Managed-Care Books

My 85-year-old mother recently fell and severely fractured her hip. Unfortunately, she belongs to a Medicare HMO based in Southern California. Because of the nature of her fracture, she required pinning of her femur, a more extensive procedure than the usual treatment for hip fractures. The HMO which was contractually responsible for her care denied payment to the Skilled Nursisng Facility after l8 days, in spite of written reports from her physical therapists and her doctor detailing the remarkable progress she was making. Thanks to this book, we were able to appeal the HMO's denial, which was immediately again denied by the HMO. The appeal then went on to HCFA for review and the denial was reversed. This has saved my mom thousands of dollars. It should be required reading for anyone involved with HMO's!

Don't Let Your HMO Kill You is an invaluable resource which every family should have. It empowers the consumer to take charge of their and their family's health care. Drs Theodosakis and Feinberg bring both insight and useful advice to help the patient make the most of managed care. From better organizing your doctor's visit to learning how to successfully appeal a denial from your HMO, there is something for everyone in this powerful book.

Read this before you go to the doctor! It explains how to work with your doctors, rather than against them, to get the care you need. It points out why the red tape exists, why the doctors are bound by it, and how the two of you can get around it. This book should be issued to every patient. It will benefit doctors and patients alike.

This book is full of great advice for all of us who have been frustrated by dealing with an HMO. It lays out the reasons why managed care has problems, and then explains in plain language how to get good health care from a system that isn't set up to be patient-friendly. There are really good tips on how to get the most out of your plan. Instead of focusing on what's wrong, Drs Theodosakis and Feinberg tell you what you can do to make it work. They are especially good on telling how to build good relationships with the health professionals that you have to depend on within the HMO system.

As a physician who has dealt with many HMOs, I believe this will become the premier guide for people to get the best care out of whatever system they're using. It is about time someone put all of the secrets and resources in one place. Medicine has changed significantly in the last few years - right under the noses of most patients and doctors. It's caused frustration as quality care has diminished. This book will help you get back in charge. I think it should be given out by insurance plans as a guide to how patients should use the system. Congrats to the authors!

Definitely would buy again from seller. Book was Brand new and price was unbeatable! Book came right on time.

This text arrived in great condition and is a comprehensive look at all aspects of managed health care over the course of managed care history.

Excellent, comprehensive primer on the intricacies of managed care. Covers all the major topics, including delivery systems, public and private sector forms of managed care, regulatory and legal issues, medical management, information systems, and operational issues. Thoughtfully done by Dr. Peter R. Kongstvedt and contributors.

The author created an invaluable tool to help begineers understand the rather complicated topic of managed care using a straightforward linear approach to the topic. All topics are covered early with references to indepth coverage found later in the volume.

Getting the book is just a tool though, you really gotta want to learn the material because as practiced as the author is at putting the pen to paper, it's a very difficult topic and therefore, read.

The book was easy to understand and was written from the perspective of someone who is unfamiliar with the managed care topic. I recommend it highly

Don't be fooled by the new title and cover, it's the same book inside. Not one word has been changed - I hope!

If you want to learn to "manage managed care," this is your book. It is certainly one aspect of private practice, but a truly "Successful Private Practice" is so much more than knowing how to navigate managed care. One of these days, maybe I will write the real "Successful Private Practice!"

I highly recommend this book to all the clients of my billing service; in fact, I gave copies for Christmas one year! Therapists are launched into private practice with no clue about how to deal with insurance companies or managed care. Suddenly they have to learn (usually the hard way) how to fill out treatment plans and work with case managers. Susan Frager maps out this new world in a clear fashion, and in language familiar to the clinician.

Any well written handbook is a plus to any mental health office. The information on what should really go on a treatment plan is useful information for a billing service or office manager to pass on to their therapists. This book teaches the therapist a "cooled-down" approach to dealing with the managed care companies instead of an antagonistic approach. Start-up billing services will also find the billing-specific information helpful. This information is spelled out clearly and is easily understood.

This book is excellent. The author's information is presented clearly, giving us mental health providers reassurance that we have a chance with Managed Care. The book is well organized and the information is helpful. Managed Care is a bureaucracy and we must learn the language and the procedures if we are to use Managed Care. This book will help you do that. If you are new to the field and considering Managed Care as a referral source, this is an excellent tool. If you have been struggling with Managed Care for some time, do not hesitate. This book will help you manage your managed care referrals so that you can be a more effective therapist. If you are a mental health provider and are debating about becoming a managed care panelist, you owe it to yourself to read this book before you take the plunge.

Don't be fooled by the new title and cover, it's the same book inside. Not one word has been changed - I hope!

If you want to learn to "manage managed care," this is your book. It is certainly one aspect of private practice, but a truly "Successful Private Practice" is so much more than knowing how to navigate managed care. One of these days, maybe I will write the real "Successful Private Practice."

When I first purchased this book, I thought it was just another pricey self help tome, written for self indulgent doctors, by a novice editor. Boy, was I wrong. This text, with CD-ROM, is a real masterpiece, written by professional CPAs, MBAs, JDs, CFPs, and even physician executives, all who have years of experience working with medical practitioners, IPAs, PPMCs, or MCOs of all types. The doctor-editor even has an MBA, is an insurance agent, securities advisor and is a board certified surgeon and finacial planner.

The book itself is divided into two parts: (1) medical practice finacial planning and (2) personal finacial planning. For, it is Dr. Marcinko's opinion, that in-efficent practices will no longer generate the free cash flow needed for personal planning endeavors. In the current managed care environment, he indeed may be right....

For example, the book augments the traditional financial plannig disciplines of budgeting, taxation, investing, insurance, retirement and estate plannig, with the new realities of managed medical care. These previously unaddressed topics include: office based managerial and cost accounting, marginal revenue and cost concepts, negotiating skills, asset protection, office computers, software and MIS, risk management and a host of legal landmines, including OSHA, Stark I and II laws, anti-trust, insurance fraud and abuse, HMOs, MCOs, PHAs, etc.

This book is so easy to read, fact filled, and stream lined for doctors, that I consider it a must read for all medical professionals. Rather than being overpriced, it is really under valued relative to the cost efficiencies it will bring to your practice and life. Without a doubt, this book will make you money, and save you even more. Don't go to the office, or through life, without it.

It is well know that doctors are poor business people, especially in the world of managed care. HMOs are killing all of them, and possibly us as well. Well, not this editor or his contributing authors; all from the fields of law, accountancy, medicine, insurance, securities, business, management and the investing and financial services professions. Not only does the first section of this book review medical office practice management tips, but it also teaches physicians how to profit more from their toil in an honest and ethical fashion. Then, the book relates best practices to invest hard earned money in the sectors of risk management, budgeting, housing, automobiles, college educaton, taxation, investing, retirement and estate planning. URLs and information resources abound, and the CD-ROM is a fabulous guide giving 'real-life' examples for the above topics. Physician and healthcare provider specificity makes this major textbook a 'must read' for all medical professionals.

Also recommended: 'The Business of Medical Practice' Springer Publishing Same Editor

This book is a wonderful new addition to the libraries of those of us who are health care professionals and are trying to deal with the daily changing of medicine and economics. As all of us who practice medicine know, our practice time has increased while our economic gains have failed to keep pace. In fact, most of us are at a net loss over the past few years if you extrapolate your earnings per hour of work. But as dedicated doctors we strive to provide the best care for our patients regardless. Dr. Marcinko's book provides alternatives to traditional thinking and helps you see light at the end of the tunnel. Wonderful ideas and many practical thoughts for us to work with today so that tomorrow is a little better. Highly suggest this to all my colleagues.

A Senior Healthcare Executive, October 23, 2000

Doctors are NOT Poor Business People

It is well know that doctors and nurses are poor business people, especially in the world of managed care. Well, not this editor or his contributing authors; all from the fields of law, accountancy, medicine, insurance, securities, business, management and the investing and financial services professions.

Not only does the first section of this book review medical office practice management tips, but it also teaches physicians how to profit more from their toil. Then, the book relates best practices to invest hard earned money in the sectors of risk management, budgeting, housing, automobiles, college educaton, taxation, investing, retirement and estate planning.

URLs and information resources abound, and the CD-ROM is a fabulous guide giving 'real-life' examples for the above topics. Physician and healthcare provider specificity makes this major textbook a 'must read' for all medical professionals.

Table of Contents Preface About the Editor About the Computer Disc Disc Contents Contributing Authors Ch. 1 Setting Up a Medical Practice Ch. 2 Office Business Equipment Ch. 3 Business Decision-Making in Medical Practice Ch. 4 Practicing Medicine in the Era of Managed Care Ch. 5 The Economic Fundamentals of Financial Planning Ch. 6 Essentials of Risk Management and Insurance Planning Ch. 7 Personal Financial Accounting and Income Taxation Ch. 8 Medical Office Tax Reduction Strategies Ch. 9 Introduction to Investment Concepts Ch. 10 Portfolio Management Ch. 11 Principles of Asset Protection Planning Ch. 12 Elements of Retirement Planning Ch. 13 Techniques of Estate Planning Ch. 14 Planning for Special Situations Ch. 15 Selecting a Financial Advisory Team Glossary of Terms Additional References Web Sites of Interest National Association of Securities Administrators and Associates 1999 Member Index Representative List Index

Also recommended: 'The Business of Medical Practice' Springer Publishing Same Editor.

Thank you.

The book is still the most comprehensive resource on Managed Care. Covers all its elements and increased my understanding of why managed care worked in the past to its extent and the challenges it faces. Helpful for professionals and policy makers in this field.

Thoughtfully edited and written by the nation's leading managed care experts, the Managed Health Care Handbook is an excellent, highly practical reference on every key aspect of American managed health care. Highly recommended to practitioners, consultants, and students wishing a thorough, up-to-date, and objective understanding of managed care strategy and operations.

This book, in its latest edition, continues to be the most complete resource for all who work in or who are associated with the managed health care industry. It can be used by the novice as an introduction to the vary complex nature of managed health care, or it can be used by the more experienced managed health care warrior as a reference book when one needs a refresher on a particular aspect of managed health care operations.

I am a consultant working with health plans, providers, employers and regulators, and The Managed Health Care Handbook never fails to provide me with the information I need to be successful.

This book is a definite must-have for the new and experienced Managed Care Professional. I found the chapters on compensation and reimbursement to most helpful. The author has successfully captured every element of managed care including, but not limited to, employer groups, networks, reimbursement, and quality.

The book explains the factors that leads to the increasing power of patients over providers. With some examples of pioneers adopting to the changes, you can have an idea where the future lie for providers.

Personally, I think this book is especially helpful for providers. As or consumers, they will experience these changes first hand within their daily lives.

This excellent treatise on the possible future path of Managed Care is a benchmark guide for all of us who are involved in healthcare. Of particular interest are the four examples of "Scenario Planning" which are offered. The reader may challenge oneself by imagining additional, or alternative, scenarios; particularly in view of the current stock market volatility as well as a new national presidential adminstration.

This is an excellent piece of analysis that looks at where we are, how we got here and where we are likely to go. The authors have done a fantastic job of outlining seven major factors that impact the health care industry (consumerism, public policy, information technology, etc.), and the four scenarios at the end of the book provide a great framework for doing your own crystal ball gazing. This book sort of picks up where Paul Starr left off. A must read for any health care executive who plans to remain an executive in health care over the next 5 - 10 years.

This is perhaps one of the most well argued and well documented cases of the detioration of America's health care system under managed care. Dr. Makover makes a persuasive and eloquent arguement and opens the eyes of the reader while sifting through and laying out in an easy to read format the problems and solutions needed for America's health care system. This is an esential item, that is both fascinating and interesting and fun to read. I have read other books like False Hopes by Daniel Callahan, but this book makes the best and most persuasive case. I reccomend this to anyone, especially those interested in the state of America's health care system.

How did we get from loving Dr. Marcus Welby ( as a country)yesterday, to mistrusting all docs today? Dr. Makeover tells you how. As a physician I have watched it happen, thinking it could never really happen....not in the US...but it has and it did. He puts into words the frustrations and fears of all citizens, both lay persons, and docs. He shows you exactly what has happened , and is continuing to happen, and yet we do nothing about it. He tells how we went from a doctor - patient relationship, to what is now a 3 or 4 person relationship with the insurance carriers in between the docs and our patients. He explains, and cites evidence of how doctor's fees are dropping in some areas by 20% per year, and yet the cost of "medical care" is going up drastically. He describes how HMO's in their non profit days spent about 5% of the premiums they received on administrative expenses ( salaries, etc. ) while now some companies spend 30-40% on administrative expenses, and about 60% on actual care. Who benefits? (insurance companies, exec's etc.) and who suffers?( our patients). A great book that clearly tells us how we got this way, and where we are going from here. Frightening!

Remember the last time you went to your doctor? Was he/she rushed, overworked, and not as attentive as you'd like? Well, Dr. Makover's insightful book details how HMOs have turned medicine into a bottom-line business, with drastic results for patients and doctors alike. After reading "Mismanaged Care," you'll understand why so many good doctors are retiring early and why so many top students are likely to avoid becoming doctors in the first place. For anyone interested in their own health as well as the public's health, "Mismanaged Care" should act as a wake-up call. Buy this book!

Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care
I received the book in excellent condition. The price of the item was the best part.

Time to Heal surveys the state of American medical education from the turn of the century to modern HMO times, providing a sweeping survey of American medical education in modern times and examining how American medical education evolved. From the transformation of medical schools and student learning processes to social programs which affected research, this provides an important history for any aspiring medical student.

This is an awesome book that describes everything new physicians need to know about managed care. A must read for any health care provider.

A great overview of the managed care world as it affects young physicians. Tells you what you're going into and how to best position yourself for success (and happiness) within it. It's about time someone wrote this book.

Why do we need the Dictionary of Health Insurance and Managed Care, and, why do payers, providers, benefits managers, consultants, and consumers need a credible and unbiased source of explanations for their health insurance needs and managed care products?

The answer is clear!

Health care is the most rapidly changing domestic industry. The revolution occurring in health insurance and managed care delivery is particularly fast. Some might even suggest these machinations were malignant, as many industry segments, professionals, and patients suffer because of them. And so, because knowledge is power in times of great flux, codified information protects all people from physical, as well as economic harm.

For example, federal government forecasts reveal that total expenditures on health services will surpass $2 trillion in 2007, and account for 17% of the gross domestic product. As a country, Americans spend dramatically more total dollars on health care, and more as a percentage of the economy, than they did two decades ago. Along with these growing expenditures, the government is assuming greater control. Currently, almost 50% of health care costs are under federal or state mandates through Medicare and Medicaid entitlement programs. The recent prescription drug program and implementation of the Health Insurance Portability and Accountability Act adds more confusion for medical providers and facilities, insurance agents, health plans, and patients. This tumult occurred so rapidly that Americans can no longer assume operative definitional stability. The resulting chaos is as expected.

Fortunately, the Dictionary of Health Insurance and Managed Care provides desperately needed nomenclature stability to health insurance policy issues and managed care procedural concerns. With almost 10,000 definitions, abbreviations, acronyms, and references, the Dictionary is the most comprehensive and authoritarian compendium of its kind, to date.

Health care economist Dr. David Edward Marcinko, MBA, and his colleagues at the Institute of Medical Business Advisors, Inc., should be complimented for conceiving and completing this laudable project. The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion, therefore, is to "read it, refer to it, recommend it, and reap."

Michael J. Stahl, PhD
Director, Physician Executive MBA Program
William B. Stokely Distinguished Professor of Business
College of Business Administration
The University of Tennessee

The need for the Dictionary of Health Insurance And Managed Care has been a necessity for a long time. Clear, concise references tools are very much needed by all Health Care providers, Managers, Administrator and every health care professional. The information contained in this book can be the difference between barley getting by in a practice and hoping to keep up with the changes to really having a true understanding of the industry and how the topics relate to an active practice or health care operation.

I found the Dictionary of Health Insurance And Managed Care to be very well thought out and the terms are easy to understand.

When you receive raw information from a reference resource such as the Federal Register or other reference resources everyone does not easily decipher the information contained. Having this type of reference book will greatly enhance the readers ability to not only understand the terms and meanings but how to apply them in a active day to day operation of medical practice.

I would highly recommend the Dictionary of Health Insurance And Managed Care to everyone who has chosen a career in any health care discipline.

Christy S. Lodwick, MHA
PhD Candidate
Health Care Administration & Policy
Rushmore University
President/Business Development
IMPACT Health Care Solutions
Columbus, Ohio