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Family Gifting and Physician Loans

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Physician Gift and Estate Planning

By Lawrence E. Howes; CFP™
By Joel B. Javer; CFP™ 

The annual gift tax exclusion allows the physician, and others, to give any individual $13,000 per year [$26,000 per couple in 2009] without paying or filing a gift tax return. 

There is no limit on the number of individuals who might benefit from your generosity.  

Marrieds 

If you are married, then you and your spouse together may gift to any number of individuals.  The recipients do not owe any tax on the money either.   

Excess Gifts 

Gifts in excess of $12,000 are subject to current gift tax.  A gift tax return must be filed by April 15th of the year following the gift.  Gifts to qualified charities are subject to a different set of income tax rules. 

Lifetime Gifting 

Gifting assets to family members or others during your lifetime can be an effective estate planning technique.  A gift of money or stock to your children automatically reduces your estate. 

If your taxable estate is in excess of $2 million, then you are in the [45] percent estate tax bracket; indexed at $3,500,000 in 2009, with repeal of the estate tax and generation-skipping tax scheduled for 2010. 

This means that each dollar you can remove from your estate, and allow to appreciate in your children’s estate can help reduce a significant potential estate tax liability.   

However, if the sole purpose of gifting is to reduce estate taxes, then the Economic Growth and Tax Relief Reconciliation Act [EGTRRA] of 2001’s reduction, and ultimate elimination of estate taxes, will nullify this technique.   

You must remember that tax laws are always subject to change and EGTRRA has a Sunset provision in 2011, which in some form may not totally eliminate estate taxes.  

Gifting strategies may still be appropriate depending on your expectation of law changes and where the estate is large and life expectancy is limited.  There are gifting traps in these situations, so consult proper counsel. 

Stock Gifting 

When you gift stock you also give the recipient your cost basis. 

For example, if you have low basis stock that you are thinking about selling but are concerned about paying 20 percent in capital gains tax, you could gift portions of the stock to your children (or anyone in the 15 percent income tax bracket) and sell just enough to pay the 10 percent capital gains tax in their bracket.

The gift value is the market price of the stock on date of gift.  We are talking about an outright gift, so before you really do it, make sure you can afford to give up the cash or the asset forever. 

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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Top 10 Diagnostic Related Groups

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High Volume Medicare DRGs

[Staff Writers]

The ten highest volume Medicare DRGs represent about 30% of total Medicare patients. Each of these higher volume DRGs represent from about 2% to 6% of total Medicare volume. 

***

  DRG DRG Description % Total Rel Wt
1 127 Heart Failure & Shock 5.99 1.0234
2 089 Simple Pneumonia & Pleurisy Age>17 w/CC1 3.85 1.1447
3 014 Specific Cerebrovascular Disorders except TIA 3.18 1.2056
4 430 Psychoses 3.18 0.9153
5 088 Chronic Obstructive Pulmonary Disease 3.11 1.0067
6 209 Major Joint & Limb Reattachment Procedures, Lower Extremity 2.78 2.3491
7 140 Angina Pectoris 2.33 0.6241
8 182 Esophagitis, Gastroent & Misc Digest Disorders Age>17 w/CC1 2.09 0.7617
9 174 G.I. Hemorrhage w/CC1 2.07 0.9657
10 296 Nutritional & Misc Metabolic Disorders Age>17w/CC1 1.93 0.9313

Source: Health Care Financing Administration [CMS] 2005

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
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Cash Based Compensation Medical Practices

Business Model Related to Concierge Medicine

Staff Writers 

A Cash Based Compensation (CBC) medical practice business model attracts patients who pay cash for desirable services, such as surgeons who dispense scar reducers or in areas such as pain relief, weight loss, aesthetic procedures, and natural health. 

Model Parameters 

According to consultant Michael Wallerstein, any well-rounded CBC program should include these parameters: 

  • existing patient demand;
  • low entry cost;
  • little marketing costs;
  • existing employees to administer the program;
  • office capacity; and an
  • operating plan. 

All Specialties Included

Even dentists and podiatrists who perform cosmetic and elective image enhancing services like teeth bleaching, veneer applications, vein reductions, toe shortenings and shoe appliances are amenable to CBC practices.  

Assessment 

With time and effort, profit for physician compensation may increase 10-20% annually by providing “wants”; rather than medical “needs.” 

Conclusion 

And so, what is your opinion of these new CBC medical practitioners; ethical physicians or medical merchants?  

Book Info: http://www.springerpub.com/prod.aspx?prod_id=23759

Institutional: www.HealthcareFinancials.com 

Linguistics: www.HealthDictionarySeries.com

 

Unlimited Marital Deduction

Understanding Physician Estate Planning

By Lawrence E. Howes; CFP™
By Joel B. Javer; CFP™
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Under the unlimited marital deduction, virtually all transfers to a spouse, whether made during lifetime or at death, are tax-free.   

Tax Consequences 

However there is a tax consequence for leaving your entire estate to your spouse. 

Leaving everything to your spouse does not utilize your exclusion amount, which was $1,000,000 in 2003.   

However, under the Economic Growth and Tax Relief Reconciliation Act [EGTRRA] of 2001, the increased exclusion amount, formerly $1,000,000 is scheduled to increase to $3,500,000 in 2009 and expire in 2011. 

Assessment 

This has no effect after the first death, but when your spouse dies, the estate of the spouse will pay higher taxes.   

Conclusion 

Please opine and comment if you have ever considered or used this strategy; and what was the result? 

Book info: http://www.jbpub.com/catalog/0763745790/ 

Institutional: www.HealthcareFinancials.com 

Linguistics: www.HealthDictionarySeries.com

IRC §2032A Special-Use Valuation

Understanding Physician Estate Planning

By Lawrence E. Howes; CFP™
By Joel B. Javer; CFP™
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Suppose you are a physician or other individual who own a farm that for many years was located well outside the city limits of a growing community, and now the farm is in the path of this growth?   

The dynamics of determining the fair market value of your farm have changed.  You might be inclined to value it as a farm and your estate would make the argument that it is a farm.

 

“Highest and Best Use” 

The IRS would argue the property should be valued at its highest and best use.  Unfortunately for your estate the “highest and best use” might be as a mega mall, apartment buildings, or a high-rise office building.  

All considerably more valuable than the farm might be worth.  

Enter Internal Revenue Code Section §2032A 

Valuation of a property at the highest and best use might force the survivors to sell the land to pay a large estate tax. 

On the other hand, valuation at its present use might enable the survivors to carry on the farm business.   

IRC Section 2032A permits qualifying estates to value at least a portion of the real property at its “qualified use.”  The section applies to farms or other trades or businesses.  

Major Requirements 

Five major requirements and conditions must be satisfied.  Ultimately, the maximum amount by which the value of the special use real estate can be reduced is $800,000 – or other amount indexed for inflation – after Y2000.  

Assessment 

While this is not an insignificant amount, if there is a large disparity between “highest and best use” and present use value, then planning to avoid the potential liquidity deficit is imperative. 

Conclusion 

Please opine and comment if you have ever considered or used this strategy; and what was the result? 

Book info: http://www.jbpub.com/catalog/0763745790/ 

Linguistics: www.HealthDictionarySeries.com 

Related: http://www.aicpa.org/PUBS/jofa/jan98/sbtaxsol.htm

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Hospital-Based Home Care

Agency Count Declines

Staff Writers 

ho-journal2 

Over the past decade, the home care industry has evolved away from agencies that are affiliated with hospitals and toward independent, non-facility-based agencies.  

Review 

For example, in a recent study it was reported that the number of home care agencies in the U.S. fell nearly 10% in this period, to 13,313 in 2005 from 14,670 in 1996.  

But, as the total number of home care agencies slipped over these 10 years, the number of agencies that were hospital-based plunged by more than one-third, to 1,636 from 2,563 in 1997. Hospital-based home care agencies accounted for just 12.3% of all agencies in 2005, down notably from 17.0% in 1997.  

Assessment 

Spurred by an aging U.S. population, demand for home care is growing. Generally less costly than hospital-based care, home care has benefited from government and third-party initiatives aimed at containing costs at non-hospital sites.  

In the years to come, these government and third-party payer cost management efforts are expected to put increased pressure on hospital-based home care agencies. 

Conclusion 

As medical practitioners, physicians and/or nurse executives, or healthcare administrators; how will the above findings affect you and your institution? Your comments are appreciated. 

Institutional: www.HealthcareFinancials.com 

Terms: www.HealthDictionarySeries.com 

Acknowledgements: We recognize Richard L Frye PhD and Verispan LLC, Yardley, Pa., as the research and reporting source for this information, reprinted with permission and based on information gathered by mail and telephone surveys gathered and effective as of December 31, 2007.  It was commissioned, sponsored and underwritten in an arm’s length fashion by the Managed Care Digest Series of sanofi-aventis, Bridgewater, NJ, and developed and produced by Forte Information Resources, LLC, Denver, Colorado, USA

IRC Section §6166 Extensions

Understanding Physician Estate Planning

By Lawrence E. Howes; CFP™
By Joel B. Javer; CFP™

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A benefit the IRS allows on the death of a doctor or qualifying small business owner is Internal Revenue Code § 6166.  This provides for the extension of the payment of estate taxes over a period of 14 years.  

Levels of Qualification 

Recent legislation has made it more difficult to qualify; there are now three levels of qualification:

  1. The first is the same as for § 303. 
  2. The second adds a strict definition of a closely held business. 
  3. The third requires that the business must have been actually engaged in carrying on a trade, medical practice, or business at the time of death.   

The first four annual payments are interest only and then the next 10 annual payments are principal and interest.  The interest rate on the first $484,000 – or currently indexed amount – of tax due is at 2 percent.   

Assessment 

Calculating the tax that qualifies for the extension requires applying the percentage of the adjusted gross estate attributed to the small business, multiplied by the total federal estate tax. 

Conclusion 

Please opine and comment if you have ever considered or used this strategy; and what was the result? 

Book info: http://www.jbpub.com/catalog/0763745790/ 

Linguistics: www.HealthDictionarySeries.com 

Related Opinion: Why IRC Section 6166 Is Outmoded By Joseph E. Godfrey III, CLU and Steven M. Schanker Esq. http://www.nysscpa.org/cpajournal/2003/0403/nv/nv3a.htm

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