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Appointment Customization For Medical Specialty

The advent in the technology has benefited most of the professionals looking for the automation and the real-time assistance. The dependence on human being is being given less priority now as there are many online tools available now that are facilitating the professionals with more competence without any fatigue. The same thing is sought in the appointment scheduling. Very good online appointment schedulers usually come with added features that compliments their primary tasks of being a 24/7 task machine. They provide other services such as automated reminder service, call forwarding, back ups, statistics and record keeping and a whole gamut of features.

One of such features is the appointment customization for medical specialty feature. This feature helps you customize the online scheduler to fit to your particular area of specialty in the health and medical practices. You may not even be running a medical practicing clinic or your business may lean more towards the health and beauty segment, you can use this feature to customize your online appointment scheduler to meet your peculiar needs.

Customization may include the name of the service being provided., the length of the scheduled appointment, the days and time of its availability, the possibility if them doing the appointment by themselves i.e. self service and any other thing you would like them to know or bring with them. All of these and more gives a complete definition of your appointment profile and enables the appointment scheduler to work in line with the definition.

Customization can allow you to change things as how you would want to be identified. You may not be a doctor as such and would to use something else rather than Dr. Special and unique messages can be written for your clients. They will appear as prompts and could be anything from a welcome message to any special instruction for those who choose certain kind of services.

An excellent online appointment scheduler will allow for a vast array of options when it comes to appointment customization for medical specialty. A physiologist should be able to take the program and comfortably customize it to suit their practice. Flexibility should be a critical factor that any good online appointment tool should have.

There are certain schedulers that do not put into account the fact that the program should be adaptable to various niches but an online appointment scheduler comes with special customization features that give you the power to effectively use such a tool.

How to Use Your Health Insurance to Save Money

I’m going to tell you about a government-approved, tax-favored program that could have you saving money on your healthcare expenses as soon as next month. This law lets you reclaim money that had been going into the health insurance company coffers. It offers you tax breaks. You could be using pre-tax dollars for some things that are not otherwise allowed to be included in your health care expenses deduction. You will have more flexibility and control over your health-related expenses than you ever thought possible, if you take advantage of what I’m about to tell you.

Wow! Just writing that down got me energized! It surprises me that what I’m writing about, though not a secret, is way under-utilized, and is misunderstood by the much of the public and health insurance agents alike.

You will see the real power of it once you put it into practice.

Now you should know, up front, that what I’m about to tell you wasn’t designed for everyone. For instance, people who have ongoing medical problems – chronic conditions that keep them going back to the doctor or being admitted to the hospital on even a semi-regular basis – or people who have a hard time managing their own money are not good prospects for this program. It requires self-discipline in setting aside money into a special account. This special account has tax advantages – even if you don’t itemize – but you must be able to keep the money separate from your spending accounts.

If you can do this, many opportunities open up for using this pre-tax money. You can buy things you never thought possible. Things like braces for your child – or any dental work. Things like eyeglasses and contact lenses. And many common purchases that you buy anyway can now be, in effect, tax-deductible.

Have you ever had a cold and bought some medications for the sniffles? Or – speaking of sniffles – allergy medicine? Pain relievers? Nicotine medications? Motion sickness pills? All of these qualify as eligible expenses!

Have you figured out what type of plan I’m talking about yet? I’m sure you’ve heard of it. President Bush mentioned it in many of his addresses to the nation. The major problem with the plan is it is not well understood, and that’s my mission today.

The plan is known as an HSA. HSA stands for Health Savings Account, and it is more correctly referred to as HSA-compatible, meaning the plan fits the IRS rules which allow the owner to open an HSA account to take advantage of all the neat deductible things I’ve been talking about.

A little about the plans themselves: As I said in the beginning, they are not for everyone. If you go to the doctor a lot due to chronic or sever conditions, you don’t want one of these plans because you would be paying more out-of-pocket than you would save with the lower premium.

And they do have lower premiums, generally. There are many different ones from many different companies, of course, so their premiums vary widely and are far too many to name them here. But the rules are the same for all of them, regardless of where you are.

The whole theory behind these accounts is this:

Higher deductibles equals lower premiums. The trick is to save the difference – put it into your pocket instead of the insurance company’s. You’ve probably heard when it comes to life insurance the axiom to buy term and invest the difference. The principle is the same here. Only here, you are putting the difference (and more, really, up to a maximum of $5,950 annually for a family of two or more) into an HSA account. The money is deductible, on the front of the 1040 or 1040A and is what is known as an above-the-line deduction. (Ask you tax adviser as I am not in that business, but I’ve been assured that above-the-line is better than a Schedule A deduction.)

The trade-off: Lower premium (money saved) versus higher deductible (money out-of-pocket before the insurance starts paying its share).

So you see, if you are generally healthy and don’t pay much in doctor bills or prescriptions, rather than paying a higher premium for coverage you won’t take full advantage of, you pay a lower premium and save the difference (which, again, is deductible). The account savings is expected to be used to pay for doctor visits, dentist visits, et cetera . There is a whole list of eligible items that money can be spent on.

But here is the best part: Money that you don’t use can accumulate and earn interest. The interest is also tax-free. And if you don’t use the money in any given year (which you probably won’t and don’t want to anyway), it can be rolled over to the next year….and the next, and the next… Indefinitely. As long as you use it for eligible expenses, you never pay any taxes on the earnings, regardless of your income.

Be aware, though, that if you do use the money for non-qualified medical expenses, you not only get taxed on the money you use, but you also get hit with a 10% tax penalty. Once you reach 65, you no longer are required to use the money on medical-eligible expenses. You are now free to spend it on anything you want, as the 10% penalty no longer applies.

That’s like an IRA. No, wait – it’s better than an IRA. With a traditional IRA, if you deduct the contributions, you pay tax on the money when it is withdrawn. And you pay taxes on the earnings either way. With a Roth IRA, you don’t pay taxes on withdrawals or earnings, but you weren’t able to deduct the contributions. With the HSA, you get triple tax savings: (1) deduct the contributions, (2) tax free earnings, and (3) you don’t pay tax on money withdrawn for qualified medical expenses.

Ah, so you smart ones who know about IRAs are thinking already, “With an IRA I can invest in mutual funds and earn a lot more than what the bank is going to pay interest on an account.” And you’d be right. Except for one thing: With the HSA-compatible account, once you reach a minimum balance (usually $2,000), any additional contributions can be invested in mutual funds, just like an IRA.

Let me give you an hypothetical example of an HSA in action:

John enrolls in a PPO plan that is HSA-compatible, and simultaneously opens an HSA. The PPO has a deductible of $3,500. John can set aside up to $2,850 for 2009, but chooses to only put aside $2,500.

During the year, John has health-related expenses (doctor visits, medications, etc) of $1,000. Because his deductible is $3,500, John is responsible for all $1,000. This is how it would look:

Estimated Income Tax Reduction: $ 583

Amount Added to HSA: $2,500

Amount Paid From HSA: $1,000

Amount Remaining (Includes 3% interest): $1,545

The amount remaining in the HSA is carried over to the next year with no tax owed.

Now, suppose John continues to add $2,500 to his HSA for each of the following five years. During this time, John’s expenses that he opts to pay out his HSA is $300 per year. Now his account would look like this:

Estimated Income Tax Reduction: $ 3,498

Amount Added to HSA: $15,000

Amount Paid From HSA: $ 2,500

Amount Remaining (Includes 3% interest):  $13,625

It’s looking pretty good for John, isn’t it? Now, let’s suppose in the seventh year, John has a fall on the basketball court and breaks his wrist. The total bill for this comes to $6,000. How would his account look now?

Estimated Income Tax Reduction:  $ 4,081

Amount Paid Into HSA: $17,500

Amount Paid From HSA:   $ 6,000

Amount Remaining (Includes 3% interest):  $13,690

As you can see, that slowed John down some. But not all that much, because John only had to use $3,500 from his HSA to cover the deductible, and the health insurance policy paid the rest.

So, now that you know all about HSA-compatible health plans, what are you waiting for? If you have health insurance through your employer, call HR today and ask what your options are for changing your coverage. If they don’t offer an HSA, or you don’t have insurance through your employer, or you are an employer who wants to install an HSA-compatible health plan as part of your employee benefits package, contact me and I will be happy to help get you started.

Global Health Economics and Outcomes Research Amgen (AMGN)

Biotechnology company Amgen Inc. (AMGN) saw the price of its shares fall from a high of $77 to around $55 as of October 2, 2007. The decline in Amgen stock followed news of reduced sales forecasts for its best-selling drug, Aranesp. With declining revenues from drug sales, Amgen is being forced to trim expenditures. The company announced it was laying off between 12 – 14% of its workforce and planned to cut capital expenditures by $1.9 billion. See the related news story is the resources box.

Surprisingly, Amgen plans no reduction in staff in its Global Health Economics and Outcomes Research (HEOR) unit. This unit comprises a hodgepodge of professionals with Ph.D.s in economics, pharmacists, medical doctors, and assorted analysts with data manipulation backgrounds. Their mission is to analyze pre-clinical trial design and post-clinical trial data to extract some causal relationship between an Amgen drug and a positive benefit to clinical trial patients. Normally, the competent medical doctors supervising a clinical trial at field locations can observe whether a drug is having any positive benefit for patients. These doctors are perfectly capable of assessing the efficacy of a drug being evaluated in the clinical trial.

The HEOR unit is called to action to verify statistically what the doctors claim they observe in the field and to try to find additional, unintended benefits from the drug so that Amgen can apply for a patent on the unintended consequence. Due to the large number of clinical trials that do not reveal efficacy of proposed drugs, the primary work of Amgen’s HEOR unit seems to be salvaging any possible value or use for an Amgen drug rejected by the medical community.

There is a fine line between manipulating data to illustrate a deeply hidden benefit for patients versus trying to find a benefit where none exists. Relying on various statistical methods, Amgen’s HEOR staff proposes causal relationships and desperately seeks data to confirm them. Only people with a certain mentality can be stimulated by the daily prospect of sifting through garbage in hopes of finding a diamond.

From what the HEOR staff told me, on and on the data manipulation goes trying to prove the drugs rejected by the medical professionals in clinical trials do in fact show some obscure, often trivial, benefit to patients. The Health Economics and Outcomes Research staff would like to believe it is smarter than the doctors in the field, because the HEOR staff claim they can find medical benefits that doctors treating patients failed to observe. In my opinion, the Amgen HEOR staff research models and their statistical results are often tenuous, at best, and ludicrous, at worst. I teach Health Care Economics at both the undergraduate and graduate level. Having seen how my undergraduate students critique health care policy initiatives and the pharmaceutical industry, I have no doubt they would easily tear apart the assumptions, analyses, and conclusions of the Amgen HEOR studies and reports. Investors have to wonder why Amgen spends an estimated $25 million in salaries for its HEOR professionals if their output is susceptible to rebuke by undergraduate students with no pharmaceutical training.

Another sign of the poor quality of Amgen’s Health Economics unit is its lack of publications. Amgen certainly takes pride when its staff can get research results published in peer-reviewed journals. Professional journal publications by Amgen staff aid the company’s marketing campaigns, add to the prestige of the company, and help enable them to recruit leading scientists. On October 2, 2007, I searched the Nexis “All Full-Text Medical Journals” database using the keyword “AMGEN” in the same sentence as “Health Economics” or “Outcomes Research.” A total of 0 articles were found. I then repeated this same search using the “All Medline Review Article References,” which contains journal publications pre-1975 to the present. A grand total of one article appeared entitled “Psychological outcomes associated with anemia-related fatigue in cancer patients,” which relates to Amgen’s now declining sales drug Aranesp. Desperate to find some evidence of tangible published research by Amgen’s HEOR unit, I then searched the database called “Healthcare Archive News,” which contains publicity announcements and press releases about even minor scientific and medical research findings. The database contained zero articles about any Amgen HEOR medical findings but did list a few press releases concerning the appointments of David Beier and Joshua Ofman to lead Amgen’s HEOR group.

In the fall of 2005, I was invited to visit Amgen’s headquarters in Thousand Oaks, California, and delivered a talk on the latest treatments for osteoporosis. The upshot of my talk was that Novartis’s bisphosphonate drug, Zometa (known generically as Zoledronic Acid) represented the best and strongest possible treatment to prevent bone fractures in post-menopausal women suffering from osteoporosis. Zometa is a drug used by oncologists to strengthen the bone structure caused by calcium leaching from patients subjected to certain forms of chemotherapy. In my talk to compare the efficacy of Zometa to other bisphosphonates, I indicated that the oral bisphosphonates (pills), such as Fosamax and Actonel, were like hand guns, while Zometa (given intravenously) was like a howitzer. I noted that in November 2005, the FDA only approved Zometa as a treatment for the consequences of chemotherapy; however, my contacts within Novartis advised me the company would soon launch a clinical trial to expand the use of this drug for treatment of osteoporosis and low bone mineral density.

I personally observed an elderly patient in her 80s trip and and sustain a traumatic fall face down on a concrete driveway, yet she sustained no fracture anywhere on her body thanks to prior treatments with Zometa. The patient struck the concrete with such force that her glasses were knocked off her head and landed 6 feet away at the base of some bushes. This same patient had sustained a compound hip fracture a few years earlier while taking weekly Fosamax pills. In another episode, an octogenarian frail patient fell backwards and struck her head so hard as to cause her to be dazed, yet she suffered no fracture of her skeletal structure anywhere — all thanks to the efficacy of Zometa to strengthen the fragile bones of osteoporotic patients.

Before I could even finish my talk, the illuminaries from Amgen’s Outcomes Research unit began carping at my conclusions. First, a 50-year old Senior Analyst, with gray, curly, shoulder-length hair, who dressed for work each day in blue jeans as a rebel against the suit-and-tie culture, said none of my conclusions were supported by clinical trials. I responded that treatment of osteoporosis with Zometa was then state-of-the-art medicine still years ahead of clinical trials, and that anecdotal case studies such as this were often the source of ideas to be tested with clinical trials.

The Amgen Senior Analyst said he would not accept any of my conclusions, nor allegedly would any competent professional, without a double-blind placebo clinical trial. This same analyst told me after my talk that he had been invited to head the Health Economics and Outcomes Research units at two other pharmaceutical companies, although based on his myopic comments, I seriously doubted it. Again, I responded to the Senior Analyst by asking if his own elderly mother or aunt or uncle had previously suffered a bone fracture and was in danger of having a significantly reduced quality of life with any further fracture, would he rely on the weak FDA-approved oral bisphosphonates or try to get Zometa therapy for his own relatives? He answered he would stick with the FDA-approved drugs, even if it meant his elderly parent would be debilitated with another hip fracture from which he or she might not recover and would quickly deteriorate in bed and die.

Next, a 6’3″ board certified radiologist, who for some unexplained reason gave up an annual salary of $350,000+ as a radiologist in private practice to become an industry hack working for Amgen, carped that bisphosphonates, such as Zometa, do not actually inhibit the leaching of calcium from bones but instead strengthen the lattice structure of the bone. Furthermore, my talk included no head-to-head comparisons of Zometa with Fosamax or Actonel or any other oral bisphosphonate, so he would not accept the conclusion. I responded by asking the radiologist how many patients he had treated for osteoporosis while in private practice. He responded “none.”

I asked the radiologist if he knew the state-of-the-art treatments for osteoporosis as of 2005, and he responded that the oral bisphosphonates were the state-of-the-art. I then pointed out that no board certified oncologist would consider the oral bisphonates for treating cancer victims with weakened bone structures from chemotherapy. Oncologists need the medical equivalent of a “howitzer” not a pop gun to strengthen their cancer patients’ bones, and oncologists’ preferred drug for this treatment was Zometa. Osteoporosis has many of the same characteristics of weakened bone structure and low bone mineral density as occurs with cancer patients who have undergone certain types of chemotherapy. Despite his objections, I stood by my conclusions that Zometa was the best available treatment for osteoporosis, and I would recommend it as a life-saving treatment for elderly patients (male or female) susceptible to immobilizing fractures.

I expected Amgen’s Health Economics staff to be cautious in describing non-FDA approved use of drugs, but I did not anticipate finding an entire department filled with narrow-minded, rigid, demagogues incapable of thinking outside the box. To them, it was either the Amgen way (methodology) or no way at all. The Amgen HEOR junior analysts had caustic expressions on their faces during my talk, and when I asked them if they would let their own parents or grandparents die from the debilitating consequences of a hip fracture or get them Zometa therapy if needed, they took their cue from the 6’3″ oncologist and said uniformly they would “let granny die.” Do we really want heartless people like this involved in testing the nation’s drug pipeline?

After my talk, I met additional staff in the Amgen HEOR unit, and each one turned out to be less impressive than the last one. One of the last people I met was a pharmacist with health economics responsibility for cardiology drugs being developed by Amgen. He told me he had little background in economics and consequently could not write any articles suitable for publication in economics journals. Yet, he claimed he knew how to develop the initial price that any pharmaceutical firm should charge for any new drug being brought to the market. In economics, the price for a normal good is determined as an equilibrium point by the intersection of demand and supply. But this pharmacist had no use for demand and supply concepts and seemed to construct prices for drugs with his own ad hoc methods.

Amgen’s HEOR unit is filled with people who are out of touch with the health care system in America. The gray, shoulder-length haired Senior Analyst at Amgen, for example, suggested the primary reason people choose to go without health insurance is that they believe they are invincible and are willing to gamble on their health. Given the overwhelming evidence on lack of affordable health insurance for the working poor, if a student in either my undergraduate or graduate Health Care Economics turned in an assignment with an asinine comment like that, I would make the student repeat that assignment.

Approximately two years after my talk at Amgen, the Associated Press circulated a nationwide story on Sept. 18, 2007, with the lead paragraph, “For the first time, an osteoporosis drug has reduced deaths and prevented new fractures in elderly patients with broken hips . . . .No other osteoporosis drug study published in the last 15 years has shown such a pronounced reduction in deaths.” What is the drug mentioned in this study? ZOMETA (marketed by Novartis for osteoporosis patients under the brand name Reclast). Two years before the Associated Press article, I predicted this drug would become the most potent treatment for osteoporotic patients in danger of hip and other bone fractures. Amgen’s brilliant HEOR staff rejected that forecast.

In my opinion, the Amgen HEOR staff needs to be terminated or reassigned to other areas where it can contribute to the company’s bottom line. Its pharmaceutical economics modeling and data manipulations seem dubious, and it appears ethically questionable to analyze data with the intended goal of proving an Amgen drug rejected in clinical trials has some medical benefit that doctors in the field overlooked. If Amgen’s CEO and top management are serious about cutting costs and eliminating unnecessary expenses, then they need to start by eliminating the Global Health Economics and Outcomes Research unit. Until the HEOR unit is eliminated, I will continue to view Amgen as a poorly managed company with a bloated, unproductive staff.

QUESTIONS FOR MANAGERIAL ECONOMICS STUDENTS

1. Describe the dimensions of job design in creating the positions within Amgen’s HEOR unit.

2. Do you believe the job design is appropriate for this firm? How would you measure the productive output of staff in Amgen’s HEOR unit?

3. What suggestions do you have for improving the job design of Amgen’s HEOR staff? Should pharmaceutical companies employ staff in this area?

4. Assume you are a manager of Amgen tasked with eliminating the HEOR unit. What is the best way to implement your task?