A master’s degree in one of a number of fields is the standard credential for most generalist positions as a medical or healthcare manager. A bachelor’s degree is sometimes adequate for entry-level positions in smaller facilities and departments. In physicians’ offices and some other facilities, on-the-job experience may substitute for formal education.

 Education and training

Medical and health services managers must be familiar with management principles and practices. A master’s degree in health services administration, long-term care administration, health sciences, public health, public administration, or business administration is the standard credential for most generalist positions in this field. However, a bachelor’s degree is adequate for some entry-level positions in smaller facilities, at the departmental level within healthcare organizations, and in health information management. Physicians’ offices and some other facilities hire those with on-the-job experience instead of formal education.

Bachelor’s, master’s, and doctoral degree programs in health administration are offered by colleges; universities; and schools of public health, medicine, allied health, public administration, and business administration. In 2008, according to the Commission on Accreditation of Healthcare Management Education, there were 72 schools that had accredited programs leading to the master’s degree in health services administration.

For people seeking to become heads of clinical departments, a degree in the appropriate field and work experience may be sufficient early in their career. However, a master’s degree in health services administration or a related field might be required to advance. For example, nursing service administrators usually are chosen from among supervisory registered nurses with administrative abilities and graduate degrees in nursing or health services administration.

Health information managers require a bachelor’s degree from an accredited program. In 2008, there were 48 accredited bachelor’s degree programs and 5 master’s degree programs in health information management, according to the Commission on Accreditation for Health Informatics and Information Management Education.

Some graduate programs seek students with undergraduate degrees in business or health administration; however, many graduate programs prefer students with a liberal arts or health profession background. Candidates with previous work experience in healthcare also may have an advantage. Competition for entry into these programs is keen, and applicants need above-average grades to gain admission. Graduate programs usually last between 2 and 3 years. They may include up to 1 year of supervised administrative experience and coursework in areas such as hospital organization and management, marketing, accounting and budgeting, human resources administration, strategic planning, law and ethics, biostatistics or epidemiology, health economics, and health information systems. Some programs allow students to specialize in one type of facility—hospitals, nursing care facilities, mental health facilities, or medical groups. Other programs encourage a generalist approach to health administration education.

Licensure

All States and the District of Columbia require nursing care facility administrators to have a bachelor’s degree, pass a licensing examination, complete a State-approved training program, and pursue continuing education. Some States also require licenses for administrators in assisted-living facilities. A license is not required in other areas of medical and health services management.

Certification and other qualifications

Medical and health services managers often are responsible for facilities and equipment worth millions of dollars, and for hundreds of employees. To make effective decisions, they need to be open to different opinions and good at analyzing contradictory information. They must understand finance and information systems and be able to interpret data. Motivating others to implement their decisions requires strong leadership abilities. Tact, diplomacy, flexibility, and communication skills are essential because medical and health services managers spend most of their time interacting with others.

Health information managers who have a bachelor’s degree or post baccalaureate degree from an approved program and who pass an exam can earn certification as a Registered Health Information Administrator from the American Health Information Management Association.

Advancement

Medical and health services managers advance by moving into more responsible and higher paying positions, such as assistant or associate administrator, department head, or chief executive officer, or by moving to larger facilities. Some experienced managers also may become consultants or professors of health care management.

New graduates with master’s degrees in health services administration may start as department managers or as supervisory staff. The level of the starting position varies with the experience of the applicant and the size of the organization. Hospitals and other health facilities offer postgraduate residencies and fellowships, which usually are staff positions. Graduates from master’s degree programs also take jobs in large medical group practices, clinics, mental health facilities, nursing care corporations, and consulting firms.

Graduates with bachelor’s degrees in health administration usually begin as administrative assistants or assistant department heads in larger hospitals. They also may begin as department heads or assistant administrators in small hospitals or nursing care facilities.

• Job opportunities will be good, especially for applicants with work experience in healthcare and strong business and management skills.

• A master’s degree is the standard credential, although a bachelor’s degree is adequate for some entry-level positions.

• Medical and health services managers typically work long hours and may be called at all hours to deal with problems.

Nature of the Work
Healthcare is a business and, like every business, it needs good management to keep the business running smoothly. Medical and health services managers, also referred to as healthcare executives or healthcare administrators, plan, direct, coordinate, and supervise the delivery of healthcare. These workers are either specialists in charge of a specific clinical department or generalists who manage an entire facility or system.
The structure and financing of healthcare are changing rapidly. Future medical and health services managers must be prepared to deal with the integration of healthcare delivery systems, technological innovations, an increasingly complex regulatory environment, restructuring of work, and an increased focus on preventive care. They will be called on to improve efficiency in healthcare facilities and the quality of the care provided.
Large facilities usually have several assistant administrators who aid the top administrator and handle daily decisions. Assistant administrators direct activities in clinical areas, such as nursing, surgery, therapy, medical records, and health information.
In smaller facilities, top administrators handle more of the details of daily operations. For example, many nursing home administrators manage personnel, finances, facility operations, and admissions, while also providing resident care.

Clinical managers have training or experience in a specific clinical area and, accordingly, have more specific responsibilities than do generalists. For example, directors of physical therapy are experienced physical therapists, and most health information and medical record administrators have a bachelor’s degree in health information or medical record administration. Clinical managers establish and implement policies, objectives, and procedures for their departments; evaluate personnel and work quality; develop reports and budgets; and coordinate activities with other managers.
Health information managers are responsible for the maintenance and security of all patient records. Recent regulations enacted by the Federal Government require that all healthcare providers maintain electronic patient records and that these records be secure. As a result, health information managers must keep up with current computer and software technology, as well as with legislative requirements. In addition, as patient data become more frequently used for quality management and in medical research, health information managers must ensure that databases are complete, accurate, and available only to authorized personnel.
In group medical practices, managers work closely with physicians. Whereas an office manager might handle business affairs in small medical groups, leaving policy decisions to the physicians themselves, larger groups usually employ a full-time administrator to help formulate business strategies and coordinate day-to-day business.

A small group of 10 to 15 physicians might employ 1 administrator to oversee personnel matters, billing and collection, budgeting, planning, equipment outlays, and patient flow. A large practice of 40 to 50 physicians might have a chief administrator and several assistants, each responsible for a different area of expertise.

Medical and health services managers in managed care settings perform functions similar to those of their counterparts in large group practices, except that they could have larger staffs to manage. In addition, they might do more community outreach and preventive care than do managers of a group practice.

Some medical and health services managers oversee the activities of a number of facilities in health systems. Such systems might contain both inpatient and outpatient facilities and offer a wide range of patient services.
Work environment. Some managers work in comfortable, private offices; others share space with other staff. Many medical and health services managers work long hours. Nursing care facilities and hospitals operate around the clock; administrators and managers may be called at all hours to deal with problems. They also travel to attend meetings or to inspect satellite facilities.

To date, the administration has given about 30 insurers, employers and union plans, responsible for covering about one million people, one-year waivers on the new rules that phase out annual limits on coverage for limited-benefit plans, also known as “mini-meds.” Applicants said their premiums would increase significantly, in some cases doubling or more.

Even some states are requesting exemptions.

Without the exemptions, the bad news would continue to pile – insurance companies discontinuing coverage, private employers bailing.

Obama is going to do the politically expedient thing.  He will grant virtually any waiver requested, and those waivers will expire in 12 months.  He’ll get past this election, and let the health-insurance world fall apart in a non-election year.

Survey: Employers Will Pass Obamacare Costs onto Employees

Posted by Clyde Middleton on May 28 2010 Filed under Economy, Health, Newsstand. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry

Here’s something we already knew:

● 90 percent believe that Obamacare “will increase their organization’s health care benefit costs”;

● 88 percent intend to pass the increases onto employees by increasing employee premium contributions or other cost-sharing measures;

● 74 percent intend to “reduce health benefits and programs” by using stingier health plans, restricting eligibility for health coverage, and using spousal waivers or surcharges.

By a wide margin, employers’ three top priorities for health-care policy are containing health-care costs (96 percent saying it is a high priority); encouraging healthier lifestyles (88 percent); and improving the quality of care (75 percent). Only 25 percent of those surveyed believe that the law will actually encourage healthier lifestyles, and only 20 percent believe it will improve the quality of care.

I sure hope these guys were anonymous.  I feel a congressional hearing may be in their future.

Yes, Nancy, now that you all passed health care, we sure are finding out what’s in it.  Thanks!

By. Joseph Rago

President Obama said earlier this year that the health-care bill that Congress passed three months ago is “essentially identical” to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.

As events are now unfolding, the Massachusetts plan couldn’t be a more damning indictment of ObamaCare. The state’s universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.

In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored “economic realities.”

Mr. Dynan added that “The current course . . . has the potential for catastrophic consequences including irreversible damage to our non-profit health care system” and that “there most likely will be a train wreck (or perhaps several train wrecks).”

Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.

The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.

In a new paper, Stanford economists John Cogan and Dan Kessler and Glenn Hubbard of Columbia find that the Massachusetts plan increased private employer-sponsored premiums by about 6%. Another study released last week by the state found that the number of people gaming the “individual mandate”—buying insurance only when they are about to incur major medical costs, then dumping coverage—has quadrupled since 2006. State regulators estimate that this amounts to a de facto 1% tax on insurance premiums for everyone else in the individual market and recommend a limited enrollment period to discourage such abuses. (This will be illegal under ObamaCare.)

Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident “will soon have affordable health insurance and the costs of health care will be reduced.”

One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the “bold initiative” in Massachusetts, arguing that it would “reduce costs and expand coverage.” A Romney spokesman said at the time that “It’s gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system.”

An entitlement sold as a way to reduce costs was bound to fundamentally change the system. The larger question—for Massachusetts, and now for the nation—is whether that was really the plan all along.

“If you’re going to do health-care cost containment, it has to be stealth,” said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. “It has to be unsuspected by any of the key players to actually have an effect.” Mr. Kingsdale is the former director of the Massachusetts “connector,” the beta version of ObamaCare’s insurance “exchanges,” and is now widely expected to serve as an ObamaCare regulator.

He went on to explain that universal coverage was “fundamentally a political strategy question”—a way of finding a “significant systematic way of pushing back on the health-care system and saying, ‘No, you have to do with less.’ And that’s the challenge, how to do it. It’s like we’re waiting for a chain reaction but there’s no catalyst, there’s nothing to start it.”

In other words, health reform was a classic bait and switch: Sell a virtually unrepealable entitlement on utterly unrealistic premises and then the political class will eventually be forced to control spending. The likes of Mr. Kingsdale would say cost control is only a matter of technocratic judgement, but the raw dirigisme of Mr. Patrick’s price controls is a better indicator of what happens when health care is in the custody of elected officials rather than a market.

Naturally, Mr. Patrick wants to export the rate review beyond the insurers to hospitals, physician groups and specialty providers—presumably to set medical prices as well as insurance prices. Last month, his administration also announced it would use the existing state “determination of need” process to restrict the diffusion of expensive medical technologies like MRI machines and linear accelerator radiation therapy.

Meanwhile, Richard Moore, a state senator from Uxbridge and an architect of the 2006 plan, has introduced a new bill that will make physician participation in government health programs a condition of medical licensure. This would essentially convert all Massachusetts doctors into public employees.

All of this is merely a prelude to far more aggressive restructuring of the state’s health-care markets—and a preview of what awaits the rest of the country.

“There will be zero tolerance for this type of misinformation and unjustified rate increases.”

That sounds like a stern headmistress dressing down some sophomores who have been misbehaving. But it’s actually from a letter sent Thursday from Health and Human Services Secretary Kathleen Sebelius to Karen Ignani, president of America’s Health Insurance Plans — the chief lobbyist for private health insurance companies.

Secretary Sebelius objects to claims by health insurers that they are raising premiums because of increased costs imposed by the Obamacare law passed by Congress last March.

She acknowledges that many of the law’s “key protections” take effect later this month and does not deny that these impose additional costs on insurers. But she says that “according to our analysis and those of some industry and academic experts, any potential premium impact . . . will be minimal.”

Well, that’s reassuring. Er, except that if that’s the conclusion of “some” industry and academic experts, it’s presumably not the conclusion of all industry and academic experts, or the secretary would have said so.

Sebelius also argues that “any premium increases will be moderated by out-of-pocket savings resulting from the law.” But she’s pretty vague about the numbers — “up to $1 billion in 2013.” Anyone who watches TV ads knows that “up to” can mean zero.

As Time magazine’s Karen Pickert points out, Sebelius ignores the fact that individual insurance plans cover different types of populations. So that government and “some” industry and academic experts think the new law will justify increases averaging 1 or 2 percent, they could justify much larger increases for certain plans.

Or as Ignagni, the recipient of the letter, says, “It’s a basic law of economics that additional benefits incur additional costs.”

But Sebelius has “zero tolerance” for that kind of thing. She promises to issue regulations to require “state or federal review of all potentially unreasonable rate increases” (which would presumably mean all rate increases).

And there’s a threat. “We will also keep track of insurers with a record of unjustified rate increases: Those plans may be excluded from health insurance Exchanges in 2014.”

That’s a significant date, the first year in which state insurance exchanges are slated to get a monopoly on the issuance of individual health insurance policies. Sebelius is threatening to put health insurers out of business in a substantial portion of the market if they state that Obamacare is boosting their costs.

“Congress shall make no law,” reads the First Amendment, “abridging the freedom of speech, or of the press.”

Sebelius’ approach is different: “zero tolerance” for dissent.

The threat to use government regulation to destroy or harm someone’s business because they disagree with government officials is thuggery. Like the Obama administration’s transfer of money from Chrysler bondholders to its political allies in the United Auto Workers, it is a form of gangster government.

“The rule of law, or the rule of men (women)?” economist Tyler Cowen asks on his marginalrevolution.com blog. As he notes, “Nowhere is it stated that these rate hikes are against the law (even if you think they should be), nor can this ‘misinformation’ be against the law.”

According to Politico, not a single Democratic candidate for Congress has run an ad since last April that makes any positive reference to Obamacare. The First Amendment gives candidates the right to talk — or not talk — about any issue they want.

But that is not enough for Sebelius and the Obama administration. They want to stamp out negative speech about Obamacare. “Zero tolerance” means they are ready to use the powers of government to threaten economic harm on those who dissent.

The closing paragraph of Sebelius’ letter to AHIP’s Karen Ignagni gives the game away. “We worked hard to change the system to help consumers.” This is a reminder that the administration alternatively collaborated with and criticized Ignagni’s organization. We roughed you up a little but we eventually made a deal.

The secretary goes on: “It is my hope we can work together to stop misinformation and misleading marketing from the start.” In other words, shut your members up and play team ball — or my guys with the baseball bats and tommy guns are going to get busy. As Tyler Cowen puts it, “worse than I had been expecting.”

Health reform director Nancy-Ann DeParle wrote on the White House Blog last week that the same government report indicates spending per insured person will be more than $1,000 lower in 2019 because of the law — some 9 percent below previous projections.

“The act will make health care more affordable for Americans,” DeParle said.

But the head of the nonpartisan economic unit at Medicare that produced the original cost report says the White House number “does not provide a meaningful or accurate indication” of the effect of the health care law.

“The amounts quoted in the White House blog are not meaningful and cannot be used to calculate the change in health expenditures per insured person,” Richard Foster, Medicare’s chief actuary, told The Associated Press.

The Obama administration stands by its statistic.

It’s a dispute about numbers and how they’re bandied about by powerful people in Washington.

But you don’t need an economics degree to follow this one. All you have to do is remember your fractions.

The health care law expands coverage, reducing the number of uninsured by more than 32 million, although about 24 million will remain without coverage.

Still, the share of the population with insurance will go up by nearly 10 percentage points, to about 93 percent. And that makes a difference in the numbers.

If you divide total national health care spending by a bigger number of insured people, you get a smaller per-person result.

It’s an interesting statistic, but it doesn’t mean the problem of rising costs is solved.

“It’s not that it’s false, it’s just that it will be a little misleading,” John Allen Paulos, a mathematics professor at Temple University in Philadelphia, said of the White House number, calling it an “apples-to-oranges miscomparison.”

Consider an imaginary country with just three citizens, Peter, Paul and Mary. Peter has health coverage but Paul and Mary are uninsured. Peter spends $1,000 on health care, but Paul and Mary can only afford $500 apiece because they lack coverage. Total national spending: $2,000. National spending per insured person: $2,000.

Now suppose a law gets passed to expand coverage. Paul gets insurance, but Mary remains uninsured. Now Peter and Paul are spending $1,000 apiece. Paul spends more than when he was uninsured, so total national health spending goes up to $2,500.

But because more people are covered, spending per insured person goes down to $1,250.

It’s a simplistic comparison, but would you call that a savings?

Paulos said it would make more sense to first figure out the share of total national health care spending by people with health insurance, and then divide that result by the number of insured people — before and after the health care law.

The government hasn’t run that calculation.

Richard Kronick, a senior Health and Human Services official, said the Obama administration disagrees that its number is misleading.

“There are a number of ways to evaluate health care spending and the new law,” said Kronick. “Examining spending on each individual with health insurance is one useful data point.”

National health care spending is a kitchen-sink statistic that includes personal health costs of the insured as well as the uninsured, and such categories as research and development and medical infrastructure. In 2019, when the overhaul is fully phased in, the tab will be $4.6 trillion.

Foster says it’s acceptable to divide the number by the total U.S. population. In that case, per capita spending would $13,652 as a result of the law, and $13,387 without it.

The difference: just $265 per person more.

Paulos, the mathematician, said that sounds like a bargain to him. “It’s a relatively small cost given that 30 million more people will be covered,” he said. “You don’t really need this kind of apples to oranges miscomparison.”

More than 200 institutions have agreed to participate in the Illinois Hospital Association’s “Raising the Bar: A Call to Action” campaign in which they have pledged to share best practices on reducing hospital readmissions and preventing and reducing infections and other complications.

Specifically, a news release said the participating hospitals will collaborate on developing programs to reduce 30-day hospital readmission rates for congestive heart failure, heart attack and pneumonia; and hospital-acquired conditions and infections such as methicillin-resistant Staphylococcus aureus, central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical-site infections, and deep vein thrombosis and pulmonary embolism following certain orthopedic procedures.

By Matthew DoBias
The CMS said it has directed Medicare contractors to begin processing physician reimbursements for the month of June with the scheduled 21.2% cut mandated by law.

The Senate passed a bill that would remove the cuts through Nov. 30, but the House, adjourned until next week, still needs to approve it. The bill instead provides a 2.2% increase in pay.

In an e-mail sent to congressional staffers and in a message posted to its physicians listserv, the CMS indicated that it would not extend the current hold on physicians’ claims—something it has been doing since June 1 in anticipation of congressional action that would halt the cuts.

“Congress continues to debate the elimination of the negative update,” the message states. “The CMS is hopeful that congressional action will be taken to avert the negative update.”

It continues: “If Congress changes the negative update that is currently in effect, we are prepared to act expeditiously to make the appropriate changes to Medicare claims processing systems.”

WASHINGTON — State insurance officials say they fear that health insurance companies will cancel policies and leave the individual insurance market in some states because of a provision of the new health care law that requires insurers to spend more of each premium dollar for the benefit of consumers.

The National Association of Insurance Commissioners, representing state officials, says the federal government should take steps to prevent disruption of the market.

Specifically, the group is drafting a recommendation that urges the federal government to allow a gradual three-year transition in states where the new requirement, which takes effect Jan. 1, could destabilize the market.

Without a transition, insurers “may cancel individual policies, if the terms of the policies permit cancellation, and cease offering these plans,” says a document prepared by the association. “This potential withdrawal could have a severe impact on the currently insured, who would lose their policies, and could also limit the choices available to prospective purchasers.”

The law will require many insurers to spend a larger share of their premium revenue — at least 80 percent — on medical care (and quality-improvement activities), rather than administration, expenses and profits. Insurers must refund money to consumers if they do not meet the standards, known as medical-loss ratios.

Democrats in Congress championed the minimum-loss ratio as a powerful protection for consumers — a way to guarantee that policyholders “receive value for their premium payments,” in the words of the law.

In its draft policy statement, the association says federal officials should lower the threshold “on a state-by-state basis” if immediate enforcement of the 80 percent requirement would destabilize the individual insurance market.

The association does not name states that might need a dispensation. Presumably, they include less-populous states with relatively few insurers. But California officials said they, too, were extremely worried.

Under the law, the association has a special role advising the secretary of health and human services, Kathleen Sebelius, on how to define and calculate medical-loss ratios. Ms. Sebelius served as president of the association in 2001, when she was insurance commissioner of Kansas and an outspoken advocate for consumers.

State officials said they expected to submit their recommendations to Ms. Sebelius next month. If an insurer decides to exit the individual market in a state, it must give 180 days’ notice to policyholders.

In effect, state officials are urging the Obama administration to exercise discretion it was granted by Congress. The new law says the health secretary can adjust the medical-loss ratio in a state if she finds that enforcement of the full 80 percent requirement would “destabilize the individual market” there.

Without a transition period, the association said, some insurers “may cancel their blocks of individual health insurance policies, resulting in possibly several million enrollees who have to shop and apply for coverage elsewhere.”

Moreover, it said, in states where underwriters are still allowed to consider a person’s health status, “many enrollees may not be accepted due to medical conditions, or would have to pay higher premiums.”

Under the law, insurers will have to accept all applicants and cannot charge higher premiums because of a person’s medical condition, but in general these provisions do not take effect until 2014.

Consumer advocates said that any exceptions from the new requirement should be limited.

“The National Association of Insurance Commissioners finds itself in a difficult position, facing essentially a threat from the industry,” said Prof. Timothy S. Jost, an expert on health law at Washington and Lee University.

“A mass exit of insurers from the individual market would, of course, not be in the interest of consumers,” said Mr. Jost, one of several consumer representatives advising the association. “On the other hand, the 80 percent loss ratio should be attainable by a well-run insurer.”

Millions of people get insurance from companies that do not meet the target. Using annual statements filed by insurers, the association has compiled a database of more than eight million people who have individual coverage from more than 400 insurers. Nearly half of these policyholders had coverage from about 70 insurers whose loss ratios were less than 75 percent in 2009.

Julia T. Philips, a health actuary who works for the Minnesota insurance commissioner, gave this example of how the recommendation might work in a state with four insurers, where state law now sets a minimum loss ratio of 55 percent and actual ratios are 55 percent to 70 percent.

The minimum, Ms. Philips said, could be increased gradually, so insurers would have to spend 65 percent of premiums on medical services next year, 70 percent in 2012 and 75 percent in 2013, then 80 percent in 2014.

The rebate is part of the new federal health reform law, and is the first step to filling that coverage gap in the Medicare prescription drug program, called Medicare Part D.

The checks will go out every 30 days until the end of the year.

Since the prescription drug program launched in 2006, most seniors enrolled in the program have had to pay all their drug costs once they reach a certain threshold, and before catastrophic coverage kicks in. The coverage gap for beneficiaries was up to $3,610 this year.

About 8 million Medicare beneficiaries fall into the coverage gap each year, according to HHS. Starting next year, beneficiaries who reach this gap will get a 50% discount on brand-name medications.

Beneficiaries don’t have to apply for the rebate checks or do anything to receive them, because qualifying is based on Medicare billing data, HHS Secretary Kathleen Sebelius said at a news conference.