TEXTBOOK PEEK

HOW THIS TEXT BOOK IS UNIQUE?

Crowd-Sourced health research studies are at the nexus of three contemporary trends: 1) Patient-Citizen science (non-professionally trained individuals conducting science-related activities); 2) Crowd-Sourcing (use of web-based technologies to recruit project participants); and 3) Medicine 2.0 / health 2.0 (active participation of individuals in their health care particularly using web 2.0 technologies).

Crowd-Sourced health research studies have arisen as a natural extension of the activities of health social networks (online health interest communities), and can be researcher-organized or participant-organized.

In the last few years, professional researchers have been Crowd-Sourcing cohorts from health social networks for the conduct of traditional studies. Participants have also begun to organize their own research studies through health social networks and health collaboration communities created especially for the purpose of self-experimentation and the investigation of health-related concerns.

The book: HOBSON’S CHOICE IN MEDICINE [Crowd-Sourced Reflections on Decision-Making, Health Economics, Rationing and Free Enterprise] is one such vital health related concern for the public good.

TARGET MARKET AND IDEAL READERS

“HOBSON’S CHOICE IN MEDICINE” [Reflections on Decision-Making, Health Economics, Rationing and Free Enterprise] should be in the hands of all:

  • Physicians, dentists, nurses, advanced nurse practitioners and physician assistants, physical, occupational, physical and speech therapists, and related assistants and allied healthcare providers.
  • Fraternal medical associations like the American Medical Association [AMA], American Osteopathic Association [AOA], American Podiatric Medical Association [APMA], American Dental Association [ADA], Free-Market Medical Association [FMMA], the and American Nursing Association [ANA], etc.
  • Hospitals, healthcare organizations, medical and surgical clinics, private practices, out-patient facilities and ambulatory care centers; along with their related risk managers and insurance consultants.
  • Medical school, law, graduate and nursing school students, interns, resident and fellows; as well as new, mid-life and mature allied healthcare practitioners of all types.
  • All undergraduate, graduate and business schools and universities with related finance, economics health care policy, management and administration degree and certification programs, or related diplomas, adult learning and CEU programs.
  • Fraternal financial services organizations like the American College of Financial Services in Bryn Mawr, PA; Certified Financial Planner Board of Standards [CFP-BOD] in Washington, DC; the College for Financial Planning [CFP] in Centennial, CO; the Financial Planning Association [FPS] and the National Association of Personal Financial Advisors [NAPFA] in Arlington Heights, IL; and The Financial Therapy Association [FTA], etc.
  • Politicians, health insurance plans, managed care CEOs, public health leaders, single and private payer advocates, corporate CFOs, employers at all levels and sector types, and medical policy-makers.

Ideal for all members of the domestic healthcare quartet [patient, payer, provider and public health policymakers] …. in short; everyone!

Power Flipping the Wisdom of Crowds for the Public Good

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”HOBSON’S CHOICE IN MEDICINE”

[Reflections on Decision-Making, Health Economics, Rationing and Free Enterprise]

TABLE OF CONTENTS [tentative]*

SECTION ONE

[The Medical Industrial Complex]

Section One of HOBSON’SCHOICE IN MEDICINE [Crowd-Sourced Reflections on Decision-Making, Health Care Economics, Rationing and Capitalism] is written by  subject matter experts that combine years of practical and applied experience for the public good. They are professors of health economics and finance, physicians and nurses, accountants and financial advisors, insurance consultants  and established players in the day-to-day activities of the medical industrial complex; teachers and practitioners eloquently defining complex selection problems.

CHAPTER ONE: Economic History Overview of the US Health Care and the Insurance Industry

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, financial and business management principles that he studied are just now becoming transparent to some physician executives and healthcare administrators. Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory and practice management era. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views.

Ultimately, savvy medical professionals are realizing that the healthcare industrial complex is in flux. Physicians are frantically searching for new ways to improve office efficiencies, revenues and grow personal assets because of the economic dislocation that is managed care, not to mention the 2007-09 meltdown of the domestic economy. Increasingly, the artificial boundaries between medical practice management, health economics, finance, banking and technology is blurring in 2010-11 and beyond.

Throw modern social media and new-wave health 2.0 collaborative business skills into mix, and a disruptive – even transformational – paradigm shift becomes evident. Patients are empowered by it and doctors are worried because of it.

First noted by grassroots medical practitioners, then elucidated by electronic citizen journalists like Matthew Holt [www.TheHealthCareBlog] and finally codified by the Institute of Medical Business Advisors Inc.,  and others, this emerging philosophy is now engrained in the popular culture. And, the twenty billion dollar American Recovery and Reinvestment Act [ARRA] of President Barack H. Obama in 2009 provided further political support for health information technology and related management initiatives by physicians going forward. With the recent retirement of Dr. Robert Kolodner, the National Coordinator for Health Information Technology’s [NCHIT] David Blumenthal MD leads the pan-collaboration of stakeholders today.

An Imprecise Science

A basic, but hardly promoted premise of this new wave, and all healthcare business, is imprecision. Nevertheless, we may define traditional healthcare economics as how the medical industrial complex allocates its limited resources (cerebral input, equipment, IT, infra-structure, time and financial assets, etc) to the insatiable appetites of the US consumer, through the natural competitive laws of supply and demand. This occurs because physicians are willing to sell, and patients are willing to buy, their services. At some point of equilibrium, supply equals demand; for a price known as market equilibrium.

For example, let’s take a look at the medical practice of Dr. Jane Smith and her competitor Dr. Harry Jones. When the price of a non-covered Medicare service is lowered by Smith, her patient load increases and Dr. Jones’ volume slows. Conversely, if she raised her fees, Dr. Jones’s practice would flourish. This phenomenon, illustrated by market forces or the “invisible hand” of Adam Smith, can be reviewed from the traditional, contemporary and futuristic healthcare economic perspectives outlined below. 

Demand Side Considerations in Medical Care

Medical care may be defined as the examination and treatment of patients. Implicit in this definition is the fact that the lower the direct out-of-pocket price offered to the patient, (all other factors held constant) the greater the number of units of medical commodity the patient will demand. In this relationship, “demand” is defined as the set of service quantities (outputs) demanded at various prices, while the “quantity demanded”, are the amount of care requested at a specific price. Changes in demand occur as a result of personal income and tastes, physician shortages and surpluses, personality and perceptions, and a host of other factors A pictorial representation of this relationship is the classic downward sloping demand curve, and the rational behind the curve lies in the possibility of substitution since very few, if any, commodities [even medical care] are absolutely identical.

Supply Side Considerations in Medical Care

Historically, physician suppliers were motivated to maximize their profits by augmenting services and minimizing costs. Implicit in this definition is the fact that physician suppliers will endeavor to provide as many services as possible. In this relationship, “supply” is defined as the set of services quantities (outputs) provided at various prices, while “quantity supplied” is the amount of care rendered at a specific price. Changes in supply occur as a result of similar, but opposite, factors as found in the demand relationship. A pictorial representation of this relationship is the classic upward sloping supply curve, while equilibrium is reached when the supply and demand curves intersect at the historic usual, customary and reasonable price point. 

Marginal Revenues and Marginal Cost

If a doctor has the opportunity to see even a single additional patient at a profit, he will rationally do so. The “marginal revenue” (MR) from the extra office visit exceeds the “marginal cost” (MC) of the visit. Once the cost of the visit equaled the revenue it produced, the incentive to see more patients is lost. In other words, no additional profits is left at the point where MR = MC. This standard business concept hold true absent situations such as monopolies or oligopolies. Once satisfied, healthcare gratification, or utility, diminishes and more care has a lower return on health and productivity.

Marginal Utility and Medical Price Elasticity

If utility is a word used to describe the value of medical service to a patient, then “marginal utility” (MU) is the value of treating one additional patient. At some point the treatment plan is completed, the patient is satisfied, and additional services are of no value. Another example of this is the inadvisability of having two offices in the same neighborhood, rather than in different geographic locations. The marginal utility of the second neighborhood office is often negligible.

In our example of Dr. Jane Smith, some patients may not decide to leave her practice despite the fee increase. Patients may consider such intangibles as her pleasant demeanor, location, or quality of service and elect to continue their relationship with her. When this occurs, we say patient demand is “inelastic” to price change or price increases. On the contrary, if patients quickly go to Dr. Harry Jones, demand is said to be “elastic” to price pressure and some experiential studies show that a mere $25-35 monthly increase in out-of-pocket costs is enough to send patients elsewhere. Medical service elasticity is affected by insurance deductibles, co-payments, physician’s reputation and communication skills, waiting room time, and the like. When an industry becomes more competitive, as in healthcare today, fees tend to become more elastic and patient volume becomes very sensitive to even small changes in price. In a managed care environment, every “non-covered” service will have its own level of pricing elasticity, and every doctor should estimate that level for all fees, in order to achieve optimum patient volume.

Traditionally, medical services and food were inelastic to price changes, while computer and technology sales are very elastic to price sensitivity. This relationship is rapidly changing and there is even a mathematic equation stating this phenomenon in ratio form:

Elasticity of Medical Supply = % Change in Total Revenue

________________________  

% Change in Price

For instance, if a twenty percent increase in an office visit charge resulted in a thirty percent increase in quantity of services supplied, the price elasticity would be 32/22 = 1.45. Therefore, a high elasticity coefficient equates to higher price elasticity. Generally, a coefficient greater than one is considered elastic, while a coefficient less than 1 is inelastic. Interestingly, exact unity prevails when elasticity of supply is exactly equal to one.

In addition to price elasticity of demand, the competitive marketplace drives supply and prices. For example, there is usually more medical competition in large metropolitan areas than rural areas. Prices tend to rise and fall, respectively while the market is more sensitive to price fluctuation due to this structure. In the traditional medical community, this led to the development of four basic medical market place types.

CHAPTER TWO:  Regulations, Free Markets and Board Governance in the Medical Industrial Complex

During the past few decades physicians have faced ever increasing challenges to the practice of medicine. There have always been mental, physical and financial challenges.  But now physicians deal with a “system” that is so overreaching in its effect and so wholly protected legislatively, that it can, without hesitation, destroy their careers and them.  The labyrinth that physicians must maneuver, especially those in small groups or solo practice, is vast. The very essence of this “system” is to make all of medicine an allopathic algorithm and healthcare providers just a cog in it. The “system” is destroying the art of medicine and its advancement, patient lives and our country. The ‘system” doesn’t allow alternatives unless “blessed” by those in power, and still only as a substandard alternative to their allopathic treatments.

Little is written on the subject of Medical Boards, Physician Health Programs (PHP); or the Medical Industrial Complex and their adverse affects on physicians and other healthcare provider’s lives. There is rare media coverage of Medical Boards despicable behaviors directed towards physicians; yet, like police violence, it’s occurring on a daily basis. An occasional article or editorial is seen in a medical journal or blog regarding the subject. So, physicians suffer silently, typically alone and without support, as their lives and financial stability crumble around them. No one has researched the professional, social and psychological outcomes of physicians who have been “disciplined”, nor is there research regarding patient outcomes post physician “discipline” by a Medical Board or other entity.

CHAPTER THREE: Medical Ethics, Capitalism and Scarcity in Domestic Health Care

There are few who would doubt that the practice of medicine today is dramatically changing. The standards that were predominant a generation ago appear to no longer drive the rapidly evolving relationship between physicians, patients, and health care organizations.  Other entities, most notably payers, patients and public health regulators, have interposed themselves into the relationship and the result is a rapidly evolving approach to health care.  Today, questions of cost, access, and quality drive a continuing, and at times contentious debate.

Yet, the ethical principles of beneficence, respect for autonomy, and justice that served as a foundation for the healing professions since the age of Hippocrates, remain as important today as two millennia ago. Ethical dilemmas arise, not from clear choices between good and evil, but when there are no clear choices between competing goods.  Often these issues surface when ethical principles themselves are weighed in relationship to each other.  When a physician’s obligation to treat conflicts with a patient’s right to liberty and self-determination; or when an individual’s demand for autonomous choice offends our society’s sense of justice and fairness, are but a few examples of ethical principles in conflict.

CHAPTER FOUR: Free-Enterprise and Competitive Business Analysis in Healthcare

The potential costs and benefits of free market competition within the healthcare field have been, and will continue to be, the focus of intense debate. Those who advocate market competition in healthcare stress numerous benefits, which include reduced costs, increased quality, improved efficiencies, and an incentive to innovate.  Those who oppose competition in healthcare argue that distinct differences exist between hospital markets and other markets, thus cautioning against the use of basic economic models when drawing conclusions concerning improving the healthcare delivery system.

Nobel Laureate Kenneth Arrow broached one side of this debate in his 1963 article “Uncertainty and the Welfare of Medical Care,” in which he argued that the market is incapable of insuring against uncertainties that an individual will likely face in the healthcare arena. Arrow concluded that “the laissez-faire solution for medicine is intolerable.”  More recently it has been argued that competition within the hospital market has created a commercialized environment that is incompatible with the needs of the community and can further lead to a reduction in social welfare.  For example, in the highly specialized area of organ transplants, competition may decrease a medical center’s incentive to increase organ donation due to likely possibility that the gains will be shared with their competitors.

The opposing viewpoint argues that, without the existence of a competitive market, individuals lose their freedom to choose, or are allowed to consume medical care for “free,” therefore the market cannot learn what an individual values most.  An additional complication in the healthcare market is the prevalence of health insurance, which has resulted in price insensitivity in consumers leading to peripheral variables weighing more heavily on an individual’s decision, rather than price and quality of service.  This argument additionally states that to further exacerbate consumers’ insensitivity to price, health insurance and fee-for-service systems create a moral hazard where service providers are compensated for performing more services regardless of whether the patient may benefit directly, and conversely the patient does not assume the costs of seeking out and receiving additional services regardless of need as they would in a free market.  Free market economics argues that, when individuals are left to interact in an uninhibited way in a competitive market, producers are encouraged to provide higher quality goods at lower prices in an effort to attract the greatest number of consumers.  Kessler and McClellan conducted a study regarding the consequences of hospital competition for elderly American Medicare patients with heart disease for the period 1984 to 1995.  In this study, the authors established that for the time period after 1990, competition led both to substantially lower costs and significantly lower rates of adverse outcomes.  The study concluded that “hospital competition unambiguously improves social welfare.”

This debate is far more complex than simply a pro or con “competition in healthcare” stance. The multi-faceted and layered structure of the healthcare system begs the question, “if competition is prudent, at what level within the healthcare sector will competition produce the largest overall utility for society?”  One view is that competition should exist among the integrated delivery systems, such as Kaiser Permanente, HealthPartners, etc., which is the optimal means to encourage high quality and efficiency. A conflicting viewpoint is that the most advantageous level for competition to take place is at the individual provider level.  It is at this level of prevention, diagnosis, and treatment of individual health conditions that competition can drive improvements in efficiency and effectiveness, reduce errors, and spark innovation.

The decade of the 1990s saw a massive restructuring of the U.S. healthcare delivery system. Technological advances made it possible for more procedures to be provided on an outpatient basis and hundreds of new provider model, arrangements and organizational structures were introduced.  Emerging healthcare organizations (EHOs) were formed in response to increasingly competitive markets where growing tension between competition and community benefits affected quality of care, patient satisfaction, profitability, and human resources, both positively and negatively.  The managed care revolution and changes in reimbursement for Medicare services forced providers to look for more efficient ways to provide services.

The move towards specialized inpatient and outpatient facilities, often owned by physicians, is a more recent reaction to these significant changes. Rather than posing a threat to the healthcare delivery system, the development of specialty and niche providers represents innovations that allow healthcare services to be provided in a more cost-effective manner while also maintaining and improving quality and beneficial outcomes.

The continuing rise in the cost of healthcare services, representing a significant percentage of both government and business expenditures (not to mention a painfully increasing portion of the budgets of individuals and families), has become a regular news item. In our lifetimes, healthcare services have seemed to be resolutely unique in our market economy, in that the demand for them has grown higher, despite their growing costs, and, many believe, supply is actually driving demand. However, Americans may be coming to a point where they must face the reality that these costs have risen high enough to overcome the impact of demand, as well as exceed the ability of many to pay for desired services.  This may increasingly lead to some form of healthcare rationing and, without governmental intervention, may result in a wider disparity in the quality of healthcare received by American families than has been seen since before the introduction of Medicare in 1965.

Healthcare quality and availability may increasingly be based on the patient’s ability to pay, a phenomenon referred to as a “two-tiered” healthcare system — one system for the “haves” and one system for the “have-nots” in our society. Cost-containment pressures have acted as a catalyst to many significant changes in the healthcare industry overall as well as in the competitive and reimbursement landscape for healthcare providers.

SECTION TWO

[Examples of Crowd-Sourced Hobsonian Decision-Making]

Section Two of HOBSON’SCHOICE IN MEDICINE [Crowd-Sourced Reflections on Decision-Making, Health Care Economics, Rationing and Capitalism] is written by  non-experts and laymen; patients, payers and providers; including the public health sector. All crowd-sourced real-life comments, experiences and anecdotes were submitted by members of the US Healthcare System Triad and curated in their own words; amateurs representing the general public by exposing their own Hobson Choice options and intimate dilemmas; writ large.

CHAPTER FIVE: Patient Dilemma Examples

CHAPTER SIX: Provider Dilemma Examples

CHAPTER SEVEN: Payer Dilemma Examples

CHAPTER EIGHT: Public and Population Health Dilemma Examples

SECTION THREE

[Emerging Free-Enterprise Solutions?]

Section Three of HOBSON’SCHOICE IN MEDICINE [Crowd-Sourced Reflections on Decision-Making, Health Care Economics, Rationing and Capitalism] is written by  subject matter experts that combine years of theoretical and hypothetical experience for the public good. They are physicians and/or professors of computer science and technology, medical information officers and healthcare informaticists, and/or established players in the futuristic virtual space of the medical industrial complex; visionaries and thoughts-leaders offering possible speculative decision-making solutions.

CHAPTER NINEThe Promise of Health 2.0 Improve Care and Reduce Cost in Support of Public and Population Health Management

The US must transform its costly, fragmented healthcare system to a new paradigm of healthcare delivery—one that is integrated, takes accountability not just for the sickness of individuals but also their wellness, and one that provides better value for patients, providers, and payors. Care providers of all types are already working to redesign care models, improve quality, and slow the rise in costs in their centers of care, but these changes will only go so far. The kind of transformation we are talking about will require changes beyond what’s happening in the provider realm alone—it requires changes in how patients and their family and friends participate in their care (when sick) and in their overall wellbeing (when healthy).

The chapter will explore this cultural transformation and the emerging role of Health 2.0—healthcare with a renewed participatory role for patients—in making change possible. We will start by examining why change is needed in the healthcare industry.

We then move to a discussion of the fairly significant shifts that are taking place in care delivery, with an emphasis on the need to engage patients more actively in their health. The remainder of the chapter explores the potential of Health 2.0 in supporting behavior change to help people become more able to manage their health, including some results of early Health 2.0 efforts.

CHAPTER TEN: Concierge Free-Market Medical Practice

In traditional primary care practices today, physicians typically have 2,500 – 3,500 or more active patients on their panels and see 20-25 patients each day in rapid 10 to 15 minute intervals. This kind of patient load makes it difficult for the primary care physician to effectively deliver care to those patients suffering with chronic illness or to address preventive measures.

Today’s medical system demands that physicians see increasingly greater numbers of patients per day. Subsequently, they are spending decreasing amounts of time with each patient resulting in declining patient satisfaction. Office-based physicians reported a weekly average of 73.7 office visits, 12.7 hospital visits and 11.1 telephone consultations. Primary care physicians averaged more encounters per week compared with other specialists. Harris Interactive reports: “The average time a doctor spends with a patient is down to 15 minutes or less and continues to diminish, putting enormous stress on both physicians and patients.”

For the physician, choosing to deliver medicine in a concierge or direct access model, at a minimum, allows for longer appointments with patients to address concerns and focus on prevention. More time with the patient creates the ability to monitor wellness screens and to get to know the patient in a more robust manner.

For the patient, they can see their physician on his/her own terms and with a list of concerns and not feel rushed. They can see their physician on the same day they contact the office. Often they have the time to discuss specialist’s reports for better coordination of care and they can focus on prevention and maintaining wellness.

Participating physicians report more time to devote to patient care and advocacy, as well as continuing medical education and family life. The result is a revolution in preventative care and a return to a more personal relationship between doctor and patient.

According to a recent CNN report, concierge medicine was virtually unknown a decade ago; in 2005, there were approximately 500 physicians taking advantage of the practice model. Today, according to the Society of Innovative Medical Practice Design suggests there are 8,000 physicians practicing concierge medicine.

CHAPTER ELEVEN: Emerging Health Organization Solutions and 2.0 Business Models?

This chapter describes strategies and lessons that may be gleaned from competition and revisits the existing barriers to competition in healthcare to emphasize their impact on effective competitive strategies. It also considers the likely future of healthcare’s competitive environment and some general overall lessons for effective competition in today’s healthcare markets.

Assuming that rising healthcare costs, both for government and consumers, will continue to act as pressure for healthcare reform, there appear to be three conceivable general outcomes for healthcare: increased socialization, increased privatization, or the continued piecemeal approach to regulation and control. The last approach appears to have acted as a barrier to significant benefits that can arise (as shown in other industry sectors) from competition.

The roots of the for-profit healthcare industry appear too deeply embedded to allow for reveral by the socialization of healthcare. The development of a single payor system similar to those that have arisen in other industrialized countries, also appears unlikely.  The Clinton healthcare reform plan was defeated with strong opposition from throughout healthcare and other industries, and was replaced by the PP-ACA, which may or may not ultimately survive.

However, considering the current trend in government to outsource and privatize government programs and let the private market act to reduce costs, will some existing barriers to free competition in healthcare be removed?  Will providers face a new competitive paradigm? In many respects, this may be the single most important question that those in healthcare planning and administration face today.  For many healthcare executives the issue may well be, not so much that they don’t yet have the right answers, it’s that they haven’t yet asked the right questions.

CHAPTER TWELVE: Futuristic Healthcare Choices Prompted by Disruptive Free-Enterprise Technology

There are various thought leaders who believe that we are experiencing the Fourth Industrial Revolution characterized by a range of new technologies that are fusing the physical, digital and biological worlds, impacting all disciplines, economies and industries, and even challenging ideas about what it means to be human. Health care will be the lead industrial area of such a revolution and one of the major catalysts for this change is going to be Artificial Intelligence.

*Note: The TOC, topics, contributors and information on this website may change without notice.

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ENDORSEMENTS AND TEXTBOOK TESTIMONIALS

As a medical provider with an advanced degree in environmental health, I always tried to balance the theoretical with the applied during my decades of clinical practice. Fortunately, the same hybrid decision-making perspective of this book makes it highly understandable.

-Dr. Barbara S. Schlefman MA [Northlake Regional Medical Center, Tucker GA]

Dr. Marcinko’s research in free enterprise and work in medical capitalism was first brought to my attention a decade ago by a physician client. I saw him lecture shortly thereafter and have been a fan ever since.

-Alex Naruska CPA [Orlando, FLA]

I have most of Dr. Marcinko’s clinical, business administration and practice management, health economics and finance planning textbooks in my library; and will add this one, too!

-Dr. William P. Scherer MS [Radiologist at Barry University, Boca Raton  FLA]

What a new-wave idea; crowd-sourcing public health experiences for the public good. Thanks for the nursing input, too. Well done!

-Cecelia T. Perez; RN [Baltimore, MD]

This book is easy to read and alternates between an academic and story telling mode. Again, Dr. Marcinko leads the way in health economics, finance and health policy management.

―Dr. David B. Lumsden [Orthopedic Surgeon, Towsen, MD]

TEXTBOOK AVAILABILITY

Our curated, cited, referenced and peer-reviewed print hardcover academic text book will be available on, or about, FY 2018 [750 pages; estimated]. But, pre-orders may be accepted soon. Cover image may change.

PRINT TEXTBOOK EDITOR-IN-CHIEF:

DR. DAVID EDWARD MARCINKO; MBBS DPM FACFAS MBA MEd BSc CMP® Website: http://www.DavidEdwardMarcinko.com

Dr. David Edward Marcinko is a multi-degreed educator, board certified physician, surgical fellow, hospital president, Chief Executive Officer and philanthropist with more than 400 published papers; 5,150 op-ed pieces and over 125+ international presentations to his credit; including the top 10 biggest pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published text books and CD-ROMs in four languages [National Institute of Health, Library of Congress and Library of Medicine]. Dr. Marcinko is past Editor-in-Chief of the prestigious Journal of Health Care Finance, and a former Certified Financial Planner®, who was named “Health Economist of the Year” in 2001 by PM Magazine. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, management and trade publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News]. As a licensed insurance agent, RIA and SEC registered endowment fund manager, Dr. Marcinko is Founding Dean of the fiduciary focused CERTIFIED MEDICAL PLANNER® chartered designation education program; as well as Chief Editor of the HEALTH DICTIONARY SERIES® Wiki Project. His professional memberships include: ASHE, AHIMA, ACME, FMMA and HIMSS.

Prior to his appointment at the University of North Carolina, FSU-SBE, Dr. Marcinko was Chief Executive Officer for the Institute of Medical Business Advisors, Inc. The firm is headquartered in Atlanta and works with a diverse list of individual and corporate clients. As a nationally recognized educational resource center and referral alliance, iMBA and its network of independent professionals provide solutions and managerial peace-of-mind to physicians, healthcare organizations and their consulting business advisors. He also helped developed medical, business, graduate and undergraduate school curriculum content for the American College of Physician Executives [ACPE], Medical Group Management Association [MGMA] and the American College of Healthcare Executives [ACHE]. A favorite on the lecture circuit, Dr. Marcinko is often quoted in the media, and frequently speaks on related topics throughout this country and Europe in an entertaining and witty fashion. He is a popular authority on transformational business strategies across a pantheon of related industries. He is also a social media pioneer and publisher of the Medical Executive Post, an influential syndicated Health 2.0 interactive blog forum.

As an award-winning journalist, media broadcaster, speaker and public health advocate and consultant, Dr. Marcinko is available to colleagues, clients and the press at his Fayetteville State University office in North Carolina; or iMBA Inc,  office in  Norcross, Georgia

Book Marcinko

PROJECT MANAGER:
MACKENZIE HOPE MARCINKO

Ms. Marcinko is a linguistic, computer science and business management major from the University of Pittsburgh. Founded in 1787, the university is a healthcare informatics and technology pioneer, and one of the nation’s most distinguished members of the Association of American Universities. It perennially ranks as one of the top public universities in total sponsored research funding and is among the top ten recipients of funding from the National Institutes of Health [NIH]. Ms. Marcinko is the most recent Slavic, East European and Near Eastern Summer Language Institute Scholarship Award Winner matriculating at the Moscow State University.

PRINT TEXTBOOK INVITED / ACCEPTED SECTION EDITORS

MICHEL FARID ACCAD; MD – Cardiology and Internal Medicine

Dr. Accad practices cardiology and internal medicine in San Francisco, offering individualized care in a free-market setting. He is a member of the Ludwig von Mises Institute who blogs about health care and medicine at: AlertandOriented.com.

WESLEY BOYD; MD PhD MA – Psychiatrist

Harvard Medical School [Assistant Clinical Professor of Psychiatry] Cambridge Health Alliance Boston Children’s Hospital [Staff psychiatrist] Yale University.

ROBERT JAMES CIMASI; MHA ASA FRICS MCBA AVA CM&AA CMP® – CEO Health Capital Consultants , LLC

Robert James Cimasi is Chief Executive Officer of Health Capital Consultants (HCC), a nationally recognized healthcare financial and economic consulting firm headquartered in St. Louis, MO, serving clients in 49 states since 1993. Mr. Cimasi has over thirty years of experience in serving clients, with a professional focus on the financial and economic aspects of healthcare service sector entities including: valuation consulting and capital formation services; healthcare industry transactions, including joint ventures, mergers, acquisitions, and divestitures; litigation support & expert testimony; and, certificate-of-need and other regulatory and policy planning consulting. Mr. Cimasi holds a Masters in Health Administration from the University of Maryland, as well as several professional designations: Accredited Senior Appraiser (ASA – American Society of Appraisers); Fellow Royal Institution of Chartered Surveyors (FRICS – Royal Institute of Chartered Surveyors); Master Certified Business Appraiser (MCBA – Institute of Business Appraisers); Certified Valuation Analyst (CVA – National Association of Certified Valuators and Analysts); and, Certified Merger & Acquisition Advisor (CM&AA – Alliance of Merger & Acquisition Advisors). He has served as an expert witness on cases in numerous courts, and has provided testimony before federal and state legislative committees. He is a nationally known speaker on healthcare industry topics, the author of several books, the latest of which include: “Accountable Care Organizations: Value Metrics and Capital Formation” [2013 – Taylor & Francis, a division of CRC Press], “The Adviser’s Guide to Healthcare” – Vols. I, II & III [2010 – AICPA], and, “The U.S. Healthcare Certificate of Need Sourcebook” [2005 – Beard Books]. His most recent book, entitled “Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services” was published by John Wiley & Sons in 2014. In 2006, Mr. Cimasi was honored with the prestigious “Shannon Pratt Award in Business Valuation” conferred by the Institute of Business Appraisers. Mr. Cimasi serves on the Editorial Board of the Business Appraisals Practice of the Institute of Business Appraisers, of which he is a member of the College of Fellows; as Vice President of the American Health Lawyers Association (AHLA) Accountable Care Organizations (ACO) Task Force; and, as Chair Emeritus of the American Society of Appraisers Healthcare Special Interest Group (ASA HSIG). In 2011, he was named a Fellow of the Royal Institution of Chartered Surveyors (RICS).

RENDER S. DAVIS; MHA CHE – Medical Ethicist

Render David was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University in Atlanta, GA. He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95. He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

ERIC A. DOVER; MD – Primary Care Physician

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

CHARLES F. FENTON III; FACFAS JD CMP® [Hon] – Physician Attorney

Dr. Charles F. Fenton is a board certified foot and ankle surgeon from Temple University, who received his law degree as class valedictorian from Georgia State University, and practices in Atlanta, Georgia. His clients include physicians involved in audits and recoupment actions, as well as disputes with insurance or managed care companies. He is a contributing author to many books on healthcare law and medical practice, as well as many other medico-legal publications for physicians and the Bar.

HOPE RACHEL HETICO RN MHA CPHQ CMP® – Quality Improvement, Assurance and Clinical Integration

Received her bachelor’s degree in nursing (BSN) from Valpariso University, and her Master of Science in Healthcare Administration (MHA) from the University of St. Francis, in Joliette, Illinois. She is author’s editor of a dozen major textbooks and is a nationally known expert in managed medical care, medical reimbursement, case management, health insurance, utilization review, National Association of Healthcare Quality (NAHQ), Health Education Data Information Set (HEDIS), and The Joint Commission (TJC) Clinical Quality Measures [CQMs] and regulations. Prior to joining the Institute of Medical Business Advisors as Chief Operating Officer, Ms. Hetico was a hospital executive, financial advisor, licensed insurance agent, Certified Professional in Healthcare Quality (CPHQ), and distinguished visiting assistant professor of healthcare administration for the University of Phoenix, Graduate School of Business and Management in Atlanta. She was also national corporate Director for Medical Quality Improvement at Abbey, and then Apria Healthcare, a public company in Costa Mesa, California. A devotee of health information technology and heutagogy, Ms. Hetico is responsible for leading the website: http://www.CertifiedMedicalPlanner.org to the top of the exploding adult educational marketplace, expanding the online and on-ground Certified Medical Planner™ charter designation program, and nurturing the company’s rapidly growing list of medical colleagues and financial services industry clients. Professor Hetico recently completed successful consulting engagements as ACO clinical integration coordinator for Resurrection Health Care Preferred in Chicago; and performance improvement manager for Emory University and Saint Joseph’s Hospital in Atlanta. She is currently on assignment for Presence Health Care, in Illinois

RICHARD S. KAHLER; MS CFP® ChFC CCIM – Physician Advisor

Rick Kahler became the first fee-only Certified Financial Planner® in South Dakota in 1983. He is on the faculty at Golden Gate University where he teaches their Facilitating Financial Health graduate course. He graduated from the American College, Bryn Mawr, PA, in 1988, earning the Chartered Financial Consultant (ChFC) degree. In 1984, he was admitted to the Registry of Financial Planning Practitioners by the International Association of Financial Planners. He obtained his master’s degree in personal financial planning in 1999. He is co-author of four books on money: Conscious Finance (FoxCraft, Inc., Second Edition 2007), The Financial Wisdom of Ebenezer Scrooge (HCI, 2006), Facilitating Financial Health (NUCO, 2008) and Wired For Wealth (HCI 2009). His work as the co-founder of Onsite Workshop’s Healing Money Issues workshop was featured in Wynonna Judd’s book Coming Home To Myself  (New American Library, 2005). The Wall Street Journal hailed this work as “an innovative effort that combines experiential therapy with nuts-and-bolts financial planning.” Mr.Kahler is also President of the Financial Therapy Association, on the Board of Directors for the Journal of Financial Therapy, on the peer review committee of the Journal of Financial Planning and on the Midwest Board of the National Association of Personal Financial Advisors. He has been published or cited in USA Today, The Wall Street Journal, The New York Times, The Washington Post, Forbes, Money, Smart Money, FoxBusiness, CNBC.com, MSNMoney.com, Parenting, Consumer Reports, Self, Men’s Health, Journal of Financial Planning, Financial Planning Magazine, Investment Advisor, and Counselor

BRIAN J. KNABE; MD CFP® CMP® – Financial Advisor at Savant Capital Management, LLC

Dr. Brian J. Knabe is a financial advisor and a member of the Savant Capital Management advisory team. He routinely meets with clients, advisors, portfolio managers, and planners in order to develop comprehensive planning, investment, and tax strategies. Dr. Knabe is also a clinical assistant professor in the Department of Family Medicine with the University of Illinois. He is a member of the American Academy of Family Physicians, the Illinois State Medical Society, and the Catholic Medical Association. Dr. Knabe is a magna cum laude graduate of Marquette University with an honors degree in biomedical engineering. He earned his medical degree from the University Illinois College of Medicine; and attended the University of Illinois for his family practice residency where he served as chief resident. Dr. Knabe is a Certified Medical Planner™, and a Certified Financial Planner® who earned a diploma in financial planning from Marquette University. Dr. Knabe often speaks to financial service and medical associations throughout the country.

RICHARD J. MATA; MD MS MI-CIS CMP® [Hon] – Medical Informaticist

Dr. Richard Mata attended Johns Hopkins University in Baltimore Maryland and received his medical degree from the University of Texas, Southwestern Medical College. He earned a Master’s degree in Medical Informatics (MI), and Computer Information Systems (CIS), and is a member of the Software Programmers Guild affiliated with the IEEE and the Project Management Institute. He is also a member of the Security Health Care Accreditation and Certification Workgroup of URAC, based in Washington, DC and the Medical Records Institute (MRI) in Boston, Mass.

BERTALAN MESKO MD PhDThe Medical Futurist(SM)

Dr. Mesko has more than  500 presentations to his credit, including courses taught at Harvard University, Stanford, Yale, Semmelweis University, the World Health Organization [WHO] and the Singularity University;  and the ten biggest pharmaceutica companies. He is one of the leading global thought-leaders in health care technology; today. Dr. Mesko was featured by dozens of top publications, including CNN, WIRED, National Geographic, Forbes, TIME magazine, BBC, and the New York Times. His popular blog, The Medical Futurist(SM), has more than 3 million readers and he is one of LinkedIn’s “Top Voices.”

CAROL MILLER; BSN MBA PMP – President Miller Consulting, Inc.

Ms. Carol S. Miller has an extensive healthcare background in operations, business development and capture in both the public and private sector. Over the last 10 years she has provided management support to projects in the Department of Health and Human Services, Veterans Affairs, and Department of Defense medical programs. In most recent years, Carol has served as Vice President and Senior Account Executive for NCI Information Systems, Inc., Assistant Vice President at SAIC, and Program Manager at MITRE. She has led the successful capture of large IDIQ/GWAC programs, managed the operations of multiple government contracts, interacted with many government key executives, and increased the new account portfolios for each firm she supported. She earned her MBA from Marymount University; BS in Business from Saint Joseph’s College, and BS in Nursing from the University of Pittsburgh. She is a Certified PMI Project Management Professional (PMP) (PMI PMP) and a Certified HIPAA Professional (CHP), with Top Secret Security clearance issued by the DoD in 2006. Ms. Miller is also a HIMSS Fellow.

JENNIFER TOMASIK; MS – Principal at Center for Applied Research

Jennifer Tomasik is a Principal at CFAR, a boutique management consulting firm specializing in strategy, change and collaboration. Jennifer has worked in the health care sector for nearly 20 years, with expertise in strategic planning, large-scale organizational and cultural change, public health, and clinical quality measurement. She leads CFAR’s Health Care practice. Jennifer has a Master’s in Health Policy and Management from the Harvard School of Public Health. Her clients include some of the most prestigious hospitals, health systems and academic medical centers in the country.

TODD A. ZIGRANG; MBA MHA ASA – FACHE Past President

Todd A. Zigrang is President of Health Capital Consultants (HCC), where he focuses on the areas of valuation and financial analysis for hospitals, physician practices, and other healthcare enterprises. Mr. Zigrang has over 20 years of experience providing valuation, financial, transaction and strategic advisory services nationwide in over 1,000 transactions and joint ventures involving acute care hospitals and health systems; physician practices; ambulatory surgery centers; diagnostic imaging centers; accountable care organizations, managed care organizations, and other third-party payors; dialysis centers; home health agencies; long-term care facilities; and, numerous other ancillary healthcare service businesses. Mr. Zigrang is also considered an expert in the field of healthcare compensation for physicians, executives and other professionals. Mr. Zigrang is the author of “Adviser’s Guide to Healthcare – 2nd. Edition” (AICPA, 2014), numerous chapters in legal treatises and anthologies, and peer-reviewed and industry articles such as: The Accountant’s Business Manual (AICPA); Valuing Professional Practices and Licenses (Aspen Publishers); Valuation Strategies; Business Appraisal Practice; and, NACVA QuickRead. Additionally, he served as faculty before professional and trade associations such as the American Society of Appraisers (ASA); the National Association of Certified Valuators and Analysts (NACVA); the Physician Hospitals of America (PHA); the Institute of Business Appraisers (IBA); the Healthcare Financial Management Association (HFMA); and, the CPA Leadership Institute.

Mr. Zigrang holds a Master of Science in Health Administration (MHA) and a Master of Business Administration (MBA) from the University of Missouri at Columbia. He is a Fellow of the American College of Healthcare Executives (FACHE) and holds the Accredited Senior Appraiser (ASA) designation from the American Society of Appraisers, where he has served as President of the St. Louis Chapter, and is Chair of the American Society of Appraisers Healthcare Special Interest Group (ASA HSIG).

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APPRECIATION

It is an incredible privilege to edit the textbook: HOBSON’S CHOICE IN MEDICINE [Reflections on Decision-Making, Health Economics, Rationing and Free Enterprise]. One of the most rewarding aspects of my career has been the professional growth acquired from interacting with the UNC-FSU-SBE faculty, as well as various inter-university cohorts, HIT experts, economists, psychologists and psychiatrists, physicians and medical colleagues, risk managers, lawyers, accountants and insurance professionals of all stripes. The mutual sharing and exchange of ideas stimulates the mind and fosters advancement at many levels.

We also appreciate that this “Hobson’s Choice Project” would not be possible without the support of our families whose daily advocacy encouraged us to completion. We appreciate our students, former clients and the contributing crowd-sourced virtual submitters, authors and peer-reviewers who crashed the development life cycle to produce time-sensitive material in an expedient manner. The satisfaction enjoyed from working with them is immeasurable.

Any accolades are because of them …. All defects are my own.

-David Edward Marcinko

BACK BOOK COVER

There’s widespread dissatisfaction with a health system that focuses on profit over health. At the same time patients, payers, providers and policymakers are beginning to understand the value of investing in wellness, rather than paying only for treatment. Technology connects us through social media. Knowledge is power and daily we are influenced by its ability to disrupt inefficient industries. The power in this book  will educate us all and help disrupt the medical industrial complex for the public good. 

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DAVID EDWARD MARCINKO

Executive Physician and iMBA Inc Scholar-in-Residence David Edward Marcinko was appointed the Lloyd V. Hackley Endowed Chair of the Department of Capitalism and Free Enterprise at the UNC Fayetteville State University  School of Business and Economics, in 2016. Originally from Loyola University MD, Temple University in Philadelphia, the Milton S. Hershey Medical Center in PA, Oglethorpe University and Atlanta Hospital & Medical Center in GA, and the Aachen City University Hospital in Koln-Germany, Marcinko is one of the most innovative global thought leaders in health care business education and medical entrepreneurship today.

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