ACO this and ACO that, it seems very confusing.  Yet I know that practicing

physicians are concerned because the ACO  system affects reimbursements, therefore being an

incentive to grasp it in some form.  With all the stirring about ACO's and

the guidelines isuued in March, CMS came out with adaptation on October 20. AMEDnews.com

stated it this way:

After criticism about its March 31 proposed rule, the Centers for Medicare & Medicaid Services

released an Oct. 20 final rule that gives physicians the option to join an ACO without being

exposed to financial penalties if saving targets are not achieved. CMS also softened program

requirements by reducing the number of quality measures physicians must report and removing

a condition that at least 50% of participants must satisfy meaningful use standards for electronic medical records.

A survey of the American Medical Group Association in April revealed the sentiment of most physicians in no

uncertain terms, "93% of respondents said they would not participate unless the proposed rule underwent major revisions". 

The jury is still out as to how the ACO model will play out in practice.  Certainly an efffort has been made

to make it easier on physicians in adjusting to the changes.  The article from AMEDnews.com goes on

to address "6 changes that make ACO's doable for physicians".

A common line you see written when discussing healthcare costs is that we need to use emergency rooms less.  According to an article on www.fiercehealthcare.com  this is not the trend. 

Based on data from the Centers for Disease Control and Prevention,  "visits to the ED jumped 10 percent in one year".

It's a new high of more than 136 million visits in 2009 the data suggest.  So this raises questions as to why the trend is moving north when all the efforts being promoted in heathcare support a decrease in ED volume. The article then shares info with quotes from those speculating as to the cause of the trend. It certainly will get the attention of many healthcare futurists.

It seems that everyone has experienced the frustration of sitting in a waiting room for several hours.  As you are sitting there you are thinking why does it have to be this way?  Why didn't the office call me to delay me from coming so I wouldn't have missed so long from work?

According to the American Medical News Health and Human Services is going to look into this matter.  The approack that is planned is by using "mystery shoppers" much like are used in retail stores.  The shoppers would visit the waiting rooms of physicians discovering the times patients are having to wait and document the findings.

According to www.amednews.com: The department has proposed using people posing as potential new patients to help gauge the availability of primary care physicians, according to an April 28 notice in the Federal Register.

HHS is planning on ascertaining information related to a physicians willingness to accept medicare patients.  It is becoming increasingly difficult for medicare patients to find a primary care physician. The article goes on to state: 67% of practices say they might limit new Medicare patients if scheduled pay cuts occur.

Obviously, the availability of healthcare is extremely important.  HHS is seemingly trying to track and be proactive in the cause.

Nearing the expiration of a contract without the next contract in your pocket can be quite distressing for anyone. But if you are a physician whose typical day comprises of thousands of life and death matters, taking time out to search for next job can be rather difficult. Whether you are semi-retired or a full time physician looking to take charge of your life with flexible working schedule, locum tenens physician jobs offered by reputable physician recruiting firms is a great option.

Once you decide to sign up with a physician recruiting firm, you will be expected to provide some basic information about yourself along with your contact information including your permanent address. You will fill in a form stating your field of expertise, names of states where you hold medical license, and your dates of availability. A good recruiting company does all the tedious leg work for you as it will match your qualification, experience, preferred locations and dates you are willing to work with the jobs available in their database.  However, the job of recruiting companies is not restricted to locating a suitable job for you. In fact, that’s the point where the real work starts for them.

Most people would agree that the most tedious, time consuming and dreaded aspects of taking up a new job and moving to a new place is making travel arrangements and arranging appropriate accommodation. But the companies that offer locum tenens physician jobs take care of such details along with helping you with other formalities such as obtaining the appropriate state licenses (for those who move away from their permanent state of residence) and providing medical malpractice liability insurance to cover you during your tenure as locum tenens physician.

For those who believe in working smart, locum tenens physician recruiting firms offer an excellent option for easy and hassle free job search and transition.

PhysicianJobs.com is a well known physician recruiting firm with years of experience in healthcare staffing and locum tenens physician jobs. To find more about their innovative approach based on integrity, creativity and towards staffing and services above and beyond the traditional concept of physician recruitment and placement, logon to, www.physicianjobs.com

Many physicians are free-lancers and/or independent contractors.  Usually this is the case for locum tenens physicians.  From a business perspective one can be out there alone, unsure of how to handle questions that arise.  Fortunately, there is assistance that is of great benefit and affordable.  It's from Back Of The House (BOTH), and they are prepared to set you up with your own virtual business as you travel around doing locum tenens or practicing independently in the community you live in.  Below is an interview with the CEO of Back Of The House, Erik Vonk, as he explains their process and system.

"Today’s reality…just makes it more logical to attach support functions like health and retirement to an individual and not to a place of work."

Back Of The House provides support services for self-employed professionals, free-lancers and independent contractors. This includes bookkeeping, tax services, financial reporting, health insurance, retirement options and more. BOTH handles all of the administrative hassles that consume the valuable time of independent professionals, allowing them to focus on what they do best. BOTH simply and cost-effectively transforms self-employment into a professionally configured "Company of One" by setting up and/or maintaining an LLC for each client, assigning a Personal Business Advisor, establishing, hosting and supporting an individual I.T. infrastructure, the Personal Virtual Office and beyond.

Erik: Right! BOTH is indeed a "business in a box‟! Back Of The House is a 1 stop, turnkey pathway to an exciting and rewarding future as an autonomous, professionally configured and fully supported Company of One. Whether you currently work as a consultant, a freelancer, or on a 1099 basis, (self) incorporation offers a host of advantages and benefits. However, the perceived burdens of business ownership and fear of the unknown are either seen as ob-stacles or lead to unnecessary mistakes by many independent professionals.

Years ago, when I ran Randstad Staffing Services, there was a growing cadre of Freelancers, who told me that Randstad had replaced "Job Security‟ by "Income Security‟ for them. That was a fantastic compliment! "But‟, they said, "can't you put all the support you provide as our temporary employer, in a "rucksack", so that our lives aren't interrupted every time when we move from project to project?‟. Self-incorporation was technically the answer, but that essentially moved the support burden from us to them. So, the challenge was to find a way to let someone enjoy the advantages of business ownership, but without the burdens. It wasn't until 2007, long after leaving Randstad, that the answers were found. That's when the "Company of One‟ concept was developed – a completely unburdened and fully resourced solo business with Fortune 500 support.

MO: Obviously most entrpreneurs are not professionals in areas of HR, taxes, Business Structures, Health Benefits and the other areas you support.  How much time and money do you estimate the average solo professional specnds trying to get his or her arms around these things when they should be focusing on delivering for their customers?

 Erik: We estimate that on average 12 to 15 hours per month are "sunk‟ into non-core support activities. For professionals who serve multiple clients, that number is higher. Overall, approximately 8% – 10% of valuable time that could otherwise be billed, evaporates! That is a terrible opportunity cost! Plus, while doing all this "non core‟ work, lots of money is spent on advisors – tax, legal, accounting, health, retirement, liability insurance, etc. – that don‟t know of each other what they know about you. Expensive, inefficient and risky. Our services have been designed to a) reduce or eliminate direct expenses and opportunity cost, b) improve efficiency through a single point of contact approach and c) eliminate risk by providing support AND oversight.

MO: One service among the many offered by Back Of The House is a Personal Office Manager. Explain how this works.

Erik: Our Personal Business Advisor is core to our concept. An experienced, educated (CPA, Law degree, etc.) dedicated professional is assigned to each client as a single point of contact. This pro-active, tailored 1 stop service has been designed as the antithesis of "self help‟. The Personal Business Advisor runs your back office, manages your IT support and monitors receivables, bank balances, due dates, filings, taxes, insurances, etc. No help desks or call centers to hassle with; just one number in your cell phone for any question about any aspect of your business. Personal "Chief Operating Officer‟ would be a better title.

MO: Your website, backofthehouse.com, encourages independent professionals to sign the BOTH Declaration of Independence. Just what is this declaration and what does it represent?

Erik: By signing the Declaration of IndependenTS, you join a rapidly growing pool of freelancers and independent professionals. You‟ll receive a newsletter called the "Un-Job Post". Once the community is large enough, we will offer communication and collaboration facilities, free of charge.

MO: Is there a threshold where it makes sense for a freelancer to leverage BOTH? That is, is there a minimum amount of revenue a person should be generating before considering your service?

Erik: Yes, there is, and it is fairly low. A bill rate of $20,- to $25,- per hour or annual billings of $40,000.- to $50,000. begin to justify the use our services. Our fees range from around $150,- per month for a basic support package to only around $500,- a month for our all-in, full service level. When I say "only‟, it is because the sum of the components, if bought individually, represents a market value of triple that amount. Further, the Company of One status make our fees tax deductible. The full service level is by far the most used option because it covers all the common needs of a business owner, including billing, collections, bookkeeping, banking, a hosted IT environment; the Personal Virtual Office, a website, wellness benefits and the Personal Business Advisor.

The only expenses not included in this amount are premiums for individually underwritten health & retirement plans and liability insurance – which are also tax deducti-ble, by the way.

The Personal Virtual Office - our hosted IT environment -is a turnkey, fully supported, cloud computing service. Clients access all their applications, files, email, calendar, contacts and collaboration tools through our Portal Desktop. Whether working at the client‟s office, a remote office, at home or on the road, all you need is Internet access. PC, Mac, Blackberry, iPhone it doesn‟t matter, the PVO is hardware, OS and browser agnostic. Work from anywhere - at anytime- on any device.  This is a uniqie composite of Software as a Service (SaaS) and genuine, personal support.

With BOTH you can be in business for yourself, not by yourself.

MO: You have an impressive history with your time and accomplishments at Randstad and Gevity, not to mention authoring a book, "Don't Get a Job, Get a Life!"  What has been the most important lesson you have learned in business?

Erik: Thank you! The most important lesson is that work needs a new platform. An employment contract is no longer an efficient instrument to connect people with work. Today's reality is that the dynamism in the employment market just makes it more logical to attach support facilities like health and retirement to an individual and not to a place of work. That is what is now accomplished through Back Of the House: being employer and employee at the same time. As your own employer you provide yourself with benefits, retirement plans, protection and support. Perhaps we should call that the employou instead of employee!  And, your legal status as a Company allows you to sell your talent or services as a Vendor, not as a Worker.  As a Vendor you are subjected to different, more attractive legal and tax regimes than as a worker.  The lesson is that work needs a new platform and it is very gratifying to be providing the solution!

Erik Vonk is Founder & CEO of Back Of The House. He is an internationally recognized thought leader and expert in the field of flexible work arrangements, contingent workforce strategies and HR outsourcing. Erik has profitably grown the operations of Randstad Staffing Services in North America from a green field start to reach $1.5 billion in 8 years. As Chairman & CEO of Gevity HR, he has strategically repositioned the company from a traditional PEO insurance arbitrage business to a recurring fee based HR outsourcing market leader, substantially increasing revenues and profitability in the process.

From www.MO.com/erik-vonk Interview January, 2011

For more information:  941.328.8708 | bridgette@BackoftheHouse.com | www.BackOf TheHouse.com

YouTube:  Be The Boss Of You

Back Of The House (BOTH) provides Freelancer Total Support ™ including self incorporation, health & retirement benefits and 1 stop back office services.

It seems like everyday there is another healthcare fraud charge being made and I'm not looking for them.  Appaently there are two types that actually take place, unintentional and intentional.  The court system then has the challenge to determine the motive. 

The Feds are increasing their crackdown on healthcare fraud according to FierceHealthcare.com.  According to a recent article, the "federal prosecutions of healthcare fraud are soaring, set to rise 85 percent". That is certainly a significant increase over recent years.

In some cases the fraud amounts can mount up in the hundreds of thousands dollars.  Certalinly these need to be a priority than the low dollar mistakes in billing that are sometimes brought up as criminal offenses.  According to the USA Today, $4 billion was recovered in health fraud cases in 2010.

What do you think was the average debt of a graduating medical student in 2010?  Would you believe $158,000?  This is according to "The Hidden Costs of Medical Student Debt", recently published in the New York Times.

The article also states that "one third of the students owed more than $200,000".  When you throw in interest over a 20-30 year payback the costs are much higher.  It makes sense why many residents entering practice only want to consider positions that have a student loan payback in the financial package. 

The article also points out that the medical schools have taken advantage of the rising costs and raised tuition rapidly.  There have been "Increases from two decades earlier of over 312 percent" in the public medical schools.  Cost is a factor in the medical student world.  In many cases it's an actual deterrent from good students entering medicine.  As we face a shortage in physicians in the United States, this is a part of the process that needs to be addressed.

Management makes a difference.  Look at any business and you can see the management style reflected in the employees.  In a company, you can tell if it is a positive environment, full of encouragement and excitement, or a negative atmoshpere, where it's obvious the employees don't like being there?  In healthcare this is true as well.

Each year Modern Healthcare publishes their Best Places to Work in Healthcare and the one for 2011 was just released.  One of the benefits of this type of survey is to raise the bar high in healthcare management, to challenge hospital administrators to implement effective management practices and procedures.

The recipients will be honored at a banquet in October. 

 In a quest to gain market share, hospital employment of physicians has accelerated in recent years to shore up referral bases and capture admissions, according to the Center for Studying Health System Change’s (HSC)...

This is according to Brief 136 from the website of the Center for Studying Health System Change.  This makes sense with tighter regulation of the provider process, the hospitals are trying to gain market share and this is accomplished by employing the providers.

The Brief goes on to point out the factors that are driving this trend  and that being an employee doesn't always mean effective "clinical integration".  One thing is certain, the healthcare world is changing. 

PhysicianJobs.com is a physician recruiting firm with years of experience in physician recruiting both locum tenens and permanent placement.  

To find PhysicianJobs go to Physician Jobs

Sixty-nine percent of physician specialties got a raise in 2010, according to an article in ModernPhysician.com. There is a major concern among many physicians that with greater regulation reimbursements will be deeply affected.  According to the article, primary care physicians saw a 2.6% increase and surgical specialties saw a 3.8% jump. Allergists led the specialties with a 6.38% increase, followed by emergency-medicine physicians at 6.37% and internal medicine hospitalist at 6.29%.

The article is base on American Medical Group Association's 2011 Income Survey, and stated that Primary-care physicians experienced an increase of 2.6% and the surgical specialties felt a 3.8% increase.  Physician pay is major component of heathcare change discussions in the United States.  The concern is that it can have an impact in two ways.  First, with the current active physicians, a reduction in pay may drive a significant number to retire earlier than they originally planned. This would have an immediate impact on the number of providers currently active.  Second, a decrease in the earning power of a physician may decrease the number of people desiring to become a physician.  The impact of fewer medical students can increase the physician shortage in the long run.

PhysicianJobs.com is a physician recruiting firm with years of experience in physician recruiting for both locum tenens and permanent placement.  To find more information, logon to Physician Jobs.