on April 18, 2003
As a layperson frequently called upon to assist physicians and surgeons in communication and marketing efforts, Dr. Marcinko's savvy book has been invaluable in educating me and advising my work. He is successful in describing and actually bringing to life both the macro and micro of this increasingly vexing enterprise of achieving profit in this pressured sector, where doctors are required not only to wear many professional and societal hats, but also to portray many conflicting roles as expert, helper, compassionate advisor, master technician, astute businessperson, educator, Hyper Time operator, lifelong student and so many others. His mastery of the subject or rather subjects provides an undertone of finiteness and even assurance to a field that is confusing and even exasperating to many in it. More than anything else, Dr. Marcinko illuminates by establishing explicit and useful displined organization to the sprawling and apparently boundless subject of how to stay afloat and persevere in a useful and effective practice. Highly recommended.
on February 16, 2002
In the current healthcare insurance crisis, THE BUSINESS OF MEDICAL PRACTICE (Profit Maximization for Savvy Doctors) is a textbook of specific value to all medical practitioners, since declining reimbursement, increasing expenses, federal regulations, and even Wall Street are all raising havoc with physician income and patient care. Contrary to conventional wisdom, we do not believe that draconian free market competition will dramatically reduce healthcare costs, for three reasons. First, it is difficult to define medical quality. Second, a perfectly competitive marketplace does not exist. Thirdly, American society is not ready for the brutally rational efficiencies of the business world. "Above all else", medicine is a uniquely personal experience.
On the other hand, we are pragmatic and realize that practicing healthcare providers of all independent degree designations (allopathic, osteopathic and podiatric physicians, dentists, optometrists, chiropractors, psychologists, physician assistant's, physical therapists and nurse practitioners), must learn to better compete in the next decade. Ultimately, practitioners who seek to be clinically and economically responsible are the wave of future. It is the physician-executive with MBA or managerial training, who can best direct future systems of autonomous care, with improved outcomes for patient, payer and physician alike.
The information in this text will help achieve this goal and is most applicable to the solo or small group practice; or for those who aspire to be decision makers. For the employed physician or resident, it will also serve as a blueprint for what can still be achieved. And, for the practice administrator, it will serve as a guide to the next generation of medical networks, IPAs or more complex large group management endeavors.
THE BUSINESS OF MEDICAL PRACTICE (Profit Maximization for Savvy Doctors) is written in prose form, using non-technical jargon, without the need to document every statement with a citation from the literature. This allows a large amount of information to be condensed into a single and practical volume. It also allows the reader to comprehend an important concept in a single reading session, with a deliberate effort to include germane examples with updated information. The interested reader is then able to research selected topics. Overlap of material has also been reduced, but important concepts are reviewed for increased understanding.
The textbook itself is divided into major three major sections, written by 20 contributing authors, and with the concepts developed in Section II (quantitative) and Section III (contemporary), building on those of Section I (qualitative). Each section is then divided into multiple parts, for a total of 25 logically progressive, yet stand-alone, chapters.
Chapter 1 briefly reviews the history of healthcare economics in the United States; from the days of private pay, to indemnity insurance and the "golden era of medicine", to contemporary managed care. Chapter 2 discusses the uses and abuses of restrictive covenant's in physician employment contracts, since more than 40% of the nations' contemporary physicians are now employees rather than independent practitioners. Chapter 3 focuses on office labor cost reduction tactics through permanent outsourcing and employee leasing options, as human resource management is the major expense driver of any medical practice. Chapter 4 surveys the management information technology (hardware and software) required for the modern digital office, while Chapter 5 extols nuances of proper CPT coding and documentation in a skeptical payer climate. The basics of capitation contracting econometrics are examined in Chapter 6. Chapter 7 provides strategies for effective managed care relations by understanding, obtaining, negotiating and servicing managed care contracts, and Chapter 8 represents a legal discourse on non-clinical risk management issues, as Section I is concluded.
Section II begins the quantitative aspects of the book, as Chapter 9 investigates the perils of indiscriminate cash flow control in rising, declining and neutral growth environments. Chapter 10 presents basic concepts of fixed and variable office cost behavior, among others, while Chapter 11
dissects the discipline of activity based costing which is a watershed concept to most physicians that has become the costing method of choice in the hyper competitive environment. Chapter 12 explores advanced cost-volume accounting techniques, emphasizing the non-traditional contribution margin approach to the income statement, with numerous spreadsheet examples to enhance understanding. Chapter 13 introduces vital financial methods to calculate and augment return on office investment and its resulting residual income. Chapter 14 on financial ratio analysis, represents the economic benchmarking equivalent of the clinical outcomes chapter; and surveys the typical office for lost sources of profit. Chapter 15 highlights the business philosophy required to create real practice equity value in an era of healthcare mergers and acquisitions, while Chapter 16, on practice valuation techniques, concludes the section and emphasizes the discounted cash flow method of appraisal since bricks and mortar are becoming increasingly worth less. It is an important chapter for the retiring practitioner in the quest for a proper payoff after years of hard work.
Section III, of the book, begins with Chapters 17 and 18 and provides utilization review, case
management and clinical benchmarking information, respectively. Chapter 19 discloses the contentious issue of medical anti-trust and the ERISA managed care exemption. Chapter 20 offers a sobering musing on change management and the new role of the physician as follower, rather than leader, of the healthcare revolution. Chapter 21 critiques Wall Street's newest security machination, the physician practice management corporation, as the initial euphoria, debacle and future of this business model is discussed using real-life examples. Chapter 22 redefines the standard of medical care to incorporates insurer financial restraints, while Chapter 23 similarly opines on the ethical and moral issues of managed medical care. Chapters 24 presents important asset protection strategies useful in an increasing litigious atmosphere, and Chapter 25 rightly concludes the third section, and book, with a discussion on choosing the business management advisor that represents the best fit for both the office milieu and individual practitioner.
In conclusion, as you read, study and reflect on this challenging textbook, remember the guiding philosophy of Eric Hoffer: "In a time of drastic change; it is the learners who will inherit the future. The learned find themselves equipped to live in a world that no long exits".
Medical Business Advisors, Inc...
on March 9, 2001
Dear Medical Colleagues,
This book is a must read for all of us who are practicing in the current managed care environment. It is not important if you are an MD, DO, DDS, DPM, DC, vet or PHD, we are all negatively impacted, and the editor and his contributing writers explain why and what we all can do about it. Although it won't be easy or fast. Medical students will be astounded at the complexity of contemporary practice, as well.
The book is divided into three parts: qualitative, quantitative and the futuristic aspects of healthcare practice. But, I must warn you that if you are an employed doctor, rather than an empolyer physician, you will feel left out since you are a captive agent. At least the independent doctor still has some control left over his or her destiny; for now. Accordingly, Dr. David Edward Marcinko; MBA, CFP, and his team, explain how you can increase your revenues, decrease your expenses and operating assets, to increase your office's Return On Investment (ROI).
In the first section, number crunching, spreadsheets, managerial and cost accounting techniques rule. Normally, somewhat mundane, it is interesting how the author make these numerics "come-alive" when real dollars are attached to the figures.
In the next section on the other hand, the qualitative aspects of medical practice are reviewed. Such topics as negotiation skills, managed care contracting, IT systems, case management and UR are given their due, along with billing, legal, anti-trust, IPA, CPT coding and asset protection issues.
Finally, the authors project their opinions about healthcare in the future; which does not look good for any of us. In fact, I won't reveal their prognosticatons about the standard of fiscal care, medical ethics, or doctors acting like passive lemmings, but they are indeed so chilling that you will just have to read this thought provoking book for yourself.
If you are a doctor, and think you know all about managed care, you will be humbled by this fact filled tome. Not reading this book definately places your practice, profession and living in peril. Do not miss it. This editor is a real doctor and business professional.
on October 25, 2000
Doctors are Not Business People-They are Physicians
It is well know that doctors and nurses, like many dads and moms, work hard at helping others but are poor business people themselves; especially in the new world of managed care, HMOs, PAs, etc.
Well, this doctor-editor, and his friends from the professions of health-law, medical-accountancy, insurance, securities, management and the investing and financial services leaders from Wall Street, have written a book to help out.
Not only does the first section of this book review medical office practice management tips, but it also teaches physicians how to profit more from their toil. Then, the book relates best practices to invest hard earned money in the sectors of risk management, budgeting, housing, automobiles, college educaton, taxation, investing, retirement and estate planning. URLs and information resources abound, and the CD-ROM is a fabulous guide giving 'real-life' examples for the above topics. Physician and healthcare provider specificity makes this major textbook a 'must read' for all medical professionals.
After all, my mom (a nurse) and my dad (a doctor) say that if doctors and nurses can't make an honest living, they will leave medicine for more lucrative jobs, and then who will help us when we are sick?
Also recommended: "The Business of Medical Practice", by the same editor at Springer Publishing, New York.
on December 7, 2000
As both a doctor and an attorney, I work on both sides of the fence. I enjoy relationships, both socially and professionally with clients of both professions. Through these sources, I was referred to Dr. Marcinko's book.
I must say, being savvy is not what it used to be AND Dr. Marcinko has explained that. This author, and his authorities who have written chapters and supplements, take time to teach professions how to become 2000 savvy and actually expand rather than stagnate. The ideas are practical, not hypotheticals as we pose at trial or deposition. For my medical bretheren, the book looks at managed care through the eyes of one of us and exhibits the skills we will need to prosper in a speculative medical amangement environment.
For either profession, the insights are a wonderful addition for providing peace of mind.