You may be able to provide income payments to your heirs for the rest of their lives through the use of a stretch annuity.

A stretch annuity (also known as a legacy annuity) makes lifetime payments to the beneficiary you name in your deferred annuity contract if you die before the annuity start date (e.g., before you begin receiving regular annuity payments).

Sean

Many thanks for this template.

Medical Student

Generally yes, if the annuity is a nonqualified (e.g., not an IRA) commercial annuity.

Typically, a variable annuity allows you to invest your premium in various mutual funds, called subaccounts. Unfortunately, these subaccounts may not perform favorably, and your premium could actually decrease in value.

Sean

http://healthcareisbusiness.blogspot.com/2012/03/capitation.html

Beverly

Everyone – not just doctors – should check their taxes.

Craig

http://healthcareisbusiness.blogspot.com/2012/03/understanding-and-setting-fee-schedules.html

Beverly

Good article … better vehicle.

Waxton

How to read a medical EOB?

http://healthcareisbusiness.blogspot.com/2012/03/payment-posting-and-how-to-read-eob-era.html

Beverly

The American Medical Association has renewed its call to hit the pause button on the national adoption of the ICD-10 diagnostic and procedural codes. In a letter to CMS acting Administrator Marilyn Tavenner, AMA Executive Vice President Dr. James Madara referenced a November 2011 House of Delegates policy vote in which that body called for a “repeal” of the move to ICD “so that physicians and other stakeholders could assess an appropriate alternative to such a costly, burdensome regulatory requirement. The AMA has since pressed the case for a second look at ICD-10 overall.

Physicians need the delay because they are “overwhelmed with the simultaneous implementation of multiple health IT programs,” Madara said. He asked for a two-year extension to Oct. 1, 2015, with the caveat that “if stakeholders cannot reach consensus on this matter during this two-year period, then the move to ICD-10 should be postponed indefinitely.”

Source: Joseph Conn, Modern Healthcare

Birthdays may seem less important as you grow older. They may not offer the impact of watershed moments, such as getting a driver’s license at 16 and voting at 18. But beginning at age 59, there are several key birthdays that can affect your tax situation, health-care eligibility, and retirement benefits.

59½ — You can start taking penalty-free withdrawals from IRAs and qualified retirement plans, provided certain conditions are met. Ordinary income taxes generally apply to these distributions. (Withdrawals taken prior to age 59½ are subject to a 10% federal income tax penalty.)

62 — You are eligible to start collecting Social Security benefits, although your benefit will be reduced by up to 30%. To receive full benefits, you must wait until “full retirement age,” which ranges from 65 to 67, depending on the year you were born.

65 — You are eligible to enroll in Medicare. Medicare Part A Hospital Insurance benefits are automatic for those eligible for Social Security. Part B Medical Insurance ­ben­efits are voluntary and have a monthly premium. To obtain ­coverage at the ­earliest possible date, you should generally enroll about two to three months before turning 65.1

70½ — You must start taking minimum distributions from most tax-deferred retirement plans or face a 50% penalty on the amount that should have been withdrawn. Annual required minimum distributions are calculated according to life expectancies determined by the federal government.

Gaylord

Massachusetts dentist Dr. Bob Gauthier responds again to my challenging comments on the Dental Economics Linkedin group discussion, “Resign now, Jim Dwyer.” Bob is a good man. One rarely witnesses such openness from ADA members:

http://www.linkedin.com/groupItem?view=&gid=2442267&item=ANET%3AS%3A116077405&commentID=81381774&trk=NUS_RITM-title#commentID_81381774

—————

Dr. Bob Gauthier:

You are fired up, and rightfully so, but please don’t direct your frustration toward me! I’m not the bad guy here. Don’t get me wrong Darrell, I’m with you! I’m not talking about open criticism and debate at all, nor was this a scare tactic. I’ve just had a lot of experience with this stuff and understand the FTC and AT law very well. Here in MA we are having to deal with very similar issues. We’ve been working hard with members of our state senate and house to bring a “non covered services” law into to state. This will not allow third party payers to set fees on “non covered” services. We’ve also brought Delta of MA to the commissioner of insurance in this state and had demonstrated that their fee methodology was fundamentally unfair to dentists and the division of insurance made Delta of MA devise a new and more fare methodology which was enacted in 2011. We’ve been in high level discussions with State Senators, Reps, MDS officers, as well as Delta of MA, CEO. I understand the subject of free speech as well as the AT laws VERY WELL. Clearly I believe in free speech and have used my speech to effect change in my area even when my views are much to the right of the majority in my state. AT laws are not just about price fixing! And YES dentists have been prosecuted for “exchanging ( ) ideas” (you fill in the blank). All I’m saying is remember that the internet has a large audience and be sure to keep these tenants in mind while posting. I’m not a big ADA guy, though I am an active member because I believe that my voice can be heard to effect change with them more than it can without them. Yes, I am on your side I applaud your bringing this topic to the national stage and we all need to advocate for our profession, but we need to do it safely to be effective.

My reply:

Sorry if I seemed uncivil, Bob. In my wholly independent 6 year personal struggle to bring more transparency to the dental industry, I’ve acquired a habit of speaking bluntly because it almost always saves time.

You are indeed not the bad guy here. For one thing, bad guys never respond, and for that reason, it’s been very, very quiet out here. The silence must and will change. I sense you agree.

Even before I learned about your personal and commendable efforts to stop Delta Dental of Massachusetts from limiting dentists’ fees on procedures Delta doesn’t even cover, I intuitively knew your heart is in the right place by the way you write – even if you don’t quite go far enough to be effective. Nevertheless, the sincerity of your concern for others’ welfare is clear. Thanks.

Now that we’ve mutually affirmed our dedication to our patients’ best interests, this would be a good time to discuss what we are forbidden to discuss so we’ll know what topics to avoid. I can see how this could get tricky: “YES dentists have been prosecuted for ‘exchanging ( ) ideas’ (you fill in the blank).” Forgive my bluntness, but “you fill in the blank” doesn’t help much if as you say, “price-fixing” doesn’t fit.

I don’t question your knowledge of anti-trust laws, nor do I intend to ask you to risk an anti-trust lawsuit for you or the ADA. But how are dentists to know which topics are federally forbidden if they are never mentioned? Do you see my point? Dentists simply need more instruction, not surprise audits.

“Yes, I am on your side I applaud your bringing this topic to the national stage and we all need to advocate for our profession, but we need to do it safely to be effective.” What if years from now “safe” sadly proves to be ineffective at protecting our dental patients from harm? I know your intentions are noble, but if dentists are unsure what’s safe to discuss on the internet and what is not, they won’t discuss anything at all, and our patients will pay the costs. Not us. That’s always been wasteful and wrong.

I don’t mean to put you on the spot with a rhetorical question, but with the tenets of the Hippocratic Oath in mind, can you think of one reason silence from ADA officials benefits my patients more than open discussion?

You and I are fighting the same hidden unfairness in the dental industry, but in different ways. Your conventional method depends on the consensus of thousands of fearful, stone-silent dues-paying members. While mine is a consensus of one, and without anti-trust liability … But just to be safe, as far as anyone knows, I never, ever encourage other dentists to express unpopular opinions that nobody wants to discuss.

Let’s keep it safe.

D. Kellus Pruitt DDS

Doctors – The history of estate taxes in America has been a long and winding road. Careful estate planning is still one of the most important ways to manage and protect your assets for your heirs.

The Stamp Act of 1797 was the first federal estate tax in the United States and was passed to help fund an undeclared war with France; it was repealed in 1802. The Revenue Act of 1862 reinstated the estate tax in order to fund the Civil War; it was abolished in 1870. To finance the Spanish American War, the War Revenue Act of 1898 was passed, and subsequently abolished in 1902. Due to the costs of World War I, the Revenue Act of 1916 reinstated an estate tax that, in some form or other, has been in effect ever since.

The Economic Growth and Tax Relief Reconciliation Act of 2001 gradually increased the federal estate tax exemption, until finally repealing the federal estate tax altogether for the 2010 tax year only. The 2010 Tax Relief Act reinstated the federal estate tax with a $5 million exemption (indexed for inflation after 2011) through December 31, 2012. The federal estate tax exemption is $5.12 million in 2012.

Unless Congress acts to amend or extend this latest tax law, the estate tax will revert to pre-2001 tax law rates, with a $1 million exemption and a top tax rate of 55%.

Murray

Interesting article. But, is this really the most diversified or the least correlated efficient frontier?

http://www.r-bloggers.com/the-most-diversified-or-the-least-correlated-efficient-frontier/

Frank

Dr. Marcinko – In 1981, Rolf Banz published his finding that small stocks had outperformed large ones. The discovery caught the attention of Wall Street, which soon introduced a slew of small-cap funds.

http://registeredrep.com/news/say_goodbye_to_traditional_517/?imw=Y

Your thoughts?

Ben

During all the recent hopla over the FB IPO, I was thinking of Ed Roberts MD. Then, I found these thwo articles from eWEEK and felt nostalgic.

Part 1: The Pioneers of the Wild Web covers those individuals who were instrumental in the early design and development of the Internet.

http://www.eweek.com/c/a/Application-Development/Internet-Hall-of-Fame-Inductees-How-Their-Contributions-Impact-Everyone-Part-1-874282/?kc=EWKNLBOE05182012FEA1

Part 2: Covers Global Connectors and the people who made the Web worldwide.

http://www.eweek.com/c/a/Application-Development/The-Internet-Hall-of-Fame-Part-2-They-Built-the-World-Wide-Web-899176/?kc=EWKNLBOE05182012FEA2

Here’s to you Ed – a true pioneer.

Dr. David Edward Marcinko MBA
[Editor-in-Chief]

Chairman Charles Boustany, Jr. (R-LA) leads the House Ways and Means Subcommittee on Oversight. On May 16, 2011, Boustany held a hearing on tax-exempt organizations. This is the first of several hearings on charitable organizations that will be held in preparation for anticipated major tax reforms next year.

Boustany noted that tax-exempt organizations have an important role in our society. Charitable organizations employ 10% of the entire work force and hold $2.5 trillion in assets. Because of this important role in society, charities must function effectively and use good principles of governance.

Boustany noted, “With so many Americans relying on, working for and engaged in economic relationships with tax-exempt organizations, taxpayers should have confidence that tax-exempt organizations, especially charitable organizations, are operating efficiently and hopefully using good governance practices to maximize benefits provided to the community.”

Ranking Member John Lewis (D-GA) agreed that charities serve an important role. He highlighted the efforts of non-profits to help “our poor and feed our hungry.” Other nonprofits educate young people and care for the sick. Lewis suggested that the 1.8 million tax-exempt organizations “make our lives and our communities better.”

He expressed concern about the proposals to reduce the income tax top rate from 35% to 25%. In order to reduce the rates, many itemized deductions would have to be dramatically changed. Lewis indicated that it will be important that “incentives for charitable giving should remain.”

Independent Sector President Diana Aviv spoke at the hearing. She noted that the 13.5 million employees of charitable organizations receive $670 billion in wages and make $32.4 billion in payroll tax payments each year. Charitable organization volunteers contribute 8 billion hours every year. This is the equivalent of an additional 4 million fulltime workers who are serving charitable purposes.

Aviv agreed that it is important to maintain charitable incentives. She observed that the end-of-year giving shows how much impact charitable tax incentives have on philanthropy. Aviv continued, “There is perhaps no better illustration of this than the fact that more than 22% of all annual online charitable donations in the U.S. are made on December 30 and 31, as taxpayers seek to make donations before the deadline to claim a charitable deduction.”

A primary goal of the hearing was to encourage good governance of nonprofit organizations. Aviv also referred to the publication of the Panel on the Nonprofit Sector with the title The Principles for Good Governance and Ethical Practice: A Guide for Charities and Foundations. The guide has been downloaded from the http://www.independentsector.org site over 184,000 times.

Source: The Children’s Home Society of Florida Foundation

Dr. Bob Gauthier, a Massachusetts dentist responded to criticism of Delta Dental on Linkedin by advising a hands-off approach. He means well.

http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=116077405&gid=2442267&commentID=81299741&goback=%2Eamf_2442267_175041914&trk=NUS_DISC_Q-subject#commentID_81299741

Dr. Bob Gauthier:

I can understand the feelings in these posts and I think the greed of all Delta Dental chapters is pervasive. It blows my mind that CEO’s with less education than the average dentist can be so condescending. Please watch how and what you post, antitrust laws are in play and dentists have been on the hook for suggestive remarks in the past. At the ADA’s website there is a free “antitrust” primer you should all read. Just trying to keep my fellow dentists out of trouble and jail.

My response:

Since I’m not an ADA member, I’m unable to read the anti-trust primer you suggested, Bob.

By warning ADA members that they risk FTC investigations should they openly criticize Delta Dental officials, the ADA is arguably an accomplice in allowing WDS CEO Jim Dwyer to harm far too many of Washington state’s dental patients for far too long.

Jim Dwyer’s ethics are so pitiful that if he were in any field other than the notoriously unaccountable discount dentistry business, transparency would have ended the man’s career long ago for natural, competitive reasons. On the other hand, I confidently express opinions without fear of retribution. I’ve been doing so for years. Can you?

Don’t get me wrong. I think it’s wise to warn dentists to steer well clear of anti-trust violations, and I would never suggest entering into any conspiratorial agreements with other dentists. The FTC justifiably spanks dentists hard for collusion. On the other hand, a dentist acting independently is one person short of the minimum number needed for a conspiracy, and can never be charged with price fixing.

The anti-trust laws you warn about simply do not apply to individuals expressing their opinions – and thank goodness! It would be counter to the tenets of the Hippocratic Oath if transparency were discouraged just to protect the reputations of Delta Dental CEOs. Regardless what the ADA primer says, Americas don’t relinquish their right to free speech when licensed to practice dentistry. Perhaps it’s only dentists who join the ADA who lose their right to complain. After all, ADA members employ registered lobbyists. I don’t.

Trust me. I’ve been publicly demanding accountability from dental care stakeholders including Delta Dental for years, and I’m not anonymous. If openly criticizing Delta, BCBSTX or even the US Department of HHS could get a dentist thrown in jail, I wouldn’t be currently enjoying freedoms guaranteed in the Bill of Rights.

God bless America.

D. Kellus Pruitt DDS

Just, please don’t ever appoint a local, state, regional or national bank as trustee. Your heirs will loose and the banks will win – your money.

Dr. Eita

On May 15th, Speaker Boehner gave an address on the economy, debt limit and American jobs. He pledged that the House would vote before the election on a bill to stop the potential January 1, 2013 tax increases.

If Congress does not change the law, the tax reductions passed in 2001 and 2003 will lapse and there will be a substantial tax increase. Boehner stated, “On that day, without action by Congress, a sudden and massive tax increase will be imposed on every American – by an average of $3,000 per household. Rates go up, the child tax credit is cut in half, the AMT patches end, the estate tax returns to 2001 levels and so on.”

Members of both political parties have been calling this a “fiscal cliff” and discussing potential results if there is no change in the law. The combination of large tax increases and the scheduled $1.2 trillion in budget cuts would have major impact on the nation.

Boehner also stated that there will be an “expedited process by which Congress would enact real tax reform in 2013.” He did not state exactly how that would work, but it may include specific time limits for the House Ways and Means Committee and Senate Finance Committee to send bills to the floor for votes. The goal of an expedited process would be to force Congress to face up to budget and tax reform issues in 2013.

House Ways and Means Committee Ranking Minority Member Sander Levin (D-MI) expressed concern about the potential impact of tax reform in 2013. He noted that a current proposal is to reduce the top rate from 35% to 25%. This would require large changes in the rules for itemized deductions. Levin noted that this reduction in rate would almost certainly reduce “the mortgage interest deduction and the exclusion for employer-provided healthcare. Yet the benefits of those provisions flow overwhelmingly to middle and lower-income families.”

Editor’s Note: Congress does have other rules that expedite action. For example, military base closing plans are created by a specific committee and then submitted to a single vote in Congress. It is possible that an expedited process would create a deadline and require a similar structure. House Ways and Means Chair Dave Camp (R-MI) has stated that any reform of taxes will include significant changes to individual taxes, corporate taxes and estate and gift taxes. If the top income tax rates are reduced, there will be dramatic changes in the itemized deduction rules. Charitable organizations will need to express strong support for retaining the deductions and incentives for charitable giving.

Source: Children’s Home Society of Florida