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Steps for How Healthcare Organizations can Maximize Cash Flow During COVID-19 Print E-mail
Written by Richard Walker and Venson Wallin   
Wednesday, 27 May 2020 19:29

With revenues declining and costs increasing because of COVID-19, cash is in short supply. Thus, it is important healthcare organizations take steps now to conserve cash to deal with immediate demands, as well as to secure future financial health and sustainability.

Maximizing cash flow at this critical time is a priority. A targeted effort focused on cash acceleration and conservation and a rigorous revenue cycle optimization plan can help organizations get through this period of severe financial strain.

Three Pandemic-Driven Pressure Points on Organizational Cash Flow

1. Patient Volume Decreases: COVID-19 has necessitated stay-at-home mandates and as a result, many states have placed bans on elective surgeries. Some, however, have begun phasing elective surgeries back in, but have experienced significant blows to their cash flow in the interim, with some seeing no new visits during the crisis.  As a result, cash flow in many cases is completely dependent on the accounts receivable generated before practices were closed or significantly curtailed and may be at considerably low levels.
2. Patient Pay Management: Collecting on patient-pay accounts (i.e., co-insurance, deductibles, etc.) may become more challenging as unemployment rates continue to rise. With reduced household incomes, families may be forced to prioritize mortgage or rental payments and other daily necessities, with medical bills falling further down the priority list. Though some providers may have accounts receivable from services performed prior to closure or scaling back of operations, collections of those receivables may prove challenging.
3. Operational Sustainability Challenges: Cash flow challenges do not automatically render obligations null and void— vendors still expect to be paid for products and services rendered on a timely basis. Mortgages or rental payments, salaries (even if to a skeletal staff), utilities, insurance and other regular expenses continue to be due and payable on a regular basis even if operations have been temporarily halted. The organization may likely face a situation where cash demands exceed cash sources.

To navigate these pressure points, healthcare organizations must take action to conserve and maximize cash flow, optimize their revenue cycles and secure their patient revenues to the best of their ability...

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Dr. Alejandro Badia’s Upcoming Book Titled ‘Healthcare from the Trenches’ Details Barriers to Patient Care Print E-mail
Written by FHInews   
Friday, 22 May 2020 09:36

The coronavirus has exposed the frailties of an American health care system that is wasteful, mismanaged and burdened by unnecessary administrative costs and bureaucracy that often delay – and prevent – patient care, says noted Doral, FL based orthopedic surgeon and now author Alejandro Badia MD, FACS.

His soon-to-be-released book - Healthcare from the Trenches details the system barriers that have led to “skyrocketing health costs, lack of patient access and inefficient delivery of care” and comes at a time when some national leaders are calling the country’s response to the COVID-19 pandemic a “chaotic catastrophe.”

More than 30 million Americans filed initial unemployment claims between mid-March and April 25, 2020 due to business and office closures during the pandemic, and many of these filers find themselves without employer-financed health insurance, according to the Urban Institute. A May 5, 2020 online New York Magazine article reports survey numbers indicating 14 percent of all U.S. adults would avoid treatment if they developed coronavirus symptoms because of health cost issues.

“People are challenged because of a flawed system,” says Dr. Badia, a physician leader who has applied innovative business principles and technology to enhance patient access to health services. “So-called ‘experts’ with zero medical training are hired by insurance companies to dictate what constitutes reimbursable care. Their interference disrupts the doctor-patient relationship, delays or prevents delivery of care and presents obstacles to new approaches that would improve patient outcomes and reduce costs.”

Dr. Badia calls his book “an insider’s account of the complex barriers of U.S. health care from the providers’ and patients’ perspective.”

And, he should know, being founder and chief medical officer of the Florida-based OrthoNOW®, a disruptive network of single-specialty, urgent-care centers and the first immediate orthopedic care center in South Florida. Dr. Badia remains a busy hand and upper limb surgeon via the Doral based (Miami) Badia Hand to Shoulder Center, a one-stop shop outpatient facility.

OrthoNOW® combines health care expertise with advanced business principles and the latest technology to offer on-demand access to comprehensive, specialized orthopedic care in one location. Services include an award winning mobile app for “patients to determine the nearest open facility, send relevant pictures and notify our orthopedic team when they are en-route to the center using the “On my Way NOW™ feature. The app will even call our patients an Uber to transport them to our facility,” says Dr. Badia, who knows that transportation is often a patient barrier to care. Furthermore, the OrthoNOW® app was ahead of the Covid19 curve allowing virtual doctor-patient communications – #teleorthopedics, several years before the current crisis.

“Since the implementation of the [U.S.] Affordable Care Act, health care in America has devolved into a bureaucratic nightmare,” Dr. Badia states. “What began as incremental interference in the relationship between doctor and patient with the passage of the Medicare Act of 1965 is now an impenetrable barrier made up of governmental and health care insurance industry red tape. The result is higher costs and greater inefficiencies.”

Experts concur. An article in a 2017 issue of the Journal of Health Informatics & Management refers to the nation’s health care system as being in “crisis” and indicates the “U.S. health care system consumes far more resources to produce the same or lesser [patient] outcomes as compared to health care systems elsewhere.” The author of the report goes on to say that “powerful interest groups,” including insurance and pharmaceutical companies, hospital organizations, medical equipment firms and information technology businesses have “rigged” the system, sending some 2,400 health care industry representatives to Washington, D.C. to lobby Congressmen.

Early last year (2019), results of a Gallup poll showed 70 percent of Americans believe the U.S. health care system has “major problems” or is in crisis.

“The current COVID-19 pandemic has only amplified the problems, further taxing our health care system – and our economy,” Dr. Badia adds. “Despite the political debates and media coverage on health care policy and reform, there remains little or no feedback from the people in the trenches – the physicians and other health care professionals who provide care to the patients.”
More information about Dr. Badia’s upcoming book is available on his web site at

Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons and an honorary member of many international professional hand societies. Dr. Badia specializes in treating all problems related to the hand and upper extremities, including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. and
Doctors, Divorce and COVID-19 Print E-mail
Written by Brian M. Karpf, Young Berman Karpf & Gonzalez   
Monday, 18 May 2020 17:44

Work and homelife can combine for fear and tension during these uncertain times. Such tensions can heighten marital discord (or worsen that which already existed). Unfortunately, increases in divorce seem imminent. How does one deal with the breakup of a marriage during COVID-19? Or, should you do a Prenuptial Agreement?

If children are involved, minimize the disruption to them. If you can no longer reside with your spouse, consider alternate living arrangements comfortable for both you and your kids. Consider the distance between homes. Or, consider “birdnesting,” where children remain in the marital home and the parents alternate moving out (with each having their own home or sharing one since there is little to no overlap). Of course, sharing a home with your soon-to-be ex-spouse requires trust. Regardless, the benefit now is not needing such a large second residence, and not requiring a long-term commitment. However, birdnesting usually only works (if at all) in the short term. Consider the various child timesharing scenarios and how they match your work schedule.

Financial planning is also key. What obligations will exist during and after divorce? Will you be paying alimony? Speak with your financial advisor or CPA and have them run cash flow scenarios.

Speak with a qualified family law attorney. Consider their experience and credentials. Are they Board Certified and members of professional organizations? And, perhaps most importantly, are they accessible and responsive? For instance, at my law firm, a live person always answers calls, e-mails are flowing, and we meet with clients virtually via video services and telephone. Accessibility is key.

With your team, focus on your biggest asset and/or income source: Your medical practice. Are you an owner? If so, have your governing documents carefully looked at. Are there restrictions on sale or transfer? Equally important is the “goodwill” factor – in Florida, only business goodwill value can be shared with your spouse, while personal goodwill is not. Consider Kentucky Fried Chicken: If customers go there for Colonel Sanders, that’s personal goodwill (goodwill value not shared); if they go for the food or “restaurant,” that’s business goodwill (goodwill value shared). Goodwill is generally the value of the practice above its “book value” (e.g., hard assets minus liabilities). Would you be required to sign a non-compete agreement to a buyer? If so, this usually indicates personal goodwill (so excess value remaining with the owner alone). In a Prenuptial Agreement, you can plan ahead for current or future business interests and disposition of income if you ever get divorced.

Your income is relevant for alimony and child support. However, is your income suffering? If so, your ability to pay support will also be down.

Did you receive government assistance? Consider any tax implications and loss of forgiveness, as these could be marital liabilities, offsetting the equity which your spouse could share.

Plan smartly. Speak to your team from in privacy. Change passwords. Ensure that your e-mails and files cannot be monitored, and do not show up on other devices, such as a family computer or even a child’s iPad. Remember that cloud-based sharing services like iCloud and OneDrive can be linked across multiple devices. This includes photo sharing applications and messaging services!

Do your homework. Copy important financial records (your phone can be scanner). Download account statements. Likewise, inventory items of significant value, such as jewelry, artwork and collectibles. Include photos with date-stamps. Store everything in a secure location—whether printed or digitally. Even if you do not proceed with divorce, you will at least have a solid grasp on your finances.

Prenuptial (before marriage) and Postnuptial (during marriage) agreements govern the rights and responsibilities in the event of divorce. They can make divorce less contentious and financially draining.  Likewise, mediation can help you avoid going to court. These are all things to discuss with your attorney.

This is a stressful time for everyone. Make sure you take the steps necessary to minimize the marital stress and unknowns so that you can continue to focus on your patients, your children, and most importantly, yourself.
Brian Karpf is a shareholder with Young, Berman, Karpf & Gonzalez in Fort Lauderdale. He is a Florida Bar board-certified divorce and family law lawyer and mediator.

Last Updated on Tuesday, 19 May 2020 08:44
New Clinical Trial Data, Initiatives, and Path Forward for Post-COVID-19 Cancer Care Delivery System Announced Print E-mail
Written by   
Tuesday, 28 April 2020 17:17

Alexandria, Va. - The American Society of Clinical Oncology (the Society) and its affiliate organization the Association for Clinical Oncology (the Association) today (4.23.20) announced the results of a survey that tracked the initial impact of the COVID-19 pandemic on cancer clinical trials, highlighted a new research initiative to address the data gap on the coronavirus' effect on individuals with cancer, and set forth a road to recovery as the cancer care delivery system prepares for life after COVID-19.
"COVID-19 is placing an incredible strain on the cancer care system, causing tragic results for some patients with cancer and their families, but there has also been an unprecedented response by the oncology community, which is coming together and adapting in new ways," said ASCO President Howard A. "Skip" Burris, III, MD, FACP, FASCO. "While we're in very tough times, this crisis presents an opportunity to improve the quality and resiliency of cancer care. To maximize that potential, we'll be drawing on the expertise of the full cancer community, action by policymakers, and data to proactively transition to post-crisis cancer care and achieve the best outcomes for patients in the months and years ahead."
During a presscast entitled, "COVID-19 and Cancer: Addressing a Healthcare System in Crisis," the Society and Association detailed the impact of the Coronavirus on cancer care, the federal government and cancer community's response, and recommendations for moving forward. National leaders and oncology experts also shared new data and laid out specific steps that need to be taken to appropriately transition to post-crisis cancer care.

More herd immunity, less herd mentality Print E-mail
Written by Ariel Pablos Mendez, MD, MPH | The Hill   
Friday, 10 April 2020 17:34

Our delayed response to COVID-19 has been rash and driven by fear, not data. This may end up costing us double because health depends on many factors. As we learned in the aftermath of the 2008 market crash, economic shocks have a direct impact on public health. The United States experienced a historical decline in life expectancy due to an epidemic of deaths of despair. In a matter of months, people lost their jobs, lifetime savings, and their homes. A strikingly similar situation is happening now. Fact is a public health and stable economies go hand in hand. But in the current COVID-19 response, we have pitted these against each other.

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