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Next-Gen Health Accountants and Tax Advisors

Avoiding the “Managed Care Ripple Effect”

By Dr. David Edward Marcinko; MBA, CMP™

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include CPAs, tax specialists and Enrolled Agents [EAs] who themselves wish to avoid the collateral ripple effects of the current healthcare debacle.

Unappreciated CPAs Working Diligently

The nation’s 330,000 or so CPAs know little about the new healthcare dynamics and managerial accounting mechanics. Many often feel as though they are laboring away in obscurity and that their doctor clients do not appreciate what they do or how hard they work.

If you are a CPA, your workweek is ridiculously long, especially January through April; and you often deliver bad news to your clients. You do not earn a generous salary, but you do receive their ire for your efforts.

The Epiphany

So, you begin to scratch your head and ponder, quietly at first, and then out loud. Perhaps managing the medical practice(s) of a physician, or providing consulting services to other medical professional is a business and financial planning opportunity that won’t require a new client base? You can keep your accounting practice during the first four months of the year, and supplement your income with something that may actually earn more than you are making now. 

A light then goes off in your head, epiphany!  Enter the CPA/PFS designation, exhorting doctor clients to “never underestimate the value”, through an additional 750 hours of financial planning experience and a six-hour comprehensive examination.

New Wave Terms and Definitions

However, new-wave terms such as capitated medicine; per member-per month fixed fees; payment withholds; activity based costing with CPT codes; utilization and acuity rates; and other investment, business and economic nomenclature is likely quite unfamiliar to you.

Furthermore, you may not have the temperament to be a fiduciary, responsible for the financial affairs of others. Then you realize that MBAs and actuaries may actually be the new denizens of the healthcare bean counting and practice management scene. Rather than present numerics of the historic past, they make logical and mathematical inferences about the future. Slowly, you realize that this has occurred because these professionals are proactive, not reactive, as the accounting profession is loosing its premier advisory position within the medical profession.

And, since some doctors are paid a fixed fee amount, regardless of the number of services performed, these futuristic projections are the most important accounting numbers in healthcare today.

Assessment

In fact, your research suggests that as a result, there are now several accountant managers and broker-dealers on the investment scene, as well as an increasing number of accounting-financial planning firms, such as Miller Ray & Houser Business Advisors and CPAs, in Atlanta, who set up a separate investment advisory firm to which they refer clients. 

Moreover, the AICPA is providing encouragement to CPAs who wish to provide more professional client services by building a financial planning practice for the new millennium.

Disclaimer: Dr. Marcinko, a member of the Microsoft accounting network, is Founder of the Certified Medial Planner™ program for all fiduciary advisors in health economics, finance and medical practice management www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts are appreciated; please opine?

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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A Fresh Look at Annuities

An Often Maligned Insurance-Investment Vehicle

[By Staff Reporters] 

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Most doctors are familiar with fixed annuities (particularly during periods of high interest rates like two decades ago), which come in two basic varieties—the traditional single or multiple-year initial rate guarantee product or the market value adjusted (MVA) interest rate product.

Once the guaranteed rate ends however, the physician-investor is at the mercy of the insurance company’s renewal rate.

MVAs have offered higher interest rates but function much like bonds if surrendered before the end of the guarantee period. If interest rates have declined, the cash surrender value increases and vice versa. This can be mitigated by “laddering” as one would do with bonds.

Literature Review

In his article “Annuities on the Horizon” (Financial Strategies, Fall 1996, pp. 44–46, Investors Financial Group Inc.), author Clifford Jack acquainted financial advisors and others with a recoup of vintage annuities.

For instance, while variable annuities were historically limited to the most basic of investment portfolios, many now offer portfolios that include international equity, mid-cap equity, high yield bonds, REITS, ETFs, and global bonds with many different fund management companies. Others include multiple guaranteed accounts offering competitive interest rates, which provide the flexibility to make a tax-free transfer into these types of accounts or to dollar cost average into the equity accounts.

Indexed Annuities

The equity indexed annuity product allows participation in the upside of the S&P 500 Index by crediting an interest rate that is tied directly to the performance of the index. Most guarantee a percentage participation rate that varies depending on the current interest rate environment. If the contract is held until the end of the guarantee period, investors can be assured of a return of original premium, plus a minimum guaranteed interest rate of 3%.

An equity indexed-annuity is likely to outperform fixed annuities when interest rates are low and variable annuities when the market is trending downward. They permit participation in stock market-like rates of return with downside protection. And, for retirement age physician investors, look at immediate versions of equity index annuity products, which link income payments to an index and thereby offer an inflation hedge.

Assessment

Faced with a rocky market and unknown interest rate scenarios, annuities may be a consideration to the portfolios of suitable physicians; if costs are appreciated, other qualified retirement plans fully funded and time-line long. Comments on this often contentious topic, are appreciated. Are these annuities an insurance product, investment product, or both; and why not use a “purer-play for same?”

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