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Executive/Physician Recruiting
Medical Management Consulting
The purpose of this page is to provide a potpourri of information including interesting tidbits about the health care industry in general, pointers for career planning, opinions (yours and ours) about where medicine is going, etc. Our newest feature is our Readers' Corner & Bookstore. Thanks to a partnership between Shlian & Associates and the Amazon.com Bookstore, readers may now order books directly from our page. Just locate the book or books of interest on our recommended reading list and click on the title. This will link you to Amazon's catalog from which you may place an order.
READERS' CORNER & BOOKSTORE:
Recommended Reading
DESCRIPTION: Fifteen healthcare managers share the secrets of their success and the various routes they have taken to get there. This is a mentoring guide for anyone interested in a healthcare management career.
DESCRIPTION: This medical thriller written in 1984, has just been republished. Based loosely on a true story, it tells a chilling tale of an unstable nurse who kidnaps babies from hospital nurseries.
DESCRIPTION: This medical thriller written in 1986, has just been republished. Based loosely on a true story, it tells a chilling tale of an unsuspecting newly divorced mother and her precocious 4 year old who choose to leave the hectic pace of the big city for the seeming tranquility of a small town in Northern California.
DESCRIPTION: Whether you are "for" or "against" managed care, this book is a must read. George Anders, senior writer for the Wall Street Journal has spent the last four years covering the health care marketplace. To write Health Against Wealth he took a year sabbatical, researching the industry in depth, talking with every level of provider, payer and consumer. The result is an outsider's critical, often provocative, but generally balanced view of managed care and managed care organizations. Although he still favors the philosophy of managed care, Anders acknowledges the inherent difficulties in balancing business performance promised to stockholders with quality and quantity of health care delivered to HMO enrollees - especially as sicker and older people sign up with managed care plans. NOTE: A more complete review can be found in the JAMA, Dec 18, 1996 issue.
DESCRIPTION: In an easy to read "folksy" style, ten physicians who have found successful niches in medical management discuss how they developed their paticular career paths. In addition, the book gives invaluable information to those in the process of choosing medical management as a specialty, offering guidance in assessing professional and personal strengths, developing self-marketing strategies, identifiying and evaluating alternatives to conventional practice, and approaching career transitions in an organized way. A must read for medical students, residents and physicians at any stage in their careers.
DESCRIPTION: This unique resource offers payers, provders, pharmaceutical companies and consultants alike the practical direction needed to asses their own disease management strategies and develop an effective model to deliver cost-effective, high-quality patient care. Illustrated with case examples,23 industry experts draw from their work in clinical practice, research, consulting and academia to offer theoretical and practical considerations in setting up disease management programs specific to various settings.
DESCRIPTION: This book explains how pharamcoeconomics, an outcomes research tool, can help quantitate the economic value of pharmaceuticals in the treatment of disease. Clear and concise, the authors present a strategy for turning outcomes theory into practical applications relevant to a variety of practice settings.
DESCRIPTION: This book provides an understanding of the basic concepts of managed care, reviews its growth and development and covers such topics as the evaluation of healthcare reform, types of organizations, integrated health care delivery systems, open versus closed panel plans, negotiating with consultants and hospitals, Medicaid and Medicare managed care, and legal issues in provider contracting.
DESCRIPTION: A comprehensive interview resource featuring complete job interviews from experts in all field and industries.
DESCRIPTION: Professor Herzlinger takes a close look at the industry representing one seventh of the US economy, explaining the ins and outs of the dramatic changes occurring in modern healthcare while making predictions as towho benefits from the revolution in medicine.
DESCRIPTION: An easy to read guide for anyone preparing for job interviews.
DESCRIPTION: The numbers of women in the medical management profession have grown so substantially that women themselves now serve as the best mentors for coming generations of women physician executives. This 119 page monograph tells of the experiences women in physician leadership roles have encountered and of the obstacles they have challenged and overcome. In individual accounts of their entry into medicine and their moves to medical management, these successful women executives describe the continuing search for challenges, the negative and positive experiences that build management careers, working from a global view, physicians as hospital administrators, the move from clinician to entrepreneur, the transition from academia and the shift from clinician to executive. Despite its focus on women, this is a book filled with so much good general information that it can help anyone interested in making the move to management - even non-physicians.
DID YOU KNOW?-1.2 BILLION
The total number of visits to physicians' offices, hospital ERs, and hospital outpatient departments during 2005.
-37 PERCENTAGE
increase in the number of visits to medical specialists from 1995 to 2005
-20 PERCENTAGE i
ncrease in visits to primary care or surgical specialty offices, or hospital outpatient departments from 1995 to 2005
-7 PERCENTAGE
increase in ER visits during the same period
Source: Advance Data from Vital Health Statistics, No 388, National Center for Health Statistics
About 33% of every dollar spent on U.S. health care goes toward inpatient hospital care, according to a report by HHS's Agency for Healthcare Research and Quality, the Washington Times reports (Howard Price, Washington Times, 9/23). The report is based on a U.S. database of inpatient hospital charges maintained by the federal government (Reuters, 9/22).
In 2004, more than 60% of hospital bills were sent to federal and state governments for Medicare and Medicaid reimbursements, the study finds. The study also finds that in 2004:
" Hospital bills totaled $790 billion, and $475 billion of that amount was billed to Medicare and Medicaid, excluding physician fees;
- Medicare was charged $363 billion, or 46% of hospital bills, and Medicaid bills were $112 billion, or 14.1 % of hospital bills;
- Hospital charges to private insurers totaled $252 billion, nearly one-third of all bills;
- $44 billion, nearly 6% of total hospital bills, went toward treating coronary atherosclerosis, making it the most expensive condition to treat. Charges for atherosclerosis ranked No. 1 for Medicare, No. 7 for Medicaid, No. 3 for private insurers and No. 2 for the uninsured;
- $41 billion, the second-highest total amount billed, went to hospital stays related to treating pregnant women and delivering babies. Newborn and mother stays were the two most expensive types of hospital stays for Medicaid; and
Schizophrenia was the fourth most expensive condition for Medicaid, while depression and bipolar disorder ranked fifth.
Although $790 billion for hospital stays was billed to payers, Caroline Steinberg, a trends analyst for the American Hospital Association, said that "only $470 billion was actually paid to hospitals (for services provided), so there is a pretty big difference" between charges and reimbursement.
The report states, "As health care costs rise and the population ages, policymakers are concerned with the growing burden of hospital-based medical care and expenses to government, consumers and insurers" (Washington Times, 9/23).
With consumers shouldering more of the burden of their health care costs,
there is a real need for clear pricing information for the services and
procedures hospitals provide. Yet according to a new CHCF report, individuals
who shop for pricing information and financial assistance at California
hospitals have a difficult time getting answers.Mystery shoppers posed as
uninsured patients requesting pricing information for elective procedures
at 64 hospitals in five regions in California. Their experiences show that
there is a serious communication gap between hospitals and prospective patients,
a gap with negative implications for the increasing number of patients who
pay all or part of their medical bills.According to the shoppers, obtaining
a price depended primarily upon luck and persistence, with experiences varying
greatly, even at the same hospital. With few exceptions, hospitals did not
appear to have a designated person or department to provide pricing information.
When information was provided, there were inconsistencies in the type of
prices given, and while most hospitals posted information on financial assistance
programs, the information was often hard to find and usually brief.
Modern Healthcare (2/20, Becker) reported, "Prices for hospital services rose 1.1 percent in January," compared to "a 0.6 percent increase in December and the highest jump since April 2002 when it increased 1.2 percent," according to data from the U.S. Bureau of Labor Statistics' seasonally adjusted Consumer Price Index (CPI). Additionally, during the "12 months end[ing] in January, the hospital CPI was up 8.8 percent, compared with a 6.4 percent rise in the year-ago period." Furthermore, "physician CPI rose 3.5 percent, compared with a 3.2 percent increase in the year-ago period." However, during the month of January, physician CPI rose 0.2 percent,...down from the 0.3 percent rise in December.
The AP (2/26/08, Freking) reports that according to the Centers for Medicare
and Medicaid Services (CMS), "[b]y 2017, consumers and taxpayers will
spend more than $4 trillion on healthcare, accounting for $1 of every $5
spent." While this increase "will be largely driven by higher
prices and an increased demand for care," said the agency, additional
"factors...include a growing and aging population." Altogether,
"federal and state governments accounted for about 46 percent of health
spending in 2006," a figure that "will increase to 49 percent
over the next decade." While "people and the government spent
$2.1 trillion on healthcare, an average of $7,026 a person" in 2006,
"health spending will cost an estimated $13,101 a person," by
2017. Kerry Weems, acting administrator of the CMS, said, "We have
an approaching crisis in this country, unless we change the way we do business."
"With consumers shouldering more of the burden of their health care
costs, there is a real need for clear pricing information for the services
and procedures hospitals provide. Yet according to a new CHCF report, individuals
who shop for pricing information and financial assistance at California
hospitals have a difficult time getting answers.Mystery shoppers posed as
uninsured patients requesting pricing information for elective procedures
at 64 hospitals in five regions in California. Their experiences show that
there is a serious communication gap between hospitals and prospective patients,
a gap with negative implications for the increasing number of patients who
pay all or part of their medical bills.According to the shoppers, obtaining
a price depended primarily upon luck and persistence, with experiences varying
greatly, even at the same hospital. With few exceptions, hospitals did not
appear to have a designated person or department to provide pricing information.
When information was provided, there were inconsistencies in the type of
prices given, and while most hospitals posted information on financial assistance
programs, the information was often hard to find and usually brief.
In the early 1300s Bernat de Berriac, MD received a modest monthly sum from each of several dozen inhabitants of a village in Catalonia. For this "PMPM" cap rate he agreed to treat all family members and servants "for every illness that requires the art of medicine." Dental coverage was not included since that was primarily the realm of the barber. This medieval precursor ro managed care has been documented in Medicine Before the Plague by Michael R. McVaugh, published by Cambridge University Press.
In 2000, the higest paid executives of 10 of the largest for-profit health plans received an average compenstaion, incluidng salary, bonuses, life insurance, retirement plans and other compensation- but no unexercised stock options- of $11.7 million, with the higest-paid executive, Willian W. McGurie of UnitedHealth Group making $54.1 million. The report, from Families USA, is criticcal of the compensation levels:
-William W. McGuire, CEO United Health Group: $54,129,501
-Wilson H. Taylor, Retired chairman, Cigna: $24,741,578
- Ronald Williams, ExVP, large group businesses, Wellpoint Health Networks: $13,205,631
-William Donaldson, Chairman, Aetna US Healthcare, $12,650,393
-Leonard Schaeffer, Chairman & CEO, WellpointHealth Networks: $11,127,465
-H. Edward Hanway, Chairman & CEO, Cigna: $9,478,634
-D. Mark Weinberg, Ex VP, Wellpoint Health Networks: $8,957,410
-Richard Huber, Ex-chairman, CEO, president, Aetna US healthcare: $6,988,987
-William Pastore, President, Cigna Healthcare: $6,779,028
-Thomas Jones, President, retirement & investment services, Cigna: $6,055,314
-Larry Glasscock, President & CEO, Anthem: $3,300,000 (this figure
is for 2001)
Thinking long-term for your next job? For 2004, experts report in Newsday, the hottest job categories are likely to include work related to older people (the fastest-growing demographic group), security (thanks to continuing concerns over terrorism and security) and bio-engineering. "As the huge population of baby boomers ages, it will require more and more health care products and in-person services such as financial planning and physical therapy. This market alone will generate jobs for the next 40 years," workplace expert John A. Challenger says in his much-watched annual job forecast.And at least we can be sure of these jobs sticking around. "They will be well protected from what is becoming rampant offshore outsourcing," says the chief executive Hoy Challenger, Gray & Christmas Inc., the international outplacement firm.That's no small consideration at a time when job creation is barely outpacing the number of jobs that are disappearing. At last count, the nation was adding just 1,000 net new jobs a month. So despite what appears to be an emerging economic recovery, you might have a tough time locating your first job or getting a better one. But your chances might improve if you looked in the fields where labor remains scarce.
A few suggestions from Challenger:
-Information security specialist: With computer science degrees, executives average about $65,000 a year at Fortune 500 firms.Financial planner: This job category will benefit from baby boomers heading toward retirement en masse.
-Pharmacist or drug sales representative: More reliance on prescription drugs and longer lives both mean "high demand for decades to come." Starting salaries for pharmacists at drug chains average about $79,000; sales agents "can easily make six figures after incentive bonuses and other perks."
-Accountant: No glamour here, but much stability and consistent demand. Computers do the number-crunching as accountants take on more problem-solving. "Must possess broad-based knowledge in research, management, economics, business and taxation." Starting salaries near $40,000.
-Investigator: "More lucrative opportunities will be in the specialty area of investigative services, particularly since a rash of corporate scandals and recent cases of resume fraud have shaken corporate America." No college degree needed, and salaries run about $50,000.
-Corporate librarian: "There are numerous and well-paying opportunities outside of the traditional environments, such as government agencies, law firms, advertising agencies, museums, professional associations, medical centers and research laboratories, with salaries reaching the low- to mid-$60,000 range."
-Nurse, physical therapist: Another baby boomer-created niche. Registered nurses average about $38,000, and physical therapists $58,300. Demand for in-home nurses is especially acute.Information technology consultant: "The technology industry may be struggling, but there is enough technology out there to keep these specialists busy for a lifetime." Government, health care and other "Old Economy institutions" all need people to manage their computer, information an networking systems. Salaries for new graduates: $29,000 to more than $50,000.
Some other hot industries: Preventive health care, insurance (agents, claims adjusters,researchers, customer service, accountants),loan agents, title company workers, investment counselors and brokers). Also check into research (agricultural, biotechnical and pharmaceutical) and energy fields (especially in development, production, marketing, technology).
· Only 27% of Americans know what "managed care" means
according to the latest Kaiser Family Foundation/Harvard University survey.
The remaining respondents either had never heard of the term (37%) or had
heard of it, but weren't sure of its' meaning (36%). Among those familiar
with the term, only 17% said they regard it as " a good thing".
Rather than ask patients about risk factors, doctors "might be better off asking how much money those patients make, how many years they spent in school and where they stand relative to others in their offices and communities," the New York Times reports. The Times notes that the current body of research was spurred by Dr. Michael Marmot's Whitehall study, "a now- classic study, begun in the late 1960s, of men in the British Civil Service." Marmot found that mortality rates over 10 years "varied continuously and precisely with the men's civil service grade: the higher the classification, the lower the rates of death." Dr. Sheldon Cohen of Carnegie Mellon University studying macaque monkeys found that males at the lower end of the social dominance scale were more susceptible to colds. In another study, researchers found that humans who had been unemployed were 3.8 times more likely to contract a virus. In 1985, Marmot launched Whitehall II, which studied stress on civil servants and found that the degree of control one has at one's place of employment "accounted for about half the gradient deaths from pay grade to pay grade." Moreover, in the United States, socioeconomic status can blur racial lines in health care. For example, black men in the highest overall income brackets "have a life expectancy 7.4 years longer than black men in the lowest brackets."
Growth in health care spending is expected to exceed economic growth in the next decade, hitting $3.6 trillion, or about 19% of the entire U.S. economy, by 2014, government experts predict. The rate would be an increase from the current 15.4% of the economy now, and the spending will equal $11,045 for every man, woman and child, up from the current $6,423. USA TODAY (2/24), MSNBC/Associated Press (2/23
It is estimated that 10% of the population accounts for 72% of today's health care expenditures, with the majority being spent in the first and the last years of life. Statistically, the number of people with the greatest medical needs are those over age 65. Over the next decade this sector of the population will increase steadily. In 1980 there were 25 million Americans over age 65. Today, the number is slightly more than 32 million and is expected to grow to 35 million by the year 2000 and 40 million by the year 2010. Taking this one step further, it is estimated that the 85 and older age group will double between 1990 and 2010. This raises increasingly difficult questions for the health care industry - in terms of how best to direct resources to an ever growing medically needy subset of the total population at the same time delivering "quality" health care to all.
Some healthcare economists have estimated that the sickest 5% of the population spend an estimated 60% of medical-care dollars. As a result, disease management is predicted to become the next major trend in managed care. The concept is to closely manage the care of patients with costly chronic ailments such as diabetes, asthma and heart failure so as to minimize hospitalization and reduce complications.
Surprisingly, getting patients and doctors to follow basic recommendations like these is a major accomplishment. A study published in the New England Journal of Medicine in the summer of 2003 found that nearly half of all Americans weren't getting the official standard of care for their ailments.
The leading disease managers improve health by reducing the number of emergencies that require hospitalization, says Al Lewis, a consultant who rates programs. The reduction in hospital stays and emergency room visits helps the top disease managers deliver to the insurer or employer guaranteed savings of, typically, twice the $20 to $90 per patient per month costs, he says.(and harder-to-reach patients cost the most) But despite these promised savings, the programs are not without their critics. There is suspicion that the management companies reward pharmaceutical firms since the programs encourage people to take prescribed medications, which results in increased drug sales. In Florida, Republican Gov. Jeb Bush has come under fire for giving pharmaceutical giant Pfizer a no-bid contract to provide disease management to Medicaid patients. The state says it made sure that the nurses promote only good health and don't mention Pfizer products. And so far, the nurses have helped patients while reducing their medical costs, the state has found. But critics say it is no coincidence that Pfizer's sales to Medicaid patients have also skyrocketed. While saving Florida's Medicaid program $7.5 million, Pfizer saw its sales of drugs to the state rise $20 million. "Drug companies should not run disease management programs," says Bernie Horn, policy director for the Washington-based Center for Policy Alternatives. "It is not in the best interest of patients." What's more, the frequent monitoring of doctor care by nurses rankles physicians. Michael Fleming, president of the American Academy of Family Physicians, says he and many of his fellow general practitioners are fed up with calls and faxes from poorly trained nurses who are using a corporate script to question their medicaljudgments. Fleming, who runs a practice in Shreveport, La., likes to see his sickest diabetic patients every three to six months. He says a disease management nurse hired by an insurer once told his patients they did not have to see him for nine months. The nurse may sound friendly and may only be giving advice, but he or she is hired "by the same people who, a year ago, denied you care," Fleming notes. There's even some question whether the disease managers actually make good on their promise to cut costs. Dawn Galbreath, director of the disease management center at the University of Texas-San Antonio, says her research has found that while disease management of elderly heart patients "does make people feel better and live longer, it doesn't necessarily save money."
Disease management companies say that while they're still working out some of the kinks, such as improving relations with doctors, they've had plenty of experience in winning over skeptics. Count among them James Pope, a Florida cardiologist who initially thought nurses' calls were a waste of his--and everyone else's--time and money. But after noticing that the nurses were catching patient problems earlier than his twice-yearly checkups, as well as keeping people adhering to their diets, he became a convert, so much so that he quit his practice and signed up as medical director for American Healthways. "If you are a better-educated person about your disease, then you are less likely to use emergency healthcare services inappropriately," he says. Even more important, the industry is winning over the skeptics who write the checks. In Minnesota, Blue Cross and Blue Shield executives figured they might improve their members' health when they started their disease management plan in 2002 but estimated they would only break even on the costs. But in just one year, and after reaching fewer than 15 percent of the insurer's members, the nurses cut their patients' emergency room visits by 18 percent and helped control the blood sugar of the diabetics. Blue Cross says the program saved it $36 million in medical costs the first year. If the nurses can keep reducing costs as the program spreads, "the potential impact is staggering," says Bill Gold, the insurer's chief medical officer.
HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, announced its list of the ten most important managed health trends to watch in the coming year.
1. The year 2006 will mark the biggest change -- and biggest free-for-all -- to hit the Medicare program since its inception -- Between 11 and 2 organizations are offering Medicare Prescription Drug Plans (PDPs) in each Medicare-defined region. Nine organizations are offering PDP coverage nationwide. In addition to PDPs, seniors face a huge range ofcoverage choices, from Medicare Advantage PPOs and HMOs to private fee-for-service plans. The Centers for Medicare & Medicaid is heavilypromoting regional PPOs as a way to extend access to rural areas, but local health plans are still drawing the most interest.
2. Health plan mergers and acquisitions will continue -- In 2005, the largest plans, UnitedHealth Group and WellPoint Inc., increased market share through purchases of other health plans. Expect to see furtheractivity in 2006: CIGNA and Aetna have spare cash, and Coventry Corp.seems ready for another acquisition.
3. Consumer-directed plans generate more media coverage than healthcare coverage -- A lot of health plans and financial institutions like the new Health Savings Accounts (HSAs) and their associated high-deductiblehealth plans. However, traditional first-dollar-coverage health plans have loosened their restrictions in recent years and remain the first choice among consumers. Despite a lot of discussion, this is unlikely to change in 2006.
4. The uninsured remain uninsured -- Employers and government tried a variety of innovative ways of getting healthcare coverage to the uninsured in 2005. Attempts included "three-share" style plans in which government, employers, and employees each kicked in a third of premium, and Maine's launch of its Dirigo Health, but both saw poor uptake. Small-scale attempts to deal with a large-scale problem are no more likely to succeed in 2006.
5. Medicaid moves back toward managed care -- Texas, Ohio, and Georgia all extended their managed care Medicaid programs in 2005, moving large numbers of beneficiaries out of fee-for-service. This won't sweep the country in 2006, but expect to see several companies, including Aetna, extending their management of Medicaid.
6. Health plans continue their progress on encouraging electronic medical records (EMRs), and 2006 could be a break-out year -- Health plans love EMRs, which make tracking and quality checking of healthcare easier and cheaper, and want providers to love them too. So the upgrading of systems will continue, with dramatic initiatives by Kaiser, Blue Cross and Blue Shield of Massachusetts, and others.
7. HMOs decline -- HMOs have been losing market share. A few bastion states, like Michigan and Massachusetts, will have high HMO participation, but, as employers move more and more to self-insurance, HMO market share nationally will continue its decline.
8. Disease management expands -- Health plans will rely on disease-management programs to attempt to control costs, and are beginning to see results. The newest programs are in managing complex chronic conditions such as hemophilia, scleroderma, and multiple sclerosis.Such conditions are relatively rare, but greater oversight of each expensive case can show good financial return.
9. Individual insurance plans with basic benefits increase market share --As the cost of health insurance rises for employers of all sizes, insurance is becoming more of an individual game. Health plans are tapping into this market with basic-benefits plans for recent college graduates, early retirees, and people between jobs.
10. Pay-for-performance shows its hand -- Health plans have been pushing
pay-for-performance measures on physicians for several years. 2006 will
be a critical year for measuring return on investment now that some P4P
programs have several years' worth of data to evaluate. Does P4P improve
physician performance or pay already high-performing physicians more for
work they would do anyway? Results in 2006 will help answer these questions.
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