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State-by-State Review

Conclusion

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Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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MasterCard Warns of Possible “Massive” Data Breach

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“Breaking-News” Report

According to Andrew R. Johnson, MasterCard Inc. MA -1.36% just reported that it is investigating a possible breach of cardholder account data involving a U.S.-based payment processor.

The Purchase, N.Y., credit-card company said law enforcement has been notified of the matter and an “independent data security organization” is conducting an ongoing forensic review of the matter. The company is alerting card-issuing banks regarding “certain MasterCard accounts that are potentially at risk.”

Assessment

Link: http://online.wsj.com/article/SB10001424052702303816504577313411294908868.html

Is there an object lesson here for HIT data protection and EHR identity theft?

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

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Physician Advisors: www.CertifiedMedicalPlanner.org

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Welfare Benefit Trust Plans for Physicians?

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“Hall of Fame” for Egregious Investment Advice

By David K. Luke MIM, Certified Medical Planner™ - candidate

[Physician Financial Advisor – Fee Only]

www.NetWorthAdvice.com

www.CertifiedMedicalPlanner.org

Physicians unfortunately often become unwitting targets of some very egregious investment advice. Usually it involves an investment product with an imbedded fat commission just waiting to be deposited in a “financial advisor’s” bank account.

In the “Hall of Fame” of egregious investment advice is the Welfare Benefit Trust. About 10 years ago, while I was working for a top five national brokerage firm (this was before my fee-only days when I was still on the “dark side”) our internal Insurance Products Department at the brokerage firm’s head office presented an amazing investment product. This “Welfare Benefit Trust” we were told should be shown to our profitable small business owners as a cure for their every ill caused by paying too much taxes. A Welfare Benefit Trust essentially works like this:

  • The business provides a fringe benefit for their employees, such as health insurance and life insurance.
  • The benefit is established in the name of a trust and funded with a cash value life insurance policy
  • Here is the gravy: the entire amount deposited into the trust (insurance policy) is tax deductible to the company, and
  • The owners of the company can withdraw the cash value from the policy in later years tax-free.

Yes, the holy grail of tax avoidance has been achieved: tax deductible up front and tax-free when you withdraw. By the way, if you are not familiar with such investments there is a reason. They are not legal by the tax code. Physician practices, as well as other small and mid-sized businesses, became buyers into these welfare benefit trusts as they were sold as a way for the practice to “protect” a large profit in a certain year from being taxed. We were told it was not uncommon for a single transaction into a welfare benefit trust to be $200,000 to $300,000 dollars or more in a single premium payment, yielding typically a six-figure commission check.

A few years later the gig was up as it became obvious these could not be tax legal. My understanding is that most medical practices that bought these “unrolled” them when the major brokerage firms realized that avarice got the best of them and stopped selling them. In 2007, the IRS and the Treasury Department issued a formal warning cautioning “about certain Trust Arrangements Sold as Welfare Benefit Funds”. The IRS called these “abusive schemes” and made such a transaction what the IRS lovingly calls a “listed transaction”. Essentially, a listed transaction is a transaction that the IRS has determined to be a tax avoidance transaction. The IRS even keeps these Listed Transactions on their website, listed in chronological order from 1 to 34. Welfare Benefit Trusts is #33.

Good Welfare Benefit Trusts

First of all, it is important to mention that “there are many legitimate welfare benefit funds that provide benefits” according to the IRS. Internal Revenue Code Sections 419 and 419A spell out the rules allowing employers to make tax-deductible contributions to Welfare Benefit Plans. There is nothing wrong with these plans and no mystery to them. After all, a medical practice or any business for that matter is allowed to deduct the costs of doing business as an expense. This includes employee salary and benefits.

VEBAs (Voluntary Employee Benefits Association) have been around since 1928 and are used by employers to provide health, life, disability, education and other benefits for their employees and are the original Welfare Benefit Trusts. When properly established and executed, a VEBA can be a legitimate employee benefit structure. In 2007 the United Auto Workers, in order to relieve the Big 3 Automakers from carrying the liability for their health plans on their accounting books, formed the world’s largest VEBA with over $45 billion in assets.

Bad Welfare Benefit Trusts

However, the IRS does have a problem with Welfare Benefit Plans that are promoted to small business owners as a scheme to avoid taxes and provide medical and life insurance benefits to key employees that in substance primarily serve the owner(s) of the business. These 419 Welfare Benefit Plan schemes claim that the employer’s contributions are deductible under IRC section 419 as ordinary and necessary business expenses, allowing the business owner to provide a life insurance policy for his favorite employee, himself, and accumulate cash value in a life insurance policy.

Lest there be any confusion or debate, IRC 264(a)(1) states:

(a) General rule

No deduction shall be allowed for -

(1) Premiums on any life insurance policy, or endowment or

annuity contract, if the taxpayer is directly or indirectly a

beneficiary under the policy or contract.

While VEBAs have been used properly, as in the UAW example above, unfortunately they are often a front for an abusive tax shelter. In the 1970’s VEBAs were being used by the wealthy as a popular tool for tax reduction and asset protection. In 1984 Congress passed the Deficit Reduction Act, which limited the use of VEBAs. In the 1990’s however VEBAs were structured to give business owners tax benefits not allowed and got back on the IRS radar. Two state medical societies along with a neonatology group practice became test cases by the IRS that helped close those VEBAs with abusive tax structures and purporting to be employee welfare benefit plans: Southern California Medical Professionals Association VEBA, New Jersey Medical Profession Association VEBA and Neonatology Associates, PA. Although the VEBAs claimed to have favorable determination letters, the actual execution of the plan did not comply with the law, mainly by allowing the employees to hold term policies in the plan that could be converted into universal life policies at the same insurer and use the conversion credit account to spring cash value in the policy. This then allowed policyholders to borrow against the UL policy as a supposedly nontaxable source of retirement income, with the repayment of the loan paid out of the policy’s death benefits. (“Making Welfare Plans Work”, Advisor Today, September 2000 P 110). This of course is not allowed under the tax code.

Those that think that they may be in the clear with their abusive tax shelter because:

  1. A large passage of time has occurred since they have owned it
  2. They have a favorable determination letter
  3. Other honorable businesses/ Medical Societies also have the same tax shelter
  4. My insurance agent said it was legal

may want to read the 98-page ruling by the United States Tax Court filed on July 31, 2000 in the case of the above-mentioned Neonatology and related cases. The long arm of the IRS reached back 9 years to 1991, 1992, 1993 disallowing hundreds of thousands of dollars and assessing deficiencies and huge “accuracy-related” tax penalties. Even the doctors that had died since then were not given a break either; their estates and surviving widows were assessed the deficiencies and penalties.

In 2002 the IRS talked Congress into passing new laws basically killing the use of multiple employer 419 plans. Some TPAs (third party administrators) that had set up the multiple employer plans discovered that they could use single employer 419 welfare benefit trusts and VEBAs because Congress forgot to include them when they passed the negative laws shutting done the multiple employer plans. This forced the IRS to issue notices 2007-83 and 2007-84, Rev. Ruling 2007-65 and make welfare benefit trusts listed tax transactions now on the listed tax transactions list. (“Negative IRS Notices On 419 and VEBA Plans” Roccy M. Defrancesco Nov 1, 2007)

Ugly Welfare Benefit Trusts

I call these “Ugly” because these Welfare Benefit Trusts were sold to small business owners after the 2007 IRS listed transaction warning, and after the multiple IRS notices and revenue rulings. The major brokerage firms by 2004 had stopped selling Welfare Benefit Trusts to protect their own financial interests, realizing these were compliance and lawsuit time bombs. The 2007 IRS listed transaction notice along with multiple other notices however did not seem to stop some smaller broker dealer firms and life insurance agents from promoting these.

I have become aware of the fact that Welfare Benefit Trusts that are in violation of the basics of the tax code (unlimited full deduction of premium,  100% tax free distribution to owner of cash value) are still being sold even today and even affecting existing clients. These Welfare Benefit Trusts go by many different names and the insurance agents selling them are using a number of different insurance companies to fund the plan. These plans involve the sale of an insurance policy usually with a six-digit premium that often pays the insurance agent a six-digit commission, so perhaps I should not be surprised that individuals (physicians?) are still being victimized

Conversation with IRS Attorney on Welfare Benefit Trusts

On January 20, 2012 I discussed with Betty Clary, an IRS attorney that helped draft the listed transaction #33 on the IRS website, on what exactly the IRS considers an abusive Welfare Benefit Plan. She stated that, once you take out the fact that the trust cannot be offering a collective bargaining element which is covered by another IRS code, there were three elements they look for:

  1. There has to be a Trust that claims to be providing welfare benefits
  2. There is either a cash value policy involved that offers accumulation or a policy in which money is set aside for a future policy in which accumulation occurs, such as a term policy that can then offer a higher accumulated value.
  3. The plan cannot deduct in any year more than the benefit provided. For example if the plan just provides a death benefit, the most that can be deducted in a year is only the term cost of that benefit, not the entire premium. If the plan offers medical benefits, then only the cost (what was paid out to the employee) for that benefit can be deducted in that year.

I found it interesting that the IRS is pursuing this broader definition as an abusive plan. Betty explained that in the case of a discovered abusive Welfare Benefit Plan, the IRS would disallow the deductions, assert income back to the owner as a distribution of profits, and assess penalties. The courts are clear that you cannot get out of penalties by claiming you are relying on the person that sold you the Welfare Benefit Plan.

What if you currently have a Welfare Benefit Trust for your Practice?

Realizing that someone you trusted has financially devastated you, carelessly misguided you and sold you a bogus tax program in order to pay cash for his new 7 series BMW can be a difficult and rude awakening. After accepting the fact that your Welfare Benefit Plan you have for your practice meets the basic criteria as mentioned in this article as an abusive transaction, I would recommend that you consult an attorney that specializes in pursuing promoters of abusive Welfare Benefit Plans and discuss your options. I have had discussions with Lance Wallach, an accountant and expert witness used in a number of Welfare Benefit Trust cases, which has confirmed to me that you must be proactive. You may be advised to file an IRS form 8886, which is a disclosure form related to prohibited tax shelter transactions. The penalties for failure to file a form 8886 can be stiff. Of course, filing this form will open the Pandora’s Box on your Welfare Benefit Trust to the IRS. Lance has told me that many of these 8886 filings are done incorrectly. An incorrectly filed IRS form is an unfiled IRS form, so please consult a CPA who is experienced in this area. Your attorney that has expertise with Welfare Benefit Trusts will be able to guide you with this. Regarding recourse, according to Lance, most all cases are settled out of court, as the insurance company, the agent, and the agency prefer to avoid the publicity.

Conclusion

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Healthcare Reform Thru 2018

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An Evolving System

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What’s at Stake in the Supreme Court’s Health Care Decisions?

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On the PP-ACA

By Lena Groeger ProPublica

Yesterday, the Supreme Court began hearing arguments on the health care reform law. So, in this essay, we made a map of the possible outcomes following the Court’s schedule over the next three days.

The Court will hear all three days of arguments, even if they eventually decide not to decide the bulk of the case, and is unlikely to issue a decision on the case until late June or early July.

Assessment

Link: http://www.propublica.org/special/mapping-the-supreme-courts-health-care-arguments

For more information on different states’ progress implementing health care reforms, see this comprehensive list.

Conclusion

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What Type of Automobile Should Future Physician Millionaires Drive?

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Re-Thinking Previously Owned [Used] Vehicles

By Rick Kahler CFP® MS ChFC CCIM

www.KahlerFinancial.com

Have you ever seen a Super Bowl ad touting how much money you could save if you bought something second-hand? Of course not! There’s not a lot of encouragement in our culture to buy used stuff. Even the one exception, a used home, is described as “existing.”

Badge of Honor

Buying used just isn’t cool—that is, unless you’re a wealth builder. Many of them look upon buying used as more of a badge of honor than an embarrassment. Certainly, there are many items that are best purchased new. Toothbrushes, toilet paper, and underwear come to mind. Yet there’s one thing that’s almost always better to buy used—a vehicle.

The Myths

Let’s look at a few common myths around buying a new [previously owned] car.

  • “Buying a used car is just buying someone else’s problem.” That can certainly be true if you don’t do your homework. When shopping for a used car, be sure you research the model’s repair record. The best place for this is Consumer Reports. An inexpensive online subscription will give you loads of detailed information about every year, make, and model. Narrowing your search to the top used car values will significantly increase your odds of buying a great used car. Before writing a check for even a top-rated used car, take it to a trusted mechanic for an evaluation. The money you spend will be well worth the future headaches you save.
  • “Never own a car that is out of warranty.” This is a good idea only if your heart is set on owning one of the many cars ranked as the least reliable. The warranty will come in handy because the car will spend a significant amount of time in the shop. Also, the value of a new car drops rapidly in the first few years. If instead you buy a used vehicle with a high reliability rating the warranty become less important, especially when you consider you’ll be getting a third to half off the sticker price. If you buy a low-mileage, late model car, your savings will be enough to more than pay for the few times you may need to take it into the shop.
  • “When a car hits 80,000 miles it’s time to get a new one because it will start costing an arm and a leg to maintain.” Once again, a top-rated used car will often run reliably for well over 120,000 miles if it’s maintained. Yes, the maintenance will increase, but the rapid depreciation of a new car will cost much more than maintaining an older car. Wealth builders routinely buy late model cars with low mileage and own them for 10 years or more.
  • “I can get a lower interest rate and longer term loan on a new car.” Here’s my rule of thumb: If you need a loan to buy a new car you are probably buying too much car. Those who manage money well create a savings account for replacing their vehicles. That way they can pay cash for a car and drive the best deal. If you must get a loan, borrow as little as possible and pay off the loan quickly. A higher interest rate on a shorter term loan on a used car is still a much better deal than what you would lose in depreciation on a new vehicle.

Assessment

Americans, especially doctors, have a love affair with their cars. Still, for most of us a new car is a luxury, a big splurge best purchased after we’ve attained financial independence. The best way to travel the road to that financial independence is in a used car.

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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ACO Opinion and Voting Poll

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Are Accountable Care Organizations Another Form of Medical Capitation Reimbursement?

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Healthcare Organizations: www.HealthcareFinancials.com

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Use Us – Don’t Abuse Us

The ME-P is Not Peer Reviewed but should be Cited

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By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

There is an amusing historical story in academia about an unsuccessful candidate for a faculty position. It might serve as an object lesson for us all at the Medical Executive-Post.

The History

After faculty appointment interviews, the exhausted chairman of a prestigious university’s search committee quipped, “What his résumé lacked was five bad papers.”

The Rationale

By that, he meant that while the candidate had published several peer-reviewed papers containing enough genuinely important ideas to satisfy any rational hiring committee — more than could be said of most faculty members — he had too few to satisfy the bean counters, who fretted about how uninformed outsiders might react to the appointment.

Assessment

Researchers have responded as expected to these incentives. But, the additional papers they’ve written often have added little value. In other words, quality trumps quantity, even in the blog-o-sphere. So, please reference and cite us, comment about us, recommend us and use us – but don’t abuse us! Oh! We are copyrighted, too. We are – what we are – and proud of it.

Conclusion

In fact, the economist Philip Cook and Austin Frakt PhD, over at the Incidental Economist, found that in the first five years after publication, many fewer than half of all papers in the two most selective economics journals had ever been cited by other scholars.

So remember, at the ME-P, we are not peer reviewed. However, we are important, helpful, focused, crowdsourced, valuable and growing!

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

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National ‘Un-Plug’ Weekend Starts Today

So, Prepare to be Bored This Weekend

Maybe it’s time for you, this ME-P and your tech devices to take a break from each other?

A Shabbat of sorts – if you will!

Why?

A Jewish organization called Reboot is planning the third annual National Day of Unplugging from sundown Friday to sundown Saturday. It’s a time to disconnect from the web and reconnect with your friends and family.

Make the Pledge

You can also pledge to be a part of the cause, which urges you to “Turn off your cell phone. Stop the constant e-mailing, texting, Tweeting and Facebooking to take time to notice the world around you.”

So far, more than 1,330 people have pledged to unplug.

Assessment

Oh, by the way, Sunday is National Make Up for Unplugging by Bingeing on the Internet Day.

More: http://www.sabbathmanifesto.org/unplug/

Conclusion

Your thoughts are appreciated. Will you unplug this weeked; or not?

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Happy Birthday PP-ACA

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What if You Threw a Party – and Nobody Came?

Assessment

Two year anniversary [2010-2012].

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

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IRS Announces Online “EO” Search Tool

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About “Exempt Organizations Select Check”

By Children’s Home Society of Florida

The IRS announced last week that it has created an online search tool called Exempt Organizations Select Check. The new search tool is very useful in understanding whether a charitable organization currently qualifies for deductible gifts.

Internal Revenue Service Website

On www.IRS.gov, select Charities and Nonprofits – More Topics. On the right side of the screen, select Search for Charities and load the Exempt Organizations Select Check page.

The new page allows three types of searches.

1. Exempt Organization Publication 78 Organizations qualified to receive deductible contributions.

2. Non-exempt Organizations – Because many smaller organizations did not file Form 990-N (ePostcard), their exemptions were automatically revoked.

3. Qualifying Form 990-N Organizations Those organizations that did comply with the ePostcard notice are listed.

Editor’s Note: Advisors or board members of charities may find the new EO Select Check useful in determining whether a charity has complied with the requirements to file IRS Form 990, Form 990-EZ or IRS Form 990-N. If an organization is no longer exempt it may be appropriate to file a new IRS Form 1023 and apply for exempt status.

Conclusion

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On the Protecting Access to Healthcare (PATH) Act

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ADA Makes Progress Against McCarran-Ferguson

By D. Kellus Pruitt DDS

The ADA makes real progress against McCarran-Ferguson. I’ve watched the American Dental Association fight long and hard against the unfair McCarran-Ferguson Act of 1945. ADA leaders and I still don’t agree on the need for transparency in the professional organization instead of proud unresponsiveness, but nevertheless, I’ve always been publicly supportive of their efforts to repeal the M-F Act.

Insurance Industry

The insurance industry is powerful in Washington. Over the short term, common sense has proven to be far less influential than their generous campaign contributions – making this a long haul for ADA officials. Yet the amendment to H.R. 5, Protecting Access to Healthcare (PATH) Act, which was offered by Rep. Paul Gosar (R-Ariz.), a dentist, is finally scheduled to come up for a vote on Thursday, March 22, 2012

Good Work – ADA

http://www.ada.org/news/6926.aspx

If passed, the legislation will restore the application of antitrust laws to the business of health insurance. Makes sense, right? After all, if every other business in the nation, including professional organizations, can be prosecuted by the FTC for collusion, why should Delta Dental, BCBSTX and other members of the National Association of Dental Plans (NADP) be exempt from antitrust laws which protect their clients.

I and others are hopeful that this will end many of dental insurers’ current business practices which unfairly force dentists to accept take it or leave it terms that would be unacceptable in a fair market. Maybe the repeal will also make insurance lawyers think twice before alerting the FTC when ADA News speaks honestly about the harm caused by suspiciously similar policies of numerous NADP members.

Assessment

Even if the M-F is repealed, here is an example of truth in dental care that I bet ADA leaders still won’t be able to share with Americans: Unfair downward pressure on contracted dentists’ payments always hurts clueless dental patients the most. Delta Dental’s greed will never be satisfied and dentists’ ethics aren’t free.

NADP, meet the FTC.

Conclusion

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A Visual Guide to Pissing Off The Financial World

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On the History of AIG

According to Wikipedia, the American International Group, Inc. (NYSE: AIG) or AIG is an American multinational insurance corporation. Its corporate headquarters is located in the American International Building in New York City. The British headquarters office is on Fenchurch Street in London, continental Europe operations are based in La Défense, Paris, and its Asian headquarters office is in Hong Kong.

According to the 2011 Forbes Global 2000 list, AIG was the 29th-largest public company in the world. It was listed on the Dow Jones Industrial Average from April 8, 2004 to September 22nd, 2008.

AIG suffered from a liquidity crisis when its credit ratings were downgraded below “AA” levels in September 2008. The United States Federal Reserve Bank on September 16, 2008 created an $85 billion credit facility to enable the company to meet increased collateral obligations consequent to the credit rating downgrade, in exchange for the issuance of a stock warrant to the Federal Reserve Bank for 79.9% of the equity of AIG.

###

A Visual Guide to Pissing Off The Financial World

Assessment

The Federal Reserve Bank and the United States Treasury by May 2009 had increased the potential financial support to AIG, with the support of an investment of as much as $70 billion, a $60 billion credit line and $52.5 billion to buy mortgage-based assets owned or guaranteed by AIG, increasing the total amount available to as much as $182.5 billion.

AIG subsequently sold a number of its subsidiaries and other assets to pay down loans received, and continues to seek buyers of its assets.

Many physician investors were affected.

Source: www.CreditLoan.com

Conclusion

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Public Misconceptions of Private Equity

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A Political Season Review

By Rick Kahler CFP® MS ChFC CCIM

www.kahlerfinancial.com

During tax time and this very political season, some of the attacks on Mitt Romney as a Presidential candidate have focused on his tenure with the private equity firm Bain Capital. Critics and rivals have denounced Romney as “profiteering off the backs of fired workers,” and running a “vulture capital” rather than a “venture capital” fund. A PAC supporting Newt Gingrich even produced a documentary about Bain which tries hard to leave viewers with the idea that capitalism isn’t evil, but private equity firms are.

The Negative Impressions

Some of this negativity may come from a lack of understanding as to what “private equity” really means. Here’s my explanation.

First, equity just means “common stock.” Whether equity is public or private depends on whether the company lists its shares on a public exchange, like the New York Stock Exchange or the NASDAQ, or is privately held.  When you purchase a share of common stock, either directly or through a mutual fund, you buy it from a public stock exchange where anyone can buy or sell shares of stock. Private equity shares, however, are bought and sold privately, just like houses or small businesses.

One of the benefits of a public exchange is that it makes owning a slice of a company exceedingly affordable. For example, for about $600 you can own a share of Apple, the largest company in the U.S. If Apple were privately held, you would need $500 billion to buy it. If you were a little short on cash but still wanted a piece of Apple, you and 999 of your closest friends could pool your resources. You’d only need $500 million each.

That is exactly what a private equity company does. It brings together substantial investors, usually institutions, pooling their money to purchase companies not available on public exchanges. This requires raising or borrowing amounts that may be in the billions of dollars. The minimum to invest in a public equity company is often one million to 25 million dollars or more, putting it out of reach of most Americans.

An Asset Class

However, that doesn’t mean John Q. Public doesn’t own a slice of the private equity pie. Public pension funds, like the South Dakota Retirement System, have invested over $200 billion in private equity funds. The SDRS invests over 10% of its $7.8 billion fund in private equity. Many investment officers and committees feel this is such an important asset class that not holding a portion of their portfolio in private equity would violate their fiduciary duty to the fund.

Why Invest Privately?

Why invest in companies that are privately held? They often are purchased for lower prices than their publicly traded cousins, which makes owning them more profitable. In other cases a private equity firm will purchase a company that is failing or purchase a public firm and make it private.

In most every case, the private equity company’s aim is to try and improve the profitability of the company in the hope of reselling it at a profit or taking it public. Sometimes this is successful; sometimes it isn’t.

Goals of Private Equity Firms

What is the goal of a private equity company? Why, to produce a return for its investors, of course. Like any other business, its ultimate goal is not to create jobs. While more jobs may be a byproduct of creating better profitability, that isn’t always the case. Nor should it be.

Assessment

Failing to turn around a struggling company or laying off a division that is sucking a company dry in order to save the company isn’t evil. It is a natural and crucial component of a competitive free market system, a system that has given the U.S. one of the highest standards of living the world has ever known.

Conclusion

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Property Taxes in America

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A Seldom Discussed Topic Among Medical Professionals

The housing market across the country has tanked. That should mean lower property taxes, right?

It’s true that property taxes do fall when housing values drop. But, this fall doesn’t happen in perfect time with the market. There’s usually a delay. And even when property taxes do fall, it’s often not enough to satisfy cash-strapped doctors and other homeowners.

Plummeting Home Values

This isn’t surprising. Homeowners today are struggling with plummeting home values. Those who bought their homes in 2004, 2005 or early 2006, especially, have most likely seen their homes lose tens of thousands of dollars in value.

It is little wonder, then, that physicians and others homeowners today are taking a closer look at their property taxes. Here is a look at what type of property taxes you pay depending on the state that you call home.

For example, if you live in New Jersey, you might not want to open that property tax bill. The state featured the highest median property taxes on owner-occupied housing, according to 2008 data by the U.S. Census Bureau. Homeowners here paid a median of $6,320 in property taxes each year. Connecticut came in second with a median property tax of $4,603 on its households. Right behind was New Hampshire, $4,501; and New York, $3,622.

Other states with high median property taxes include Rhode Island, $3,534; Massachusetts, $3,404; and Vermont, $3,281. Looks like you shouldn’t buy a home in the East if you want to pay lower property taxes.

On other end of the scale, Louisiana homeowners paid a median of $188 on their property taxes. In Arkansas, that number rose a bit to $383, while it stood at a still low $457 in West Virginia. In Mississippi, this median value stood at $468. Other states with low median property tax figures were South Carolina, $678; Oklahoma, $762; and New Mexico, $843.

Median Values

In general, these median property tax numbers do make sense. The states that have the highest median property taxes tend to have the highest median housing values, too. The opposite holds true, too.

For instance, the states with the lowest median housing values include West Virginia, $95,900; Mississippi, $99,700; Arkansas, $105,700; Oklahoma, $105,500; North Dakota, $112,500; and Alabama, $121,500. These states also tend to have some of the lowest property taxes.

Highest Median Home Values

Some of the states with the highest median home values include Hawaii, with a median value of $560,000; California, $467,000; New Jersey, $364,100; Massachusetts, $353,600; and Maryland, $341,200. Again, the property taxes tend to align well with these prices. Homeowners in these states pay some of the higher median property taxes in the country.

Relation to Home Values

The most important number, though, when analyzing property taxes isn’t what homeowners pay in each state. It’s how high this figure is in relation to home values.

For instance, Texans don’t pay the highest median property taxes in the country. They do, though, pay the highest percentage of their home values in property taxes, 1.76 percent.

Other states fare poorly in this measure, too: New Jersey, 1.74 percent; Nebraska, 1.72 percent; Wisconsin, 1.71 percent; and New Hampshire, 1.70 percent.

If you want to live somewhere where property taxes take up the lowest percentages of your home’s value, you might want to consider moving to the South.

For instance, homeowners in Louisiana pay 0.14 percent of their home values in property taxes, lowest in the nation. Hawaii comes in second with a figure of 0.24 percent. In Arkansas, that number is a still low 0.32 percent, while it’s at 0.47 percent in Mississippi. In West Virginia, the percentage rises to a still low 0.47 percent.

Assessment

Analyzing the impact of property taxes is far from an exact science. But by looking at how large of a percentage these taxes take up when compared to housing values, homeowners will get a better idea of what kind of financial burden property taxes are placing on them.

Source: www.CreditLoan.com

Conclusion

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What is a Social Impact Bond?

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New Financial Product – or Societal Economic Hammer

By Dr. David Edward Marcinko MBA CMP™

At a time when government finances are stretched there is growing interest in finding new ways to fund public services [healthcare, for example] which improve social outcomes [public health]. And, one new funding model currently being tested, in the United Kingdom, is Social Impact Bonds (SIBs).

Definition

A SIB is a form of payment by results (PBR) in which funding is obtained from private investors to pay for interventions to improve social outcomes. If these interventions succeed in improving outcomes, they should result in savings to the Government and provide wider benefits to society. Of course, as part of a SIB, the Government agrees to pay a proportion of these savings back to the investors. If outcomes do not improve, investors do not receive a return on their investment.

Link: http://en.wikipedia.org/wiki/Social_impact_bond

Wall Street’s Securitization

Wall Street can securitize almost any asset for a commission, or to hold it for profit or loss. Remember David Bowie bonds?

“Securitization” is the process through which an issuer creates a financial instrument by combining other financial assets and then marketing different tiers of the repackaged instruments to investors. The process can encompass any type of financial asset and promotes liquidity in the marketplace.

Link: http://thehealthcareblog.com/blog/2012/03/05/could-social-impact-bonds-help-restore-public-budgets/

SIBs

SIBs may be an example of securitization. By combining small debt into one large pool, the issuer can divide the large pool into smaller pieces based on each individual bond’s inherent risk of default, and then sell those smaller pieces to investors. The process creates liquidity by enabling smaller investors to purchase shares in a larger asset pool. Individual retail buyers, like physician-investors and others, are able to purchase portions the bond. Without the securitization, retail investors might not be able to afford to buy into a large pool of bonds.

Read more: http://www.investopedia.com/terms/s/securitization.asp#ixzz1oGtOPTvZ

Assessment

This is the first time we’ve discussed SIBs on this ME-P. But, they should get much more attention from our CPA, investment advisor [IA] and financial advisory [FA] readers now that President Obama has announced his support for this British idea like getting private investors to pay for public services such as housing for the homeless, health care for vulnerable populations; or even education. It could work for anything that can save the Government money in the long run, but costs money up front, as long as we can measure it.

Link: http://www.fastcompany.com/1728321/the-most-exciting-00003-of-obama-s-budget-social-impact-bonds

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Should Dr. Marcinko Speak in Malaysia?

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Information Sought on Laures International

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Recently, I was pleased to be invited to speak at a Regional Public Workshop [RPW] for the healthcare clients of Laures International, in Malaysia, Kuala Lumpur. I don’t know if  I’m personally that famous, infamous, or our newest book is just garnering rave reviews.

“Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies].

In-Process from: (c) Productivity Press 2012 http://www.crcpress.com/product/isbn/9781439879900

The Firm

Briefly, Laures International is touted to be at the forefront in organizing strategic business intelligence in Asia and Middle East with headquarters in Petaling Jaya, Malaysia. As of 2011, they’ve supposedly held events in Kuala Lumpur, Singapore, Philippines, Thailand, Indonesia, China and Dubai.

Goals and Objectives

Representatives state their goal is to provide world class events with an uncompromising attitude towards quality. The aim of Laures is to provide a platform for delegates to be involved in discussions and case studies to enhance their understanding and to apply what they learn immediately to improve their performance when they return to their respective workplace. A worthy goal!

Offices

+603 – 78034444

www.LauresInternational.com

Assessment

Now, I like to speak and learn, and have done so frequently around the country and in Eastern Europe the last three decades. Usually, my presentations are for medical societies, financial services groups, pharmaceutical companies or other consulting firms.

But, Laures is heretofore unknown to me, and other than their contact and website review, I am concerned about their credibility. With all due respect, I’d frankly hate to be duped or ultimately “stuck” in Kuala Lumpur!

Conclusion

Your thoughts and comments on this ME-P are appreciated. Is Laures International credible? Is the region safe? I’d love to experience its’ culture, people, food, colleagues, sights, sounds and sites. Accept or not? Your ME-P crowd sourced experience and wisdom is appreciated.

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Some Common Surgeries You Can’t Afford‏

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The Cost of Common Surgeries

By Muhammad Saleem

With a broad range of healthcare options, it is often difficult to understand just what your pocketbook can afford.

So, we took a look at the costs of the most common surgeries performed every year.

Source: Medical Billing and Coding

Conclusion

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How the ME-P Helps Doctors Become and Remain Professionally and Personally Fiscally Fit

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Financial Planning Handbook

Conclusion

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###

TESTIMONIAL

In his book Financial Planning Handbook for Physicians and Advisors, Dr. David E. Marcinko, MBA CMP® CFP® provides us with a simple and yet very complete view on the basics of financial planning that every physician should know in order to maximize our chances for success in the financial aspect of our medical careers and personal lives.

The book is well structured, organized and easy to read. Divided in ten chapters, it covers important aspects of personal financial planning such as insurance, home mortgages, retirement plans, auto buying, taxes and more. In an era where doctors must have a solid understanding of the basics of financial management, this book is a must-have on every physician’s private book collection.

Although not a substitute for a formal business education, this book will help physicians navigate effectively through the hurdles of day-to-day financial decisions with the help of an accountant, financial and legal advisors.  This book would make an excellent reference for teaching medical students and residents the basics of monetary management.

I highly recommend this book and commend Dr. Marcinko and the Institute of Medical Business Advisors, Inc. on a job well done.

Manuel J. Colón, MD

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Half of All Americans Don’t Pay Income Tax to Uncle Sam

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Were you Aware?

It often seems [especially to frustrated medical professionals] that we all have that cash-creative “friend” who manages to find every loophole, legal or otherwise, come tax time.

But, a startling new infographic from the Heritage Foundation shows that nearly half of all Americans avoided paying federal income taxes in 2009.

Assessment

That’s not even counting the folks who’ve fallen off the paycheck grid because of the nation’s high unemployment rate – OR – financial advisors, doctors and medical management professionals who’ve experienced same.

Conclusion

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A “Buffett Tax” Voting and Opinion Poll

Taxing Millionaires?

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Nearly two-thirds of Americans support imposing a minimum tax rate of 30 percent on those who earn $1 million or more a year, according to a recent Reuters / Ipsos poll.

And so, we ask: Do you favor the Buffett Tax?

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

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Physician’s Update on Dividend-Paying Stocks

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But Some Doctors Ask – Why All the Hype?

By David K. Luke MIM CMPcandidate [www.CertifiedMedicalPlanner.com]

www.NetWorthAdvice.com

In an effort to help the US economy recover, the Federal Reserve has lowered interest rates to historically low levels. Furthermore, the Fed has announced its intent to keep interest rates low until 2014. Classic income-producing investments such as savings accounts and certificates of deposit pay next to nothing.

Borrowing Good – Saving Bad!

Borrowers are being rewarded, but savers are being punished. Low interest rates may have spurred the economy somewhat, but they have been devastating for retired people who have a low tolerance for risk. Physicians, other investors and their advisors are turning toward alternatives that pay higher returns, but these vehicles necessarily carry more risk. Among these alternatives, some investors are considering the purchase of stocks that pay reliable dividends.

Assessment

But, is this an appropriate strategy for mature doctors and similar retirees? What are the potential benefits and drawbacks?

To learn more: http://networthadvice.com/2012/03/02/dividend-stocks-whats-all-the-hype-about/?utm_source=March+2012+-+David+Luke&utm_campaign=Feb+Newsletter+David+L&utm_medium=email

Conclusion

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Beware Internet Related Illnesses

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Use the ME-P Carefully

Working on the computer and surfing the internet has become totally unavoidable these days, for all financial advisors, medical professionals and laymen. In fact, the local weather forecast, daily news, Monte Carlo financial simulator or eMR are just a few mouse clicks away. It’s like having knowledge, patients and clients, information and the world at your fingertips.

However having the Internet at your fingertips at all times might not always be a positive thing. Why not?

According to a recently published study in General Hospital Psychiatry [Journal Article: General hospital psychiatry (impact factor: 2.67). 10/2011; DOI: 10.1016/j.genhosppsych.2011.09.013] excessive use of the Internet can cause Internet Addiction Disorder, or IAD, which can lead to anxiety and depression.

Source: Infographics Archive

Assessment

This infographic takes a closer look at 7 internet related illnesses that you may have heard about, or even treat in your professional medical capacity. So, use the wonderful resource, known as the ME-P and internet, wisely.

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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On Payroll and Income Tax Paycheck Deductions

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Explaining  Your Paycheck

This infographic takes a dry topic, unknown to some employed medical professionals and healthcare workers, and makes it interesting by visually walking us through a paycheck.

The design allows us to understand all the different deductions that may come out prior to the final amount that makes it to your bank account.

Importance

Most American [healthcare] workers aren’t aware of the factors that determine how much is deducted from their paychecks, yet it’s important to have that understanding so you can speak up about any errors.

The Deductions

So what exactly is that payroll software deducting from your paycheck?

Typical deductions include federal income tax, OASDI, Medicare tax, disability and state income tax. Your tax bracket will range from 10% to 35% depending on your amount of taxable income. Medicare tax rates will be different depending on whether you work for a hospital, clinic or are a self-employed medical professional.

Assessment

At the state level, individual states handle taxes differently, with seven states charging all residents a flat tax rate and nine other states not collecting any income taxes at all.

Source: Paycor

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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How a Charity Accept Gifts of Copyrights and Related Intangibles?

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Estate Planning Information for Doctor-Donors

By Children’s Home Society of Florida

Doctors and other medical professionals are brights folks. Some even have additional degrees and designations like MBA, PhD, CFA, CPA, CFP, CMP, etc. Others hold copyrights, trademarks, servicemarks and patents, etc. Innovators and entrepreneurs, indeed!

So, donors may be surprised to learn that gifts of intellectual property such as copyrights [©], while less common than tangible assets, may nevertheless be valuable and can make wonderful gifts to charity. And, there are some specific considerations that doctors, and other donors and charities should understand when dealing with gifts of copyrights and related intangibles.

For more copyright information, go to http://www.copyright.gov

What is a Copyright?

A copyright is an intangible property right that protects an original artistic or literary work. The protection of copyrights is rooted in the United States Constitution and is among the enumerated powers granted to Congress

Trade Marks and Service Marks

  • A trademark is a word, phrase, symbol or design, or a combination of words, phrases, symbols or designs, that identifies and distinguishes the source of the goods of one party from those of others.
  • A service mark is the same as a trademark, except that it identifies and distinguishes the source of a service rather than a product.

 

Do Trademarks, Copyrights and Patents Protect the Same Things?

No! Trademarks, copyrights and patents all differ. A copyright protects an original artistic or literary work; a patent protects an invention.

For more patent information, go to http://www.uspto.gov/main/patents.htm

Assessment

Link: Click Here

Conclusion

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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The [Healthcare] Start-Up Ecosystem

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Predator versus Prey

We’ve written about medical innovation and e-health before on the ME-P. So, this is a fun but informative infographic on the topic.

It looks at the different roles related to technology startup companies in an amusing way by personifying them as fish in the sea.

Source: http://www.udemy.com/blog/startup-ecosystem-infographic/

Assessment

This one is light on data, but does convey valuable information to the reader. The visual scale of Ubiquitous to Endangered is easy to understand, and the color coding is consistent throughout the design.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Anatomy of a “Best Doctors and Dentists Award” [Marketing] Scam

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What is the value of an honor if it costs $6,000?

By D. Kellus Pruitt DDS

I apologize for misleading those I recklessly told that my name will appear in the December edition of TIME magazine as one of the winners of the Texas Best Doctors and Dentists Award. It’s been an embarrassing learning experience, and my pride is a little wounded from not recognizing signs that an ambitious salesperson in California was lying to me. But I’ll get over it, and will be wiser for the experience.

Wishful Thinking

Looking back on my wishful thinking, I should have known the honor of appearing in TIME magazine simply sounded too good to be true. On the bright side, in preparation for photos that weren’t taken, I did get my hair cut and vacuumed my office for this morning’s interview-turned-sales pitch.

About a month ago, a Texas Best Doctors and Dentists representative calling from a few feet south of the San Francisco Ethics Commission made it past my office manager and got me on the phone. Anthony, whose last name is unintelligible in the recording of our conversation, told me that I had been chosen by the Tarrant County Community to receive the 2012 Award, and would be featured along with other winners in TIME.

“Alright, how much does this cost?”

“There’s no cost to receive the award Doctor, or to appear in TIME magazine. You’ve been chosen based on your reputation in the Tarrant County community.

“OK, what are you selling?”

“We’re not selling anything, Doctor. You know this is the first time TIME magazine is featuring this award and what they are trying to do is they are trying to conduct their readers to the best doctors and dentists from local communities in America.”

Surveys Determine Award Winners?

When I asked him how I was chosen, he explained that the Texas Best Doctors and Dentists Awards firm was hired by TIME to conduct surveys of local specialists and research the popular dentist ratings websites to determine the award winners. Up until he said, “You may be familiar with droogle … “ in two syllables instead of four (DR.Oogle – doctoroogle.com), his pitch was credible. Even though I recognized the faux pas instantly, rather than probing a little deeper and asking him just one more common sense question – perhaps about how the “advertorial” insert in the Texas edition of TIME will be paid for – I apologized to Anthony for rudely assuming he was trying to sell me something. It was then that he knew I wanted to believe him more than experience. That’s the anatomy of a scam, even though no money was exchanged in the lesson.

A Legitimate [Free] Award

The award is indeed legitimate. I won it because of the kindness of my wonderful staff, patients and local colleagues. But I’m by far not the only dentist interviewed in Tarrant County like Anthony said. That was just one more lie targeting my pride – enticing me to consent to today’s interview. Only hours ago, I learned that 100 dentists in the state won the award, so there are probably a couple of dozen award winning dentists like me in Tarrant County.

Declining the Paid Upgrade

Even though I declined to purchase advertisement from Texas Best Doctors and Dentist today, my name will still be listed on the Texas Best Doctors and Dentists Website free of charge, and I’ll also receive a “nice plaque” in the mail in a week or so that will have the TIME magazine logo on it. All I had to do was listen to a 30 minute sales pitch for upgrading my free, ordinary listing on Texas Best Doctors and Dentists Website to something that might attract patients.

Who Needs It?

As far as my name appearing in the advertorial insert in the December edition of TIME magazine, statewide recognition of dentists’ efforts to please patients naturally can’t be given away. Oh hell no. In spite of what Anthony said, a write-up in TIME costs award winners $6,000. I’m certain those who say nice things about my staff and me don’t want us to raise fees to cover the expense of statewide advertising. Who needs it?

Assessment

I don’t think I have room on my wall for a Texas Best Doctors and Dentists Award plaque with a TIME magazine logo. I’m trying to find a place to hang my 1972, B – Team high school basketball plaque I came across while cleaning my office for a surprise sales pitch with no photos.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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About “Comments” on the Medical Executive-Post

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One of Just Many Ways to Interact with Us

By Ann Miller RN MHA

[Executive-Director]

If you are not reading our subscriber “comments”, you are not getting all you can from each Medical Executive-Post. And, if you are not reading the links in each post, you are not getting all you can from the ME-P.

Industry Specificity

Then, purchase our text books, white-papers, hand books, dictionaries and journal for deeper integrated industry specificity.

Consulting Too!

And, we are now scheduling private consultations, events and corporate engagements, too. Online and on-ground seminars and appointments are available!

Conclusion

So, there are several ways to interact with the ME-P, and more are scheduled in the future.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Where Does An MDs Salary Go?

Are Doctors Typical or A-typical?

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Here is what typical Americans earn in salary, spend in a month, and how they pay their bills. Now, compare this to physicians and other medical professionals.

This analysis suggests that many people [even some doctors] are most likely spending more than they earn each month. It also shows steady movement away from cash and checks toward plastic and electronic payment instruments, which can result in unfamiliar or unchecked fees and interest charges that can increase overspending and indebtedness.

Source: creditdonkey.com

Assessment

Managing your spending and payments will help track monthly expenditures.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Videos on Setting up an ACO

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Opposing Viewpoints in Context?

The Theory

In this first didactic video, Thomas Cassels, Executive Director of the Advisory Board Company’s Health Care Advisory Board, summarizes the forces driving accountable care, outlines the steps necessary for a hospital or health system to transition toward operating as an accountable care organization (ACO), and provides insight into the question of whether all providers must plan to become ACOs.

The Reality

The second video is a real world look at negotiation between a hospital administrator and a PCP over setting up an Accountable Care Organization [ACO].

Video links:

Assessment

True or not?

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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On Sexual Violence Against Women

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The Hard Truths

International Women’s Day – March 8th – is a day that celebrates the achievements of women, but also raises awareness of the struggles and barriers to equality that still exist worldwide.

Sexual violence against women is a serious abuse of women’s human rights, and an injustice experienced by women around the world. On International Women’s Day 2012 ActionAid is saying NO to violence against women.

Assessment

Sexual violence against women is a serious abuse of women’s human rights, and an injustice experienced by women around the world. The infographic above aims to highlight the reality of sexual violence and the different ways that women – children, adolescents and adults – can be affected by sexual violence throughout their lives. The first step to change is education, so let’s share the hard truths about sexual violence.

Source: actionaid.org.au

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Rethinking the Reverse Mortgage Paradigm

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Option of Last Resort  -or- Something Else?

By Rick Kahler CFP® MS ChFC CCIM

www.KahlerFinancial.com

Like most financial planners, I generally recommend not thinking of your home as a part of an investment portfolio or a source of retirement income. One possible exception to this rule, for medical professionals to consider, is a reverse mortgage.

Lenders

Lenders which are FHA-approved can offer Home Equity Conversion Mortgages, or HECM’s. These are insured by the U.S. government and allow homeowners age 62 and older to borrow against the equity in their homes. When the homeowner dies or moves out, the property is sold to repay the loan. Any equity left over belongs to the owners or their heirs. Any outstanding loan balance must be forgiven by the lender.

Reverse mortgages may be useful for elderly people in good health who have limited income or assets but who are living in paid-for homes.

Until now, I have viewed them as options of last resort. But, a new report by financial planner Michael Kitces CFP® has given me some cause to re-evaluate that position.

Link: http://www.kitces.com/index.php

Disadvantages

  1. One major disadvantage of reverse mortgages is that the income uses up the equity in the house. Seniors who take out reverse mortgages too early risk spending most of their home equity to cover living expenses. As long as they can stay in the house, that’s no problem. If they have to move, however, they will have to pay rent or long-term care costs. Without income from the sale of their house, they may be left with little except Social Security to pay their bills.
  2. A second disadvantage has been high upfront fees. A new option described by Kitces, however, significantly lowers those costs. The HECM Saver option eliminates the upfront mortgage insurance premium of 2%. This would drop the costs of a reverse mortgage on a $500,000 home from $17,000 to $7,000. The tradeoff is a lower lump-sum or monthly payment.

Typical Uses

  1. The most typical use of a reverse mortgage is to tap into home equity to pay the bills when all other means of support become exhausted. Instead of selling or refinancing, the homeowners can choose to stay in the home and receive monthly payments for life. They don’t have to sell the property until they can no longer continue to live in it.
  2. Another way to use a reverse mortgage is to refinance an existing mortgage. This can not only eliminate the monthly payment, but if there is enough equity in the home it can also provide a monthly income or a lump sum payment.

Example

Kitces uses the example of a 70-year old couple paying $1000 a month for a $175,000 traditional mortgage on a $450,000 property. A $175,000 reverse mortgage would eliminate the $1,000 payment. Assuming the net principal limit for the borrower was $250,000 on the property, they could use the reverse mortgage to extract an additional $75,000 of equity. They could receive this in a lump sum payment, create a $75,000 line of credit, or receive lifetime monthly payments based on the $75,000.

Let’s assume this couple’s monthly expenses, including the mortgage payment, are $5,000. They receive $1,500 a month from Social Security and withdraw $3,500 a month from their $600,000 investments. The total $42,000 annual withdrawal is an unsustainably high 7% of their portfolio.

The reverse mortgage would eliminate the $1,000 mortgage payment and reduce the investment withdrawal to $2,500 a month. This totals $30,000 annually, a more sustainable withdrawal rate of 5%. Investing the $75,000 of excess proceeds would produce additional monthly income and reduce the withdrawal rate even further. Using a reverse mortgage in this way makes sense if the lost home equity is offset by an increase in investment assets.

Assessment

We’ll look at some other reverse mortgage options another time, so stay tuned to this ME-P, and subscribe today!

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

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How Much are the 2012 Presidential Candidates [Net] Worth?

Surprised or Not?

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As the presidential election continues to heat up for “Super Tuesday” this March 6th 2012 – and candidates are weeded out – we look to their bankrolls to learn who has the most cash in the bank, and who’s funding their campaigns.

Source: creditsesame.com

Assessment

From small donors to large, and donations from men versus women, do these numbers surprise you?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Please review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: http://healthcarefinancials.wordpress.com/2007/11/11/advertise

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Physicians Taking Stock of the “Stock Act”

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A Side-by-Side Comparison

By Lena Groeger
ProPublica

The Stop Trading on Congressional Knowledge Act, or Stock Act, recently passed in both the House and Senate. The new law would make it easier for the SEC to prosecute federal officials from all three branches who trade equities like stocks based on nonpublic information they receive in the course of their duties.

The versions passed in each chamber are similar, but have notable distinctions that will have to be hashed out when legislators from the two chambers eventually meet.

Assessment

Here, we break down the main differences, with real-life scenarios that illustrate activities the bill targets

Full link: http://www.propublica.org/special/taking-stock-of-the-stock-act-a-side-by-side-comparison

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Please review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: http://healthcarefinancials.wordpress.com/2007/11/11/advertise

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Challenging the NPI Requirement of Blue Cross Blue Shield of Texas Again

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How Far Can They be Pushed?

By D. Kellus Pruitt DDS

Command-and-control organizations like BCBSTX find Facebook difficult to control. Even a small nidus of a complaint posted by a client named Mark about poor service can attract a huge bolus of payback by a dentist, and nobody respects anonymous gatekeepers for huge, unresponsive companies like BCBSTX anyway:

https://www.facebook.com/bluecrossblueshieldoftexas

Mark, as a dentist, I’m very familiar with BCBSTX’s inconsiderate behavior in our communities. At least the anonymous moderator invited your feedback. When I sincerely asked her on Wednesday what federal employees are told about BCBSTX’s NPI requirement, she acted as if the absurd policy hadn’t already wasted enough of my time that day when she provided me an irrelevant link to nowhere – just to get rid of me.

Secret Requirement?

I would actually love to treat federal employees who have BCBSTX insurance because they are some of the nicest people I’ve met. But, BCBSTX’s secret requirement that their clients see only dentists with arbitrary NPI identification numbers (not required by law) makes their employment benefit purchased with taxpayer money worthless if they receive treatment in my office. My office has been told that it has become impossible for paper claims to enter BCBSTX’s modern, computerized system without NPI numbers, and nothing humanly possible can be done to correct the unfortunate problem for dentists who choose not to be HIPAA covered entities.

Evasion?

The moderator’s evasion confirms that even though BCBSTX’s federal customers are led to believe that they can use their dental benefits to help pay for treatment at any licensed dentist’s office, they are not being informed of the NPI requirement, and if they pay the dental bill in full for work done by a dentist without an NPI number, BCBXTX pockets the reimbursement. It just cannot be helped. That’s technology. Tough-luck!

BCBSTX executives naturally prefer that my office manager tell their clients about the obscure restrictions of the dental plans they sell. She catches most federal employees before blocking out time in our schedule to treat them, but nevertheless, one got through on Wednesday morning. It wasted my time as well as the federal employee’s.

Congressional Action?

It’s troublesome to know that the government callously encourages such waste of small business owner’s time and money, not to mention the inconvenience to patients. I’m simply fed up with open appointments for uninformed BCBSTX clients. What’s it take to force BCBSTX to take some responsibility in the community and warn their customers about the limitations of their dental policy before they call my office? Congressional action?

Assessment

I do hope the anonymous BCBSTX employee doesn’t choose to delete this post. Since it seems obvious that their windfall profit is a powerful disincentive for BCBSTX to warn their clients about the NPI restriction any time soon, the more federal employees I can ethically warn through BCBSTX Facebook, the fewer open appointments I’ll have, and less taxpayer money will be wasted on silliness.

cc: Senator John Cornyn

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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On Consumer Confidence and Savings Rates

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Are Doctors Just Like the Rest of Us?

By Rick Kahler CFP® MS ChFC CCIM

www.kahlerfinancial.com

After a short period of saving more of their disposable income at the depths of the recent recession, Americans are returning to recent historical patterns of spending more and saving less.

Usually this trend indicates “happy days are here again” as the decline in savings means consumers’ confidence is rising. That is not the case today. Consumer confidence is just half of what it was at the peak of the “good old days” of 2007. That year our national savings rate was 2.1%, just above its post-WWII low in 2005 of 1.5%.

A Jobless Recovery?

As millions of jobs disappeared and consumers hunkered down during the 2008-09 recession, our savings rate almost tripled. In 2008 it was 6.2%. This thriftiness didn’t last long; by the fall of 2011 our savings rate was back to a paltry 3.6%.

American Not Always Big Spenders

We were not always such spenders. During the four years of WWII we saved over 20% of disposable income annually. Between 1974 and 1992 the savings rate often bounced between 7% and 11%. Since 1992, the beginning of the unprecedented 18-year bull market in stocks, our personal savings rate reflected the good times in the economy and averaged just 4%.

Savings Rate Decline

One possible reason for the decline in the savings rate in the past three years may be that we’re paying off all the consumer debt that got us into trouble in the first place. In 2000 our individual debt load (including student loans and mortgages) was $19,750 per person. In the fall of 2011 it was $36,420, 8.6% less than the 2008 high but 85% higher than the 2000 amount.

Running out of Money?

While Americans are not substantially reducing their debt, their equity in home ownership plunged from $12.9 trillion in 2006 to $6.2 trillion in 2011. No wonder consumer confidence is so low.

It appears our return to low savings rates isn’t the result of renewed optimism, paying down personal debt, or a surging economy, but rather that Americans are running out of money in the face of staggering personal debt and declining net worth. This leaves them incredibly vulnerable to another downturn in the economy.

Ironically, Americans’ personal finances are a reflection of our government’s fiscal woes. Washington also finds itself compromised to respond to a national emergency because of a debt that exceeds our national income.

Personal Three-Pronged Approach

There isn’t much you and I can do about our government’s over-indebtedness and overspending except to vote for politicians that promise to end the insanity and hold them accountable. But, we can take better care of our own affairs with a three-pronged approach.

1. Get out of debt. We may not be able to earn more or work harder, but I’ll guarantee you that we can spend less.

2. Start saving for emergencies. You need one savings account for periodic expenses like medical deductibles and car repairs. A second is for bona fide emergencies like losing your job or the death of a spouse. It should represent six to 12 times your monthly expenses.

3. Start investing for financial independence. Ideally, you need to put aside 15% to 35% of your income for the time you no longer can or want to work.

Assessment

The hardest part of this approach is becoming willing to downsize your lifestyle. Too many of us say we are willing to cut spending and economize until it actually comes time to do it. In the two decades before the recession, Americans got out of the habit of making hard decisions in our own best interests. However, as our historical patterns show, we’ve treated ourselves with “tough love” in the past. When we have to, we can do it again.

Conclusion    

And so, your thoughts and comments on this ME-P are appreciated. When it comes to consumer confidence and savings rates, are doctors and medical professionals just like the rest of us?

Please review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: http://healthcarefinancials.wordpress.com/2007/11/11/advertise


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How We Use the ME-P to Market and Reach Our Target Audience

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A Marathon –  Not a Sprint

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

I am a runner on LSD. I have been running long, slow, distances for more than three decades. And, this is our advertising philosophy at the ME-P. Say What?

Goals and Objectives

The goal is simple enough to state, but reaching it is a challenge. The ever-rising expectations of social media, e-connectivity and Internet users require us to make constant improvements to the ME-P so that our visitor’s experience is relevant, meaningful and worthy of recommending to others.

Going Viral

For example, the humorous “viral videos” that often appear on YouTube, and elsewhere, may get forwarded in emails and generate millions of viewers for a few days, but then drop out of sight quickly. This is not an ME-P goal for our staff, expert contributors, and informed readers and subscribers. Such a “spike and drop” phenomenon is interesting, of course, but it is not our focus.

So, much like my LSD metaphor, we favor LSD … and are on cognitive steroids, of sorts.

The ME-P Way

Instead, at the ME-P, we post short and long topical essays, comments, graphics, videos and other website URLs with a much different goal in mind. What is it? To market to our niche audience, and obtain higher search engine rankings over the long term, in our areas of expertise and on a continuing basis. Sound like a long term stock-market investor, or LSD runner? You bet!

Assessment

We trust all ME-P readers, subscribers, advertisers and visitors agree.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: http://healthcarefinancials.wordpress.com/2007/11/11/advertise

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What Did You Do When the Stock Market was Down?

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Investing Hero or Zero … On Market Timing or NOT!

By Staff Reporters

Here at the ME-P, we believe we have some of the most intelligent and savvy readers in the blog-o-sphere. And – why not?

Most are physicians, nurses and medical specialist of all stripes. Others are CPAs, financial advisors and wealth managers. And, some are medical management and HIT consultants with PhDs and MBAs, etc. More than a few more even have dual and triple degrees and professional designations, like www.CertifiedMedicalPlanner.com

The Question

Accordingly, our friends over at The Finance Buff recently asked:

Q: Do you remember those days last summer when the Dow went down 400 points one day and then it went up 400 points the next day, before it went down another 400 points the following day?

Going Granular

Well – if you do – what did you, or your clients do about it? Did you invest more, stay put, bail out or something else? Go granular on us and your fellow ME-P readers, subscribers and lurkers.

Assessment

Please tell us who you are, what you did during the “flash-crash” a few years ago, or last summer’s mini-meltdown, and how it turned out in hindsight?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Please review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: http://healthcarefinancials.wordpress.com/2007/11/11/advertise

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An Update on Maslow’s Hierarchy of e-Needs for Modernity

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Understanding the New-Wave Social Media that Fuels Them

By Staff Writers

All medical professionals, and some FAs and behavioral economists, realize that Maslow’s hierarchy of needs is often portrayed in the shape of a pyramid, with the largest and most fundamental levels of needs at the bottom, and the need for self-actualization at the top.

So, this infographic takes Maslow’s theory and looks at the electronic social media tools that fulfill these needs.

Source: ticsyformacion.com

Assessment

Yet, another new-paradigm assessment of social media for doctors, financial advisors … and us all.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: http://healthcarefinancials.wordpress.com/2007/11/11/advertise

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Events Planner: March 2012

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Events-Planner: MARCH 2012

By Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement!  Watch for a new Events-Planner each month.

First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 175,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions.  As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention.

So, enjoy the Medical Executive-Post and this monthly Events-Planner with our compliments.

A Look Ahead this Month – And now, the important dates:

  • March 21-24: AONE Annual Meeting, Boston, MA.
  • March 25-29: AORN Congress, New Orleans, LA.

Please send in your meetings and dates for listing in the next issue of our Events-Planner.

MarcinkoAdvisors@msn.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. It’s free. You can unsubscribe at any time. Security is assured.

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