-roots medical practitioner level.

Unlike me, perhaps, he is not a political wonk, ivory tower educator or academic theoretician. He is a medical practitioner who still works in the trenches.

Post Review

If true, as posted, I find the reaction of Lisa Algeo; Editor of http://www.Advanceweb.com, to be astonishing and demeaning. Here it is again, in review:

Hi Mr. Pruitt;

“I’m going to stop posting your comments, as they really aren’t relevant toward the article you’re posting on. Our audience does not consist of dentists.”

My Reaction as a Doctor and IT Advocate

In addition to being a doctor, health economist, speaker, former Professional Practice Management Corporation [PPMC] president, IT advocate and health 2.0 journalist – I wear several hats.

For example, I am the Founding Editor-in-Chief of the 1,200 pages, quarterly premium subscription-print institutional journal Healthcare Organizations: [Financial Management Strategies] http://www.HealthcareFinancials.com, as well as Editor of the Dictionary of Health Information Technology and Security http://www.HealthDictionarySeries.com, and two others.

Current and former memberships include the American Health Information Management Association (AHIMA) and the Healthcare Information and Management Systems Society (HIMSS); member and a beta-tester for the Microsoft Corporation (NASD/FINRA-MSFT), member of the Microsoft Professional Accountant’s Network (MPAN); member of the Microsoft Health User’s Group (MS-HUG) and the Sun Executive Boardroom program sponsored by CEO Jonathan Schwartz; and SUNSHINE [Solutions for Healthcare Information, Networking and Education [NASD/FINRA-JAVA].

I think therefore, I may be in a unique position to render a second opinion on the matter of Lisa Algeo’s response to Dr. Pruitt.

First, it seems incomprehensible for the editor of a newsmagazine that purports to be “the nation’s leading newsmagazine for HIM professionals”, and whose website is supposedly “supporting the healthcare community”, to opine thusly. One can only wonder: exactly for whom do these, so-called, HIM professionals labor; if not for dentists, doctors, nurses and those of us in the medical community?

Second, to address Dr. Pruitt, as Mr. Pruitt, is personally and intentionally demeaning, as dentists hold medical degrees [doctor of dental surgery (DDS) or doctor of medical dentistry (DMD)] and are rightly addressed as “Doctor.”

Yes, he is persistent and verbose, in his views. But, I believe the salutation “Mr.” was intentional, as Editor Algeo correctly identifies Pruitt as a dentist – in what I interpret as a dismissive tone.

Note to Lisa

Lisa, you were angry or frustrated at Darrell and lashed out because you didn’t agree with him. How sad! Or, let’s give you the benefit-of-doubt, “cause you had a bad day” [apologies to songwriter Daniel Powter].

Call to Action

Therefore, please allow me to suggest that those offended with the comments of Editor Algeo, write Lisa and her employer, and/or post your thoughts and opinions here; or elsewhere. On the other hand, if you believe us to be incorrect, please tell us same.

At the very least, we believe that Lisa Algeo owes Dr. Darrell K. Pruitt, not only a sincere apology, but a complete reassessment of her professional raison d’etre. You may contact her:

Lisa Algeo
Editor
lalgeo@advanceweb.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Was Editor Algeo’s position [un] predictable behavior for a HIM professional – and her newsmagazine by extension – or not?

Are such folks “professionals”, at all? Please opine.

Fraternally,
Dr. David Edward Marcinko; MBA
Editor-in-Chief
Atlanta, GA
http://www.MedicalBusinessAdvisors.com
http://www.HealthcareFinancials.com
http://www.HealthDictionarySeries.com
http://www.CertifiedMedicalPlanner.com
Alan, on January 23rd, 2009 at 11:38 AM Said:

On UHG,

According to Brian Orelli of the Motley Fool, on January 22, 2009, there is little doubt that UnitedHealth Group is pleased to have 2008 behind them.

Rising health-care costs and a higher unemployment rate – and therefore more uninsured people – is a bad combination for health insurers.

The company finished the year with another quarter of sinking earnings which fell 15% per share, after adjusting for the previously an-announced charges. This brought the adjusted net earnings for the year to $2.95. Compare that to the $3.95 to $4.00 per share that the company was predicting it would earn this time last year and you can see just how bad a year it was.

Revenue in the fourth quarter was actually up 9%, but unfortunately the company’s costs rose even faster. The medical care ratio – medical costs divided by premiums – jumped to 80.8% in the fourth quarter from 79.9% last year. But that’s still an improvement compared to earlier in the year when the medical ratio was increasing at alarming rates.

And so, is UHG rapidly becoming the company which patients, hospitals, medical providers and all stakeholders “love to hate?” Is it symptomatic of what’s wrong with health insurers?

Or, is it a righteous firm in a bad, but temporary, situation?

-Alan
Mike, on January 23rd, 2009 at 12:44 PM Said:

Pray for Rain – and Go Away Thain,

Former Merrill Lynch CEO John Thain just resigned from Bank of America at the request of its chief executive officer Kenneth Lewis.

Rest assured, I have never been a fan of Merrill, its CEO predecessor, or its legion of stock-broker salesmen and related shills. Nor, have I been a fan of Ken Lewis or the BoA, itself. But, I do applaud Lewis for firing Thain.

Want more; OK, if you paid an overdraft or over-limit fee after using a BofA debit card in recent years, you may be able to apply for $78 in a proposed lawsuit settlement. The bank did not admit to wrongdoing in the allegation that it charged overdraft and over-limit fees that it should not have. Fiduciary accountability; I don’t think so?

Now, if Ken would just resign, perhaps we could begin to get back to a “new-norm’. One that is much less egregious.

-Mike
Darrell, on January 23rd, 2009 at 3:02 PM Said:

In Defense of Disobedience,

1. Markets are conversations.
2. Markets consist of human beings, not demographic sectors.
3. Conversations among human beings sound human. They are conducted in a human voice [The first three of 95 Theses from “the cluetrain manifesto,” by Locke, Weinberger, Searls & Levine, published in 1999].

http://www.cluetrain.com/book/index.html

I recognize that my writings are sometimes verbose, crude and unprofessional. And I also know that even though taunting and name-calling are against the traditional mores of publishing, bad behavior not unknown on a grassroots level – otherwise known as “the marketplace.”

In my defense, I am not vulgar and I am not anonymous. This is my voice. I suggest that if it offends anyone, skip-reading is wonderful.

Even though the Editor-in-Chief of Medical Executive-Post @ HealthcareFinancials.com, Dr. David Edward Marcinko, acknowledges that he and his staff do not always agree with what I write, he has time and again proven that he recognizes the importance of transparency in the healthcare marketplace – even if it occasionally appears crude beside traditional journalistic standards.

Today he posted a reply to my grassroots comment “[Un] Predictable HIM Behavior” that I posted on his website.

http://healthcarefinancials.wordpress.com/2009/01/21/predictable-him-behavior/

I am grateful to Dr. Marcinko and the staff of Medical Executive-Post for the support. I am fortunate.

I think Thesis number 26 explains Advance Editor Lisa Algeo’s traditional behavior: “Public Relations does not relate to the public. Companies are deeply afraid of their markets.”

-D. Kellus Pruitt; DDS
Frank, on January 24th, 2009 at 6:23 PM Said:

Laugh or Cry?

Did you know that investigators are looking into allegations that Kaiser Permanente allowed unlicensed staffers to make medical decisions?

Managed care, National healthcare, Hillary care, Kaiser care; ya gotta love em’ all?

-Frank
David, on January 24th, 2009 at 10:47 PM Said:

Hospital Expenditures Unrelated to Bed Supply,

According to Robert J. Cimasi; MHA, CMP™, of Health Capital Consultants LLC, in St. Louis, MO, there is a widespread perception in healthcare that “Where there’s a bed, there’s a patient day”, a cornerstone rallying cry for those who seek to restrict competition through legislation and regulatory control.

http://www.HealthcareFinancials.com

In fact, I was involved in a similar situation competitive situation back in the day [1986-1998] when involved in a private physician-owned ambulatory surgery center [ASC] that required a CON for licensure. And; at the time, similar though less vehement allegations were made.

Cited in the establishment of many CON laws restricting the construction and expansion of healthcare facilities was the “Roemer Effect.” In their 1959 study, Roemer and Shain argued that hospital beds can be intentionally filled by providers who induce ill-informed patients into hospital stays.

However, an example of the ineffectuality of this type of limited control is early attempts to limit costs by controlling the number of hospital beds. In the 1970’s, for example, Certificates of Need [CON] had little effect in controlling hospital costs even when bed supply was controlled because hospitals often simply increased their expenditures per patient.

And, so, an informed update on this topic in modernity would be appreciated for our readers and subscribers.

-Dr. David Edward Marcinko; MBA
[Editor-in-Chief]
Dr. Stevenson, on January 25th, 2009 at 1:07 PM Said:

Jeff,

Trusted Advisors … Think Again! [More on the Madoff Mess]

Forget about the value chain … how about the integrity chain?

Did you know that according to former SEC chairman Christopher Cox, “a consequence of the failure . . . is that subpoena power was not used to obtain information, but rather the staff relied upon information voluntarily produced by Mr. Madoff and his firm?”

That’s one reason lawyer Howard Eilisofon is taking on the US government on behalf of clients.

“It is quite admirable for Chairman Cox to stand up to the plate and actually make public statements that there was credible evidence … It’s very admirable, but it is also very telling. That will go a long way to proving liability.” Eilisofon is reported to have said to NY Times reporters.

The irony, of course, is that Bernie Madoff’s record appeared unassailable, until then. For example, he was a former head of the NASDAQ. Now, recall that this is the same outfit that ordinary folks like us are told to use to investigate stock-brokers, financial planners, wealth managers, etc [now FINRA]. Still, may burned investors are blaming Cox and the SEC for the Madoff fiasco.

And so, I ask our all Medical Executive-Post readers:

1. Is this a classic case of negligence by the SEC?

2. Does the SIPC have enough funds to even make Madoff investors partially whole?

3. Do you think bank industry CEOs are intimated by governmental nationalization of banks, given the poor history of oversight?

4. Who should you trust to manager your money; if anyone?

Any other other thoughts?

-Dr. Jim Stevenson
Nurse Mary, on January 25th, 2009 at 1:18 PM Said:

Jim,

Great comments. Now, just think about it and extend the analogy.

The Obama administration, and many citizens, want nationalized healthdcare? Another case of the fox guarding the henhouse?

Nurse Mary
[quite contrary]
Luellen, on January 25th, 2009 at 1:25 PM Said:

Hello Ben, Hope and all,

According to SEC chairman Christopher Cox, “the [SEC] relied upon information voluntarily produced by Mr. Madoff and his firm?”

Moreover, Bernie Madoff was head of the NASDAQ!

Aren’t these the same outfits that ordinary folks are told to use to investigate stock-brokers, financial planners, wealth managers, etc.

Just remember, a sucker is born every day.

-Luellen
Greg, on January 25th, 2009 at 1:46 PM Said:

Hi Nigel, Stu and Frank,

1. Does the SIPC even have enough money to compensate the Madoff investors?

2. The loss of over $100 billion of shareholder wealth since Lewis and Thain joined forces, has raised questions about how long Lewis’ nearly eight-year tenure should continue.

Many opine it’s time for Lewis to join Thain in retirement; voluntarily or not!

-Greg
Dr. Pruitt, on January 25th, 2009 at 10:07 PM Said:

More about Hayward Zwerling and Glen Tullman,

Do you know what Dr. Hayward Zwerling, President of ComChart Medical Software, and Glen Tullman, CEO of Allscripts have in common? Apart from their healthcare IT interests, both are fighting the good fight against diabetes – each in their own honorable and effective ways.

Hayward Zwerling MD is professionally involved with the treatment of the disease at the Lowell Diabetes & Endocrine Center in Lowell, Massachusetts. A year ago, he was recognized by the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) for his exceptional care to his patients as part of the Diabetes Physician Recognition Program.

Mr. Glen Tullman, on the other hand, has supported important and significant diabetes research for years. He not only donates millions of dollars of hope for finding a cure, but Mr. Tullman also serves on the International Board of the Juvenile Diabetes Research Foundation.

In addition to his voluntary service to the diabetes foundation, Glen Tullman, CEO of Allscripts, also serves on the Board of Trustees of the Certification Commission for Healthcare Information Technology (CCHIT) – which has been appointed control of the direction of the market for healthcare IT products in the nation – by mandate if necessary. Large government, as well as Wall Street, naturally favors large companies … like Allscripts.

A couple of days ago, Dr. Zwerling, President of ComChart Medical Software, a much smaller, grassroots-level eHR company posted a critical comment about the commission on ModernHealthcare.com titled “An inherent conflict of interest within CCHIT.”

http://www.modernhealthcare.com/article/20090121/REG/301229990/-1/YOURVIEWS

It is clearly evident that Zwerling is referring to CEOs like Glen Tullman when he says,

“Approximately half of CCHIT’s board of directors work for medical insurance companies or commercial medical informatic companies, or are physicians employed by very large group practices or electronic health-record companies. As a result, CCHIT’s priorities have been tailored to reflect the interests of its board, rather than the needs of the physicians and the health interests of our society at large.”

By the way, dentists are not represented at all. God only knows whether the American Dental Association is involved in any part of the eHR struggle. The leadership of my professional organization is silent, yet they claim they are representing our patients’ interests. How can we trust the organization when it supports rationalization over evidence for the need for eHRs in dentistry, as described in Dr. Robert H. Ahlstrom’s testimony to DHHS?

(See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony.”)

http://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

Like Glen Tullman, Dr. Robert Ahlstrom is a nationally recognized expert on paperless practices. And like Tullman, politicians like what he says more than doctors. He’s got game.

Sorry; I just had to slip that in. Like Dr. Zwerling, I sense that these are critical times.

I truly find Dr. Zwerling’s character historically interesting, and encouraging. His timing is perfect. He is a rebel at a time when the President of the United States won an election on the promise of meaningful change.

This is from Zwerling’s software website. ”ComChart eMR: The advantages of a comprehensive eMR, without the hassles/bloat that come with all CCHIT certified eMRs.”

http://www.comchart.com/

See what I mean? It is like a dentist saying, “I’ll tell you what you can do with your HIPAA paperwork…”

So now that we know that Dr. Hayward Zwerling has little respect for board members of CCHIT, how much respect does CCHIT board member Mr. Glen Tullman have for doctors? The truth is not hard to uncover. As always, to find allegiances, sometimes it is as simple as following the money.

Over a month ago, Alex Nussbaum of Bloomberg.com posted a story titled, “Insurers, Costs Spur Rise in Online Medical Records.”

http://www.bloomberg.com/apps/news?pid=20601109&sid=aX4cYX.5J0pg&refer=home

Nussbaum writes:

“Pressure from insurers such as Aetna Inc. and WellPoint Inc. and the need to cut hospital costs are speeding a move by doctors to computer recordkeeping, said Glen Tullman, chief executive officer of Allscripts-Misys Healthcare Solutions Inc.”

Tullman was speaking at a forum sponsored by NASDAQ OMX Group Inc. and Leerink Swann & Co.

So how credible is Tullman on Wall Street? Like Zwerling, his timing isn’t bad, but in addition, he backed the right candidate in meaningful ways. He’s got game.

In October, as the last question of an interview on HIStalk blog, Glen Tullman, a major player in the healthcare IT industry was asked if he would accept a cabinet position should Obama be elected.

http://histalk2.com/2008/10/14/live-chat-with-allscripts-ceo-glen-tullman-wednesday-1015-700-pm-et/

Tullman coyly evaded the question, but conveniently allowed that he has always been an Obama supporter. Americans should know that if worse comes to worse, and Tullman’s appointment comes down to a selection committee approval, be aware that Tullman’s support can be worth millions of dollars to his favored charities. He’s got game, and you can bet he also has Obama’s ear.

Two months following the interview and Obama’s election, at the NASDAQ forum in December, Tullman’s confidence was obviously hard to control, and he became reckless – in my opinion. Pride does those things. He found it easy to humor the already eager investors by pronouncing that federal spending on the eHR system should be tied to doctors’ use of the eHR system, which he sells. He added that if doctors find themselves short of available cash, the funding could come in the form of loans,

“to ensure doctors have some skin in the game.”

Those words must have boosted the mood of the audience to giddy, because immediately upon hearing that providers would be gambling with their own “skin,” they were still giggling and barely maintaining continence when they sent the text messages that immediately goosed the stock price of Allscripts.

-Darrell K. Pruitt; DDS
Rachel, on January 25th, 2009 at 11:02 PM Said:

ME-P Readers and Subscribers,

According to experts David Kibbe MD MBA and Brian Klepper opining elsewhere,

“interoperability is the key to the broad use of electronic health records. The Tower of Babel is unacceptable. Fortunately, those stewarding EHR at the Federal level seem to be emphasizing interoperability as they develop the National Health Information Network (NIHN).”

Moreover, “other countries have done a better job of implementing electronic systems. Sixty percent of New Zealand family physicians already use electronic medical records, while US estimates range between 4% and 20%. That leaves U.S. healthcare players needing to cooperate even more zealously toward an electronic system.”

More video discussions: http://www.healthcaretownhall.com

Sounds much like HIT dentist blogger Dr. Darrell Pruitt, to me.

-Rachel Penti-Maki; RN, MHA
Hope, on January 26th, 2009 at 12:51 AM Said:

More on Public Equity Relationships,

The above post by our Editor, and his discourse on the public consolidation model of RIAs as reported in Great Expectations – Disappointing Realities, by John Churchill in the January issue of Registered Representative magazine, also reminded me of the same roll-up model of medical partnerships briefly popular in the late 1990s.

Back then, the frenzied medical consolidators offered employed doctors experience within a large group whose decisions were made by managers. Thus, leaving them unfettered to serve patients; or so they said!

Compensation stress was controlled and replaced with the stress of investor expectations, as Physician Practice Management Corporations (PPMCs) needed to grow revenues by 10-15% annually to maintain price-to-earnings ratios. If stock was held in a growing PPMC, physician employees shared in both practice and corporate compensation. If not; well, too bad!

But, of course, after the dot.com explosion of 2000, most PPMCs collapsed, according to the Cain Brothers PPMC Index. Reports suggest they suffered a market capitalization loss of more than 99%. And, the PPMC business model has all but disintegrated, since then.

And so, let a word to the wise FA be sufficient. But, it probably won’t be. These consolidators sold RIAs the same vague commodity [time savings] that some FAs sell to their clients [time savings]. Of course, the words of my grandmother still ring true;

“if you don’t have the time to look after your own business, medical practice or money; you probably won’t have it for very long.”

Fraternally,
Hope Rachel Hetico; RN, MHA, CMP™
Darrell, on January 26th, 2009 at 1:54 AM Said:

On Interoperable eHR Languages,

The Tower of Babel is under-rated in history. I have heard that during World War II, Americans’ lives were saved because the Japanese were unable to hack the Navajo language used by the US to transmit valuable military secrets.

I know for a fact that it is beyond this dentist IT blogger’s acting ability to even imitate New Zealand zeal for slippery, interoperable eHRs. Common sense tells me that eHRs are expensive, dangerous and disregard Americans’ Constitutional Rights to privacy.

Maybe experts Kibbe and Klepper should try their act elsewhere. It’s not funny here.

-Darrell K. Pruitt; DDS
Susan, on January 26th, 2009 at 11:26 AM Said:

AMGA Physician Supply Study

According to a report by the American Medical Group Association (AMGA) and Cejka Search, the economic imbalance in supply and demand for physicians will intensify as the U.S. population continues to grow faster than the physician workforce. Moreover, added pressure will come with the increasing number of physicians practicing medicine on a part-time basis.

In the recently released survey, responding groups reported an increase in the percentage of physicians practicing part-time from 13 percent in 2005 to 19 percent in 2007, while males increased from 5 percent to 7 percent, and females increased from 8 percent to 12 percent.

The age group with the greatest number of physicians practicing part-time is between 35 and 39; the gender split among part-time physicians in that age group is 15 percent male and 85 percent female.

Of the physicians practicing part-time, 83 percent practice more than half of a workweek and 45 percent practice at least three-quarters of a workweek. Eighty-six percent of respondents reported that they hired hospitalists or engaged with a hospitalist organization in the past year, while the likelihood of the group doing so increased with the size of the group and if it was owned by a hospital or an integrated delivery system.

-Susan
Hope, on January 26th, 2009 at 11:31 AM Said:

Defensive Medicine,

Behavioral psychologists tell us that doctors, like most people, tend to experience losses more intensely than gains, and evaluate risks in isolation. So, it’s no surprise that they practice defensive medicine and order an abundance of tests and/or procedures as an inappropriate risk management tool.

Similarly, in healthcare economics, we have seen goaded physicians prefer financial products like the guaranteed minimum death benefit of variable annuities, or the assurance that comes with long term care or traditional cash value life insurance policies, despite decidedly higher costs. Some other physicians enter denial mode and eschew the potential practice impact of HIPAA and Balanced Budget Act risks; self referral risks; OSHA, DEA, EPA, OCR, or managed care contract risks; employee, expert witness, peer review and on-call risks; and even educational debt load risks, among so many others.

In fact, this has become such a contentious issue that we have codified our experiences, tools and techniques in the new book: “Risk Management and Insurance Planning for Physicians and Advisors”, edited by Dr. David E. Marcinko, MBA, CFP©, CMP© of the Institute of Medical Business Advisors, Inc:

http://www.jbpub.com/catalog/0763733423/table_of_contents.htm

The book contains a Foreword from Lloyd M. Krieger, MD, MBA of the UCLA School of Medicine and has been referenced by the Medical Group Management Association (MGMA); American College of Physician Executives (ACPE), American College of Emergency Physicians (ACPE) and American Medical Association (AMA), among many other medial and business schools.

It is an essential textbook because it explains the background, theory, and practicalities of medical risk management and is helpful to all doctors trying to survive in this litigious environment, or attempting to make good decisions about the insurance risks they face.

With time and money at a premium, and so much information packed into one well-organized resource, this book should be on the desk of every medical practitioner.

Hope R. Hetico, RN, MHA
http://www.MedicalBusinessAdvisors.com
Norcross, Georgia
Tom, on January 26th, 2009 at 11:41 AM Said:

Yada … Yada … Yada,

An abundance of federal agencies regulate the financial industry. But no agency is responsible for understanding or containing risks affecting the financial system as a whole. In fact, none even has a complete picture of the financial markets.

So forget about the SEC, FINRA, Ways and Means Committee, NASDAQ, SIPC, Bankg Association, etc; and all the so-called private vetting and matching firms for financial advisors, too.

Just watch your own back!
No one else will.

-Doubting Thomas
George, on January 26th, 2009 at 1:43 PM Said:

Verification Might Spur HIT and OSHA Initiatives,

I believe that if medical providers adopted a set of common practices used for validating the identity of online consumers, not only would our records be safer, it’s more likely that Personal Health Record [PHR], and related other HIT initiatives, would become more popular with all patients, and safer.

Of course, the use of “knowledge-based authentication systems” - a security method that uses one’s knowledge of facts only they should know – to establish identity is vital. In addition, confirmed identities managed by reliable third-parties, such as financial institutions, should also be included in the security-mix.

Naturally, the devil-is-in-the-details, and who among us can define a ”reliable third party”, with the daily barrage of security breaches coming at us at increasingly faster rates.

Nevertheless, hospital rules and regulations mandated by both the Sarbanes-Oxley Act, as well as the Patriot Act for MSAs/HSAs might be satisfied in this manner, as well as OSHA related HIT initiatives.

But, that’s just my opinion.
Keep up the thought-leadership.

George
Dr. Pruitt, on January 26th, 2009 at 6:45 PM Said:

Careful with that, Mr. Tullman of Allscripts,

On my good days, when things I predict seem to fall into place just like I described, I like to proudly announce to my Medical Executive-Post readers that I will continue to do my best to describe the event horizon of history for them in an interesting manner – in the hope that they too will grab a voice and get involved.

I don’t want to lose you now, because I think it is going to get really interesting for Allscripts soon, and I want the opportunity to tell you “I told you so” … or not. I predict that within a week, CEO Tullman will feel the start of a prolonged media backlash because of his close relationship with CCHIT (I mean really, who could not see that disaster coming)?

I also think the price for Allscripts’ (MDRX) stock is in for a tumble when physicians really begin to understand what Dr. Hayward Zwerling already knows about CCHIT – I will say that by June, MDRX will lose everything it gains in the next two months, while the Fortune 500 will show slow, unexciting gains. I could be wrong. Remember, I’m a dentist, this is a hobby, and I’m just guessing for crying out loud. No wagering, please.

My comment from yesterday, “Dr. Hayward Zwerling, meet Mr. Glen Tullman,” scooped Fortune Magazine reporter Mina Kimes’ article about Tullman by a day … and Kimes probably had a head start on me. Her article is titled “One potential winner from stimulus bucks.”

http://money.cnn.com/2009/01/26/technology/allscripts.fortune/?postversion=2009012611

Like my own article, Kimes’ article describes how Allscripts CEO Glen Tullman is the luckiest business dude in America. He’s in the right place at the right time. He’s got game. And he’s got Obama’s ear.

Kimes confirmed my suspicion that Tullman and Obama had more than a passing interest in each others’ interests. Kimes writes that Tullman advised Obama about the EHR issue before the election. It didn’t hurt that they are both from Chicago.

After reading my article, one only needs to read a few of Kimes’ words to understand why what is good for Allscripts is not necessarily good for the nation’s healthcare:

“Tullman hopes that Obama will swiftly use the money to implement incentives and penalties. ‘The government has to make sure that they incentivize not only the acquisition, but the utilization of these systems,’ [Tullman] says.”

Kimes adds, “In order to receive grants, doctors would need to embrace information technology — and, inevitably, embrace Allscripts’ products.”Kimes also confirmed that Tullman has problems keeping his pride in check. He says things he will surely regret. Doesn’t he have PR people?

“Imagine — the most influential person in the world says everyone has to have your product in five years. You can’t paint a better picture.” – Allscripts CEO Glen Tullman, January 26, 2009.

I’d be careful where you point that, Glen. You could put a hole in a nice shoe or two.

Darrel K. Pruitt; DDS
Betty, on January 27th, 2009 at 3:29 PM Said:

Calvin,

I agree with your post above. In fact, according to a new survey by the American Hospital Association titled, “Report on the Capital Crisis: Impact on Hospitals,” the capital crunch and current recessionary environment is severely restricting those US hospitals seeking to obtain funds to upgrade facilities or invest in new clinical and health information technologies.

The AHA survey, provided data from 639 hospitals collected from late December 2008 to January 6, 2009.

-Betty
Peter, on January 27th, 2009 at 4:18 PM Said:

Dear Hayward and Darrell,

Q: What gives with HIT security?

According to an article by Alice Lipowicz, Jan 20, 2009, in the HiMSS trade industry magazine – Government Health IT – HHSD must become a leader in identifying and fighting medical identity theft and should make it a central part of health information technology initiatives.

The article also states that medical identity theft poses serious dangers to patient-consumers because false information in a person’s health record could affect treatment. It cited, for example, that false information could lead to a patient receiving the wrong medicine in an emergency room, resulting in the patient’s injury or death. Health identity theft could also lead to financial costs for individuals, payers and providers and the loss of privacy for individuals.

Yet, I thought this Obama HIT initiative was so secure; or is it? Just what gives? It seem like we are getting mixed messages from Uncle Sam on this issue, aren’t we?

-Peter
Harry, on January 27th, 2009 at 6:29 PM Said:

Hi Luellen,

I wonder just how many more charlatan financial advisors are in the pipeline?

For example, did you know that the owner of a Long Island, New York investment firm accused of cheating people out of more than $100 million just appeared in court?

Yep; it’s true. According to the FBI, financial advisor Nicholas Cosmo surrendered at a US Postal Inspection Service office in Hicksville, New York, the other day.

And, separately, missing Florida hedge fund manager Arthur Nadel finally turned himself in to authorities in Tampa, Fla. He was accompanied by two attorneys and is awaiting an appearance in federal court.

Now, how many more of these so-called fraudulent financial advisors will fess-up; or be caught? Of course, certifications be damned.

-Harry
Phillip, on January 28th, 2009 at 11:03 AM Said:

Bravo VA – Not!

RE: HIT Privacy Issues

And, some politicians, patients, doctors and pundits want national healthcare?

Didn’t the Veterans Affairs Department just agree to pay $20 million, in a class action lawsuit alleging invasion of privacy, to veterans for exposing them to possible identity theft in 2006 by losing their sensitive personal information?

The lawsuit came after a VA data analyst admitted he had lost a laptop computer and external drive containing the names, birth dates and Social Security numbers of up to 26.5 million veterans and active-duty troops.

Of course, the money will come from the US Treasury exactly at this time of financial meltdown. Jus consider; how many kids could be immunized; or uninsured patient treated with this money.

Now, we all understand human error; but it could only occur on such a large scale with eHRs.

-Philip
Darrell, on January 28th, 2009 at 11:27 AM Said:

Chairman Leavitt Speaks,

In a parallel thread about CCHIT elsewhere, I warned readers that it is my bet-the-farm guess that things are going to get dicey for Allscripts and CEO Glen Tullman really soon.

http://community.pennwelldentalgroup.com/forum/topics/dr-hayward-zwerling-meet-mr

I even went so far as to say “I predict that within a week, CEO Tullman will feel the start of a prolonged media backlash because of his close relationship with CCHIT.” That would be six days from today; Feb. 2-3; or so.

If one occasionally wonders if I am simply full of it, note the timing of events I describe as history unfolds before us. It is my opinion that from this forum, we have a wonderful vantage point. What’s more, it may occur to some that we are not completely independent of the action. I think my credibility will soon be vindicated … or not.

Either way, I call this an adventure.

Look at tomorrow and allow me to share with you a peek over the horizon. Following reading this comment, decide for yourself if what we are witnessing is not a few steps into the future of healthcare IT; I do.

It was on the “Zwerling meet Tullman” thread that I mentioned that Dr. Zwerling’s critical assessment of CCHIT was posted on ModernHealthcare.com on Jan. 21, early in the morning. Today, Jan. 27, Mark Leavitt, MD posted a scathing response to Dr. Zwerling’s criticism, also on http://www.ModernHealthcare.com

http://www.modernhealthcare.com/article/20090127/REG/301279962

The title of Levitt’s piece is “Unfounded claims threaten dedicated work at CCHIT”. Dr. Leavitt pleads:

“Dr. Hayward Zwerling’s claims attempt to disparage the work of hundreds of volunteers who have contributed to the mission of the Certification Commission for Healthcare Information Technology.”

He terminates his defensive message with what sounds like a plea for merciful compassion: “I hope Dr. Zwerling will think about his oath to ‘first, do no harm’ and learn the facts before making false claims that threaten the constructive, dedicated work of so many individuals.” Ouch.

And so; who is this Dr. Leavitt, and why is he so passionate in defending over-worked volunteers, including CCHIT board member Glen Tullman, CEO of Allscripts?

Why; Dr. Mark Leavitt is none other than the Chairman of CCHIT. Do you find it odd that someone in a position like Leavitt’s would risk opening up on a common stakeholder on the Internet? I do. I find it shocking and wonderful entertainment on a day far too cold to golf.

Please hang with me a little longer. I promise it gets really better soon. You have to admit that it is obvious that Dr. Leavitt’s ill-advised defense based on pitiful misdirection is so lame.

Remarkably, it is even less creative than the usual committee-approved talking point. Don’t these command-and-control types have PR people who warn them what not to try on the Internet? This isn’t the first time that it has occurred to me that insulated good ol’ boys have been drinking their own hooch in the dark for decades – often making them blind to their stupid stuff. Then when they finally venture out into the transparency of the Internet, they are soon stunned by freedom of speech in a small town, and fall easy prey to uncontrollable gossip.

For example, CEO Tullman, the CCHIT board member, has squeezed off a couple of special faux pas of his own over the last few months. Here is his latest, in which he describes the origin of his respect for President Obama:

“Imagine-the most influential person in the world says everyone has to have your product in five years. You can’t paint a better picture.”

- Allscripts CEO Glen Tullman, January 26, 2009.

http://money.cnn.com/2009/01/26/technology/allscripts.fortune/?postversion=2009012611

Contrary to what Dr. Leavitt would have us believe, I am fairly certain that hurting the feelings of volunteers was neither an intention nor a concern of Dr. Hayward Zwerling when he wrote his comment. I think Zwerling was after something more strategic. Even though Zwerling never mentioned Leavitt by name, they both know very well that it is ultimately Leavitt’s “skin” that is in the game. That is undoubtedly the reason that Leavitt found he could no longer remain silent. Did you notice the panicky tone of Leavitt’s voice? I have to assume that he must have been feeling a tremendous amount of pressure to respond because he noticeably lost his composure and was careless in his response.

I don’t think Dr. Leavitt is the only one trapped in CCHIT.

“CCHIT, a not-for-profit, 501(c)(3) organization with a public mission, has worked diligently to create an open, transparent collaboration among all healthcare and health IT stakeholders. Hundreds of volunteers have given countless hours in service to its mission.”
-Dr. Mark Leavitt, January 27, 2009.

For those who still may not believe how close I am bringing us to the edge of history in healthcare IT, let me point out that I posted Dr. Zwerling’s letter on the PennWell forum, three days before it appeared on ModernHealthcare.com. Now let me review with you what happened over those three days. I think you will find this revealing.

1.18.09
I found Dr. Zwerling’s critical January 2 comment on Boston.com which he wrote in response to an article which questioned the value of EHRs in healthcare.

http://people.boston.com/articles/nation/?p=articlecomments&activityId=6778798549471809193

That same day, I copied and posted his comment on this PennWell forum under the title “Bad CCHIT” as the focus of the discussion.

1.19.09
A friend suggested I send the Certification Commission for Healthcare Information Technology (CCHIT) a copy of Dr. Hayward Zwerling’s critical comment about the Commission. I liked the idea and I was provided with this address: http://www.cchit.org/about/contact/index.asp

I left a message on the CCHIT website announcing that I posted the question “Where are you taking us, Mark Leavitt?” here on the PennWell forum, and I invited a response. That would be the same Mark Leavitt who yesterday, took out his frustration on Dr. Zwerling.

To my surprise, I almost immediately received a response from the CCHIT staff – informing me that questions are handled on a first-come, first-served basis but nevertheless, I was promised that I would receive an email reply by January 25.

1.21.09
I wrote “It only took two days for CCHIT to respond to my question that they didn’t receive.”

Latrice Knight, Executive Assistant at CCHIT (233 N Michigan Avenue, 21st Floor|, Chicago, IL 60601, 312.233.1582 – voice, 312.896.1466 – fax, lknight@cchit.org), emailed me this message:

“Darrell, We did not receive your question. Please resubmit your question at http://www.cchit.org

After visiting the link she suggested, which required intricate registration steps before demanding the appropriate “line numbers” from legal documents somewhere, I gave up and resubmitted my question to Dr. Mark Leavitt, once again including Dr. Zwerling’s comment, in the tried and proven link to Executive Director Latrice Knight on the same day, Jan. 21.

That means that if it takes CCHIT five days to respond to emails, I should at least hear something by tomorrow, Jan. 28. If I don’t, I’ll remind Latrice Knight that I am patiently waiting for a response.

Did you notice that this time, I did not receive an immediate response CCHIT confirming receipt of my question?

Do you think that some who work hard at CCHIT Headquarters recognized the Zwerling article titled, “An inherent conflict of interest within CCHIT” on ModernHealthcare.com as the same one that arrived early that morning?

If you don’t find this adventure exciting yet, just wait until tomorrow. Either Ms. Knight will be contacting me or I will be contacting her. She is trapped along side Dr. Mark Leavitt. They are in my neighborhood now, and beyond the rescue of traditional command-and-control PR techniques.

I really should be golfing.
-Darrell Kellus Pruitt; DDS

Editor’s Note: Note: Dr. Pruitt blogs here and at others sites where this comment first appeared.
Dr. Marcinko, on January 28th, 2009 at 12:01 PM Said:

Hello Darrel, Mark, Peter and all ME-Post Readers and Subscribers,

RE: Disingenuous, Ironic; or Both? You decide.

The VA just settled a $20 million class action privacy lawsuit for exposing 26.5 million veterans them to possible identity. The lawsuit came the VA analyst admitted an analyst lost a laptop computer and external drive containing the names, birth dates and Social Security numbers of the vets and active-duty troops.

Of course, if the US government and the DHHS can’t secure private healthcare info and eHRs; how does Uncle Sam, Tom Daschle, Mark Leavitt and Barack Obama etc, expect private doctors and hospital to achieve same; and at what cost? Just ponder how many kids could be immunized, uninsured patients treated, new pharmaceuticals developed, or medical RD pursued with this money. The system is just not ready for eHRs right now; but perhaps in the next generation?
We don’t need to use an A-bomb, when a fly-swatter will do.

And so, since it seems this reply from Dr. Leavitt preceded the VA settlement; my vote is for irony. No doubt Leavitt is a genuine guy; just wrong and too far removed from the trenches. Candor – Intelligence – Goodwill to all.

Fraternally,
Dave
Dr. David Edward Marcinko; MBA
[Editor-in-Chief]
Perry, on January 28th, 2009 at 3:09 PM Said:

An Oxymoron?

Barack H. Obama just delayed the move to digital TV citing difficulties experienced by the average citizen in making the transition.

Yet, on the other hand, the administration believes that the average patient can use, and understand, inter-operable eHRs!

Amazing!

Perry
Darrell, on January 28th, 2009 at 10:44 PM Said:

20 Billion Dollars – minus – 20 Million Dollars,

In the best of circumstances, when an aircraft remains trapped in a tailspin in spite of the pilot’s determined and exhausting efforts at commanding control, simply pouring on more gas may just hasten the abrupt, messy arrival – way ahead of schedule and way short of the runway.

However, having the courage to let go of the stick early enough – allowing time-tested, built-in aerodynamics to resume functioning according to natural laws can mean the difference between life and death.

In my opinion, it is time for Dr. Mark Leavitt, Chairman of CCHIT to start listening to doctors instead of Wall Street. Wall Street has been known to crash a time or two because of natural laws and fingers like potatoes.

If after blowing through all 20 billion dollars, there floats an unsubstantiated rumor that it is unsafe to allow personal information to enter eHRs, a significant number of patients will lie about their health histories. The distrust will not only ruin meaningful research, but it could cost more peoples’ lives than eHRs save. As bad as it sounds, that is as good as it gets if Americans cannot “opt-out” of perceived harm from eHRs. Consider it a natural law.

If after the money is spent, it is not a rumor, but a well-known fact that eHRs cannot be trusted with patients’ personal secrets, doctors will do the lying for them. Consider it the Hippocratic Oath.

Let’s call the 20 million dollar payout to victims of the VA breach an unexpected, but really clever part of the 20 billion dollar economic stimulus plan, and move on in a more secure direction that involves fewer attorneys, more doctors and more cures.

How about this idea: Let’s return to basics before we spend any more money. Since we are arguably heading in the wrong direction, the last thing we need is more momentum.

-D. Kellus Pruitt; DDS
Dr. Pruitt, on January 29th, 2009 at 7:37 PM Said:

Dear Latrice Knight,

In our last exchange of emails, I was attempting to obtain a response to a question for CCHIT about a comment made by Dr. Hayward Zwerling. His comment appeared January 2 on Boston.com, and he was very critical of your organization.

If you recall, Dr. Zwerling’s comment caused me to become understandably concerned about the direction CCHIT is taking healthcare. Dr. Zwerling suspects that the CCHIT board members represent stakeholders rather than doctors and patients. I looked over the list of board members. I find Zwerling’s arguments credible and alarming.

Per your encouragement, I resubmitted my question both as an email to you, as well as through the “Contacting the Certification Commission” link on the CCHIT website, which initially brought us into contact.

http://www.cchit.org/about/contact/index.asp

However, this time, I failed to get a response from either, and it has already been seven days. What happened?

In the meantime, Dr. Zwerling’s comment was independently picked up by ModernHealthcare.com, and a couple of days ago, and Dr. Leavitt himself responded (badly) to Zwerling’s concerns. Let’s move on.

I now have a new question. It is simple, and not at all controversial: How is dentistry being represented by CCHIT?

Since I didn’t see a single dentist listed anywhere in the organization one wonders who CCHIT is depending on for information about my profession. I think you can understand my concern in light of Dr. Zwerling’s accusations.

In order to save time, I prefer to submit this message both to you as an email, and to the CCHIT website. I hope I am not kept waiting form more than five days for a response this time.

Sincerely,
D. Kellus Pruitt; DDS
Ann and Darrell, on January 29th, 2009 at 7:41 PM Said:

Bad News,

Dr. Pruitt sent us an email regarding the above and said he’s received a reply from C Sue Reber the Marketing Director for CCHIT. It turns out that nobody in CCHIT has considered dentistry. It could have been worse news.

http://community.pennwelldentalgroup.com/forum/topics/bad-cchit

Ann Miller; RN, MHA
Executive-Director

How to Demand Accountability?

As noted previously in this thread, an answer from CCHIT concerning issues brought up by Dr. Hayward Zwerling is overdue. So, today I sent a follow-up email to CCHIT Executive Assistant Latrice Knight that I copied above.

Since CCHIT Chairman Dr. Mark Leavitt responded to Dr. Zwerling online on ModernHealthcar.com – answering my initial question – I asked Ms. Knight how dentistry is represented in CCHIT’s decisions. If I get a response, I expect the worst. I am afraid we will hear that the CCHIT is in close, daily contact with Dr. Robert Ahlstrom and/or the ADA Department of Dental Informatics. [See “HIPAA and Dentistry - About Ahlstrom’s Controversial HIPAA Testimony]

http://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

It would be a more reassuring to get no response at all, or even to hear Ms. Knight say, “Oh my! We completely forgot about the dentists!”

Anyone can see that I’m going through CCHIT to prod the ADA into surrendering to accountability. I am fond of this unconventional PR tool, and there are an unlimited number of portals I can use.

I regularly go through the ADA’s for-profit partner, Intelligent Dental Marketing and CEO Trajan King to poke a sharp stick into a tender spot. I do it between checking hygiene patients – just for grins.

Shy good ol’ boys who cannot do a thing about it, hate to hear me broadcast that anyone can demand accountability from any traditional command-and-control bureaucrat these days using the Internet. It may take a while to flush out hard-headed and entrenched leaders, but accountability in any organization, including CCHIT, always begins with trouble that otherwise simply will not leave and gets progressively worse.

D. Kellus Pruitt; DDS
Dr. Marcinko, on January 29th, 2009 at 11:52 PM Said:

A Smoking Gun?

This scenario, if true, is so unreal that I have asked our Executive Director, Ann Miller, to keep all ME-P readers, visitors and subscribers abreast of this evolving situation. Although this may be a slight breach of conventional blogging protocol, it is well worth the effort. Nevertheless, we include the email attributes below, for added journalistic clarity.

Dr. David Edward Marcinko
Publisher-in-Chief

From: Sue Reber [mailto:sreber@cchit.org]
Sent: Thursday, January 29, 2009 10:57 AM
To: pruittdarrell@sbcglobal.net
Cc: Latrice Knight
Subject: RE: New question – it’s easy

Dr. Pruitt:

I apologize for our failure to respond as quickly as you may have liked.

When HHS contracted with CCHIT in September of 2005 to develop an inspection and certification process for health information technology, ONC specified primary care physician offices – where most Americans get their care – followed by acute hospitals in year two, and health information exchanges in year three. That contract ended in September 2008. Our initial development process was largely dictated by that contract. ONC also specified a range of shareholder groups that should be included in our Commission and volunteer work groups. Dentistry was not among them.
However, since the launch of our first inspection program in May 2006, we have seen demand from many other care settings, patient populations and professional specialties. In response to that we have conducted open calls for requests for expansion, in November 2007 and December 2008. Those calls were published in press releases and carried in the health IT trade press. We also included the calls on our Web site and in our own electronic news letter, CCHIT eNews. We have never had a response to those calls from dentistry. In fact, I think I can safely say that your comments are among the first we have ever had from dentistry.

In both cases, the Commission has reviewed and prioritized the submissions and added programs to our future development cycles. As a result, child health, emergency medicine and cardiovascular medicine programs were launched in 2008. Long term care and behavioral health will be added in 2010. And our current proposed roadmap is open for public comment until Feb 5. You may review that work and respond by following the instructions at:

http://www.cchit.org/expansion/

Regards,

C Sue Reber
Marketing Director,
CCHIT: Certification Commission for Healthcare Information Technology
503.288.5876 office | 503.703.0813 cell | 503.287.4613 fax
sreber@cchit.org
Sue and Darrell, on January 30th, 2009 at 12:04 AM Said:

New Question for CCHIT,

“The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’ That’s why we absolutely need the profession to be represented in the discussions about EHR to make sure our ideas are enacted to the greatest extent possible.”

President-elect Dr. John S. Findley, September 2008, ADA News.

http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp

Oh Really; Dr. Findley?

In the last comment thread above, we shared an email that was sent to CCHIT, requesting information about who is keeping the commission informed of the needs of dentists.

We speculated about three possible results to our efforts:

The first was that a CCHIT rep would assure me that the ADA’s experts are all over it – just like Findley promised they would be.

The second was that there would be no response at all – that was proven wrong quickly by the email from Sue Reber, Marketing Director of CCHIT, whose reply we copied below.

And the third was, “Oh my! We completely forgot about the dentists!” — Oh my!

How could CCHIT overlook our needs with someone from the ADA “making sure our ideas are enacted to the greatest extent possible”?

Since the Certification Commission for Healthcare Information Technology is where the most important decisions are being made about the mandated eHRs that Findley warned us about, where is the ADA?

Friends, we are rudderless, our leaders are nowhere to be found, and a storm is approaching fast. What are we going to do?

-D. Kellus Pruitt; DDS
Elliot, on January 30th, 2009 at 12:57 PM Said:

Greetings Subscribers,

Did you know that according to MarketWire on January 29, 2009, the Securities Law Firm of Tramont Guerra & Núñez, PA (TGN) made an announcement concerning American International Group (NYSE: AIG) and major Wall Street firms which were named in a class action lawsuit (Case No. 08 CV 10586) filed in the Southern District of New York on December 4, 2008.

The syndication of Wall Street underwriters that were named parties for their role in raising tens of billions of dollars from the investing public while generating hundreds of millions of dollars in fees included:

Citigroup Global Markets (NYSE: C), Banc of America Securities (NYSE: BAC), Barclays Capital (NYSE: BCS), Wachovia Capital Markets (NYSE: WB), a successor in liability to AG Edwards, Credit Suisse Securities (USA) (NYSE: CS) and Deutsche Bank Securities (NYSE: DB).

The class action filed on behalf of investors alleges that the Wall Street underwriters failed in their obligation to assure the accuracy of the information used in the three shelf registration statements used to solicit clients to invest funds in the company.

Furthermore, MarketWire said that the Offering materials failed to disclose the massive liability and exposure to Credit Default Swaps, a financial instrument used by investors to hedge exposure on collateralized debt obligations and other debt securities.

Financial certifications? – Fiduciary responsibility? – Trusted Financial Advisors?
I think not!

Sorry.
Elliot
Darrell, on January 30th, 2009 at 10:47 PM Said:

So what does it take to change the direction of a dinosaur?

I’ve learned that part of the insulating design of having a committee as a central nervous system means that the ADA is excusably insensitive to its own errors, and therefore never has to correct itself. Unquestioned support of the NHII was a huge mistake at the wrong time in history for slow-moving dinosaurs to be posting things on a website – even before the downturn in the economy.

Here is another over-ripe news bite that smells worse every day: In the “Advocacy” section of the ADA website, there is a part called “ADA National Oral Health Agenda” which lists dentistry’s six highest priorities for Congress.

http://www.ada.org/prof/advocacy/agenda.asp

The introduction to the section invites the reader to “Learn how the collective voice of dentistry is changing American health care for the better.”

“Reducing the Cost of Dental Care” is one of the priorities. As a means of achieving that goal, “Health Information Technology” is the ADA’s first tool listed. Following HIT, are insurance reform, medical liability reform and regulatory reform.

Since everyone knows that HIT will never save money in dentistry, I wonder how we are doing with the reforms, and if we will be told more jokes.

D. Kellus Pruitt; DDS
Dr. Marcinko, on February 1st, 2009 at 12:42 AM Said:

A Word to the Wise …

More than two decades ago, as a young private practitioner, I cautioned my medical colleagues, and others, about United Healthcare and their ilk. These aggregators pursued their own interests; not the patient or medical provider – despite corporate protestations otherwise.

Unfortunately, I did not prevail, as this was well before the commercial Internet era; circa 1995. Neither did the private PPMC that I launched in 1999.

Later, as a Certified Financial Planner™, and licensed insurance agent, I could not stomach selling the financial, or insurance, products of the UHC Group or its subsidiaries. For example, “Golden Rule” plans were among the first commercial MSA/HSAs on the market. Initially fine and innovative, these tanked with the UHC purchase of GR, despite enthusiastically endorsing and personally using the high-deductible-health-plan concept.

Of course, the CPT® code - Igenix situation was well known to health insurance industry insiders and professional “coding-optimizers”; before it ever became the scandal it is today!

Ditto, the current financial meltdown on Wall Street, as a host of certification holders, and the many non-fiduciary “financial-advisors”, wealth-managers” and financial-consultants” who have finally demonstrated what they really are; salesmen and shills for the industry.

And so, going forward, I trust a word to the wise will be sufficient. But, if history is prologue, it won’t be!

Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
http://www.HealthcareFinacials.com
http://www.MedicalBusinessAdvisors.com
http://www.HealthDictionarySeries.com
http://www.CertifiedMedicalPlanner.com
Darrell, on February 1st, 2009 at 12:58 AM Said:

Easy PRey,

If the name Ari Adler sounds familiar, he is the Public Relations professional quoted in Mughal’s article. “Dentists or patients …” presented in the Introduction to this thread, “I will hurt you Delta Dental.” Mr. Adler is employed by Delta. He heads its Corporate and Public Affairs division. He is also an adjunct journalism/PR instructor at MI State University (from Twitter).

Mr. Adler’s website says: “I’m available for hire as a professional speaker and trainer for company meetings, conferences, workshops, etc. Presentation topics include public relations, media relations, and new media/social media.”

I wonder how well he handles Search Engine Optimization [SEO]. Let’s find out.

Adler’s latest comment “Hey, Big Brother, over here — the copy,” exposes the problem one must have maintaining personal transparency when one works for Big Brother as a day job, and runs a progressive blog at night. I can only imagine that it is difficult for traditional PR people to live in both worlds these days.

In the article, Adler asks this question shortly before requesting readers’ opinions about his social dilemma: “What should we be telling people looking to join us in the online universe? Is this like Big Brother watching everything we’re doing – only we’re some sort of insane masochists who volunteer to be watched?” I think the answer is, “Yes.” You didn’t volunteer, Ari Adler. You sold out. You are a hired gun.

Comparatively speaking, I am a free-lance amateur with wattage. It sort of makes me like the first shameless ham radio operator to show up in a polite, quiet, neighborhood – dressed in underwear and scratching.

I posted responses to three of his other questions below on his blog.

http://aribadler.wordpress.com/2009/01/28/hey-big-brother-over-here-the-copy/#comments

You’re learning hard lessons fast in the PR business, Ari Adler.

“If I make a bad pun or a risque comment on Twitter, and it’s been known to happen, should that impact how people treat me at work?”- Yes

“If a blog post I write is written specifically to provoke a discussion but someone who does business with my company disagrees, will that come back to haunt my employer?”
- Yes

“Please offer your opinions below — don’t make me write something provocative just to elicit a response. My boss might not like it.”- No, your boss will not like this.

http://www.drbicuspid.com/forum/tm.aspx?m=646

Let’s you and I discuss your thoughts about Delta Dental. How about it, Ari Adler? What do you really think of transparency?

Darrell K. Pruitt; DDS
Chris, on February 1st, 2009 at 1:05 PM Said:

Obama – It’s all about Credibility,

I can not think of two industries that rely on credibility more than healthcare and finance.

Well, it now seems that Thomas A. Daschle apparently procrastinated over his back tax problem even after being nominated to be Secretary of Health and Human Services? It appears that Tom paid more than $140,000 to the US Treasury this January 2nd – although he may have known since June 2008 that he needed to correct his tax returns for his car use problem?

And, since leaving office, he was reported to have made more than 5 million dollar without becoming a registered lobbyist, including $220,000 from the health-care industry. This included current perks – like the chauffeured Cadillac – that may have gotten him into the mess in the first place.

Of course, Timothy F. Geithner who was the ninth president and chief executive officer of the Federal Reserve Bank – who just became the 75th United States Secretary of the Treasury in the Obama Administration – also had a tax problem. Yet, he was confirmed.

So, what’s up with all that?

These two disclosures, Geithner and Daschle, have yet to raise series eyebrows among those who expected Obama to be wary of insiders; as he supposedly sought to increase the credibility of his administration; SHAME!

Tom and Tim must go!
-Christopher
Dr. Pruitt, on February 1st, 2009 at 8:37 PM Said:

More on Dental Quality Control and Low Bids,

Delta Dental representative Ari Adler complains that it is unfair to his boss to have to mail payments to dentists out of network – even if they are dentists who Delta’s clients prefer over the providers Delta prefers. Delta customers’ preferences of out-of-network dentists are clearly understandable in a market that unfairly favors managed care dentistry like Delta Dental’s – performed by the lowest bidders without quality control.

But now, Delta’s good ol’ boys can no longer ignore Adam Smith and basic principles of economics, even equipped with the best PR squad. And Ari Adler is not the best. So, he’s a part-timer.

Adler reasons that making payment convenient for their clients, who pay the insurance premiums, cheats Delta because dentists who refuse to sign a contract with Delta reap unfair benefits from Delta’s network without following cost guidelines and adhering to quality control measures – like those demanded of Delta’s preferred providers.

Such nonsense makes it surprising that Ari Adler’s alter-ego maintains a reasonable and progressive blog called 5Ws.

http://aribadler.wordpress.com/.

That is why I find it stunning when the part-time Delta employee confidently says, “We put our dentists thorough a credentialing process and provide quality assurance.” I’ll get to Delta’s level of quality in a moment.

Adler blunders on: “That means if a dentist does a filling that should last a certain amount of time and it doesn’t, they have to fix it without charging the network or the patients.”

Please note that Mr. Adler does not offer exactly how long fillings should last. Delta Dental hires experts who do, though. They are called dental consultants.

Quality control – Is that Why Consumers buy Dental Insurance?

Some dentists think so, and they invariably belong to the American Association of Dental Consultants (AADC), and are hired by dentistry brokerage firms like Delta Dental and UnitedHealthcare Dental to maintain the highest quality in dentistry in the nation for the lowest possible price – and still maintain profits for those who sign their checks. Not an easy job.

I’ll introduce you to Dr. Robert S. Laurenzano, immediate past-president of the AADC later, and I’ll let him describe to you what he likes most about his job. But first, let us look at Delta’s success at promoting quality dentistry.

DR. Oogle and Delta’s Dentists

Do you think continuity of care is important to dental patients’ health? If so, you have to agree that dentists’ popularity is the most important measure of quality available. Dental patients can sometimes recognize bad dentistry even as it is being performed.

In November of 2007, I performed a study of Delta Dental PPO participating dentists in Austin, Texas using DR. Oogle’s dentist popularity rankings on the Internet.

http://austin.doctoroogle.com/dentist_ratings.cfm/pageID/2

From Delta’s PPO website, I chose 50 preferred dentists whose practices are located in or near the 78704 zip code in Austin, and simply compared the dentists’ DR. Oogle rankings with other dentists in the area.

SUMMARY

* 76% had no listing on DR. Oogle.
* 12% had no review.
* 12% were ranked, averaging a rank of 206 out of 297.

The study is so easy to repeat that I will not waste your time with my proof. The important result to note: Delta’s preferred providers were in the bottom third of patients’ preferences in Austin a little over a year ago. Is that quality?

Here is something more current: On November 9, 2008, I posted an article on PennWell titled “Transparency and managed care dental plans” which describes another study based on preferred providers and their popularity ranking on DR. Oogle. This time it was for Phoenix, Arizona.

http://community.pennwelldentalgroup.com/forum/topics/transparency-and-managed-care?page=1&commentId=2013420%3AComment%3A19577&x=1#2013420Comment19577

In all fairness, I must reveal that according to the grading system I designed, of the twenty most common discount dental plans available in Phoenix a few months ago, Delta’s Premier was the managed care plan most likely to be accepted by a popular dentist, as rated by DR. Oogle. Even so, Delta’s plan still only scored a 5.5 on a scale of 0 – 10, so the chances of picking out an unpopular dentist was about the same, with or without Delta’s list. Is that quality? Yes. That is average quality, and the best that Phoenix has to offer in managed care dental plans. Surprised?

Here is something else I learned about the dental market in Phoenix: From the data available for UnitedHealthcare, if one purchased their plan, he or she would be much more likely to be sent to a dentist in the bottom 4% of popularity than in the top 4%.

Did I mention that UnitedHealthcare, also the owner of Ingenix, is the largest contributor to the American Association of Dental Consultants? The AADC will be meeting again in Scottsdale, Arizona this spring – not far from Phoenix.

I wonder if Gordon Christiansen will be addressing the group this year like he did last May. The crowd fits in well with his repeated criticism of dentistry in the US, doesn’t it? They soak it up.

D. Kellus Pruitt; DDS
Acre, on February 2nd, 2009 at 1:31 PM Said:

More On Tom Daschle and UHCG,

It has come to light that another healthcare client paying for HHS secretary elect Tom Daschle’s policy advice was UnitedHealth, the giant insurance company with many issues pending before the Department of Health and Human Services.

In fact, about a third of its $81 billion in revenue last year came from federally regulated sales of Medicare Advantage and Medicare supplement and prescription drug plans. The company even boasted in its annual report that “one in five Medicare recipients participates in a UnitedHealth Group Medicare program.”

-Acre Stansky
Dane Petchul, on February 2nd, 2009 at 4:00 PM Said:

More on LTC,

You bring up many points of concern when a family member requires some long-term care.

Yes, most seniors would like to stay in their homes as long as they can. It’s familiar to them and change is hard as people age. The carriers for long-term care insurance are paying out more for home care and assisted living than for nursing home care.

There are two issues here: Where will the money come from to pay for these services? Who will be available to provide the services of caregiving?

Dane Petchul, LTCP, CLTC
Dr. Pruitt, on February 2nd, 2009 at 6:17 PM Said:

Progress Report on Delta Dental,

My thread, “Delta I will hurt you,” posted elsewhere, including this civil version being simul-post on this Medical Executive-Post, are gaining significant popular momentum on the Internet according to a couple of indicators I follow. Believe it when I tell you that a crowd is gathering regardless if one invites friends to witness the public lynching of sleazy businesses.

At the risk of causing a riot against calculated tyranny that has been kept hidden up until now, I must say that this thread could prove to be the tipping point to the introduction of accountability in the managed dental care industry. It has already been shown in this thread that Delta Dental deceives its clients as business policy. The lies that Delta tells in order to expand its network hurt their clients by breaking up dental homes. Let me allow a Delta representative to help me explain the harm:

Common sense tells us that if patients are comfortable with the dental teams of their choice, they are not only more likely to have cleanings and check-ups regularly, but they are also more likely to keep better care of their teeth at home. That seems so logical, doesn’t it? So what does this mean for patients who are limited to dentists on preferred provider lists which run for only 12 month periods? Someone with access to vast sources of longitudinal dental claims data could confirm the benefit of a dental home very quickly and easily. I think someone should have done the simple study long, long ago. Well, finally the investigation has been accomplished. It is incredible that it was a Delta Dental representative who broke the news that will bring certain harm to Delta Dental – possibly by accident.

I was in the audience of about a hundred dentists and dental industry representatives on the morning of August 15, the first day of the 2008 National Dental Benefits Conference in ADA Headquarters in Chicago.

I heard Delta Dental Plans Association (DDPA) representative Maxwell H. Anderson DDS admit: “The greatest hazard to teeth is changing dentists.”

That quote was not reported in the ADA News article about the conference, so if you were not there, and you didn’t read “Managed Care or Dental Homes – You can’t have both” (September 30, 2008), you missed it.

http://community.pennwelldentalgroup.com/forum/topics/2013420:Topic:14014

Dr. Anderson said that by data mining their “proprietary” dental claims over 11 years, Delta uncovered evidence-based information revealing that clients who change dentists regularly are likely to receive more fillings than those who enjoy long-term consistent care from dental homes.

Note: It took Delta 11 years to mine this valuable information from their “proprietary” data. When challenged about their inaccessible information, a Delta rep replied that business pressure forces Delta to keep claims data secret from competitors. Forget about the dental patients.

By this point in the adventure, it should be obvious to everyone that Delta Dental not only lies to its clients about quality control, but Delta also disregards its own research that shows that their business model causes expensive harm to their clients.

That is why it is against the morals described in the Hippocratic Oath for dentists to enter into contracts with Delta Dental representatives.

Delta Dental, a traditionally sleazy company, will continue to cause harm regardless what I do. That is why it all depends on what you do with the information I provide … or not.

D. Kellus Pruitt; DDS
Matt, on February 2nd, 2009 at 9:41 PM Said:

Hello,

This is a great entry dealing with some important issues. I think it can assist others not knowing how to deal with such sensitive issues.

For example, I spent nearly four years working in an Alzheimer’s / Long Term Care facility in Utah and I know the difficulties and pains associated caring for a loved one.

I personally got to know some great people I helped care for and became close with some of their families. I also assisted with care planners. I’ve seen a lot of resources that help, like this one and will pass it along to anyone would might benefit from it.

Matt
Darrell, on February 3rd, 2009 at 11:10 AM Said:

Parasites and Stoic Individualism,

In contrast to the health insurance industry’s attractive corporate successes with micro-management of physicians’ careers – causing physicians to no longer encourage their children to follow in their paths – only a few CEOs seek to control dentistry.

Of those fifty or so, I bet not a single executive in the nation grasps why dentists have traditionally proven to be unusually difficult to domesticate. And if Ari Adler is the best PR person Delta Dental can muster, my goal of bringing Delta’s good ol’ boys down a notch or two for my readers’ entertainment (for starters) could be easier than I thought it would be.

From Delta’s silence, I learned long ago that the sleazy company is aware that its business model is defenseless. Otherwise someone might have attempted to defend the honor of Delta Dental. And that, of course, would mean that we would have us some real fun, friends.

Here is something that would-be healthcare parasites will forever stumble over: Did you know that 85% of dentists in the nation are sole proprietors of solo dental practices? That means that there are well over 150,000 different characters in 150,000 separate offices, completely independent of each other – especially in personalities. For those who are up for the world’s most difficult management challenge, they should know that each dentist represents a brand new unpredictable battle in a resilient, quiet neighborhood. Yea; too quiet!

Even though the profession may consist of an exceedingly vast assortment of über-individuals, I know of one characteristic that seems to be common among my colleagues who have also endured dental school. When it comes to public forums, dentists are stoically quiet from their freshman year forward in life. Almost every one of us learns to be reticent like those outside the profession would never believe. I am an anomaly at the extreme end of a long tail of a bell curve.

Over the last three or four decades that began with the seemingly benign arrival of dental insurance, followed by progressively worse interference in the dentist-patient relationships by dental consultants hired to save insurers money, it was easy for lots of people to temporarily forget who rightfully should be in charge of dental care in the nation. Until universal healthcare is forced onto dentistry – and as long as American small businesses can thrive in a free-market economy where competition controls quality efficiently – it will from this time forward be informed consumers who determine dental treatment in the land of the free – not dental consultants like Dr. Robert S. Laurenzano, the immediate past-president of the American Association of Dental Consultants (AADC).

On March 5, 2007, Dr. Laurenzano shared with ADA members not only the reasons that he likes his job working for dental insurance companies as a dental consultant, but also his desire to be welcomed as part of the dental team.

The title of the article he posted as a “ViewPoint” on the ADA News Online pleads “Is collegiality between dentists and benefit consultants possible?”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2390

Personally, I don’t give collegiality much chance on ethical grounds. But, don’t take my word for it, please read Dr. Laurenzano’s plea for respect and judge for yourself! I could be unfairly biased against dental consultants. Perhaps they have been more honest with other dentists’ patients than they have been with mine.

I studied the viewpoint. From what I determined, here is the list of dental consultants’ obligations according to UnitedHealthcare’s AADC as mentioned by the organization’s former President, Dr. Robert Laurenzano:

- Validate treatment quality and appropriateness (mentioned 2 times)
- Reduce fraud (4 times)
- Increase profit for dentists (1)
- Increase trust from patients (1)
- Assure ethics (6)
- Prevent mistakes (1)
- Save money on healthcare (1)
- Assure professional ideals and reputation of dentistry (4)
- Assure evidence and science-based dentistry (7)
- Assure best practices (3)
- Improve record keeping (2)
- Improve accessibility (1)
- Improve globalization of dentistry (1) [(?)]

So how involved is the ADA?

Dr. Laurenzano writes, “Last year [2006] the AADC invited Dr. James Bramson, ADA executive director, to speak at one of our meetings. He called for cooperative action by and between the ADA and the AADC in his keynote speech, and the AADC welcomes the opportunity to do just that.”

From the number of times Dr. Laurenzano mentions his desire to enforce other dentists’ ethics (6); it is obvious what he likes about his job. My question is who is enforcing Dr. Laurenzano’s ethics? UnitedHealthcare!

But look what dental consultants like most. “Assure Evidence-based and otherwise science-based dentistry.”

He makes Evidence-Based Dentistry sound like it favors Delta Dental, like his ethics perhaps?

D. Kellus Pruitt; DDS
Samuel, on February 3rd, 2009 at 2:17 PM Said:

More on Primary Care Docs,

According to the American College of Physicians, it is imperative that Congress fund immediate and sustained increases in payments for primary care to make it competitive with other career choices and to help struggling primary care practices keep their doors open.

Although Congress could fund primary care through budget neutral adjustments in the Medicare physician fee schedules, this option has several distinct disadvantages-including the likelihood that it will face strong opposition from other stakeholders that will undermine the political support needed to improve payments for primary care.

Source: ACPonline.org February 3, 2009
Sarah, on February 3rd, 2009 at 6:29 PM Said:

On Daschle and Killefer,

I must admit that I didn’t believe Tom Daschle would ever withdraw his DHHS nomination, and I thought the ME-P’s call for him to resign was wrong, and premature. Wow; was I mistaken!

Nice job Dr. Marcinko and staff.

Now, add Nancy Killefer, “Chief Performance Officer”, to the list of non-tax payers.

Too bad we didn’t get Tim G, too! Poor Barack Obama … seen as just more of the same, already!

-Sarah
Darrell

Medical Executive-Post @ Healthcare Financials.com

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