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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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    Later, Dr. Marcinko was a vital recruited BOD member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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Major Accounting Scandals of Interest to MDs and FAs

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Including Health South, AIG and Others

According to Wikipedia, the company HealthSouth was involved in a corporate accounting scandal in which its Chief Executive Officer, Richard M. Scrushy, was accused of directing company employees to falsely report grossly exaggerated company earnings in order to meet stockholder expectations.

The AIG bonus payments controversy began in March 2009, when it was publicly disclosed that the American International Group (AIG) was to pay approximately $218 million in bonus payments to employees of its financial services division.

 

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What It Costs to Hire and Train New Employees

H. R. Financial Information for Doctors, Clinics and Hospitals, etc.

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Sometimes, during slack periods in the economy, you have to reduce expenses by laying-off workers. Replacing them later, though, can be costly for your hospital HR department, clinic, medical practice or other business. Especially, for the knowledge based healthcare sector.

The Complete Financial Picture

So, whether it’s recruiting, on-boarding, extra salary, or something else, hiring new staff isn’t cheap. Make sure you understand the entire financial picture before you move forward with staffing changes.

 

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Conclusion

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More on Life-Cycle Investing [Revolution or Evolution]?

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Are you Ready for its Implications – Doctor?

By Peter Benedek, PhD CFA

Founder: www.RetirementAction.com

Background

The financial planning and investment advice, like that offered on this website, has been rolling along on a framework based on wealth accumulation by saving and investing for the long-term; especially for medical professionals, but generally for us all!

The emphasis is generally heavily slanted toward equities, which historically delivered much higher average return than fixed income investments; this of course is due to the fact that the higher volatility (risk) is rewarded by higher returns. The effect of average historical inflation is included by working with “real” dollars. The analysis to estimate required savings rates to achieve certain standard of living and withdrawal rates or methods once in retirement, tends to be built on historical average returns of different asset classes, largely disregarding the potential impact of volatility of equities around the expected retirement date (and start of de-accumulation); the implication being that stocks are a safe investment in the long-run. More recently, Monte-Carlo methods started to be used to include the effect of historical or predicted volatility, and then calculating the probability of exhausting your actual/expected assets at retirement, given various withdrawal rates or methods.

Chorus of Growing Rumblings

During the past few years a faint though growing rumble has been emerging. It remains to be determined if this is a revolution or just an evolution, but under the heading of “life-cycle investing” many are starting to challenge both the fundamental framework and implementation that is used in investing in preparation for retirement. This matter has taken on increasing urgency as the demise of traditional Defined Benefit pension plans and the corresponding transfer of risk from plan sponsors (professionals) to individuals (mostly untrained, undisciplined and incompetent in the financial field).

The New Framework

Zvi Bodie PhD, of Boston University is one of the earliest and most in-your-face advocates of this new framework. (The first time I came across his work was around the technology stock crash after I read in the papers that my lifetime employer had a $2.5B pension plan shortfall, and I started reading about how pension plans should be managed; contrary to practice he was advocating significant reduction of equity component in pension plans). One has to pay attention because he is a well respected financial economist of long standing and he challenges the current ‘common wisdom’ that leads to the following fallacies:

– stocks are safe in the long-run (not)
– diversification is the only way to reduce risk (not)
– wealth is about assets (not quite)
– stocks overcome the effect of inflation (maybe)
– target-date funds solve asset allocation/rebalancing problem (maybe).

Definition of Total Wealth

In fact the whole starting point of the new framework is about the definition of wealth (Total Capital), which in this new framework is defined as:

TC (Total Capital) = HC (Human Capital) + FC (Financial Capital)

and Human Capital is defined as the present value of future earnings.

Typically, we start out with a mix of 0% FC and 100% HC and ends up with 100% FC and 0% HC. Wealth is not about assets, but about sustainable ‘real’ spend-rate. Looking at wealth through the entire Life-Cycle as HC and FC forces us to rethink what is an expense vs. an investment (e.g. cost of higher education). But even more so, it forces us to think about risk.

Risks

So let’s look at risk, or rather risks and their changing nature/emphasis throughout the life-cycle:

–  disability (initially most wealth is HC, so loss of earning ability can be disastrous)
–  death (with young family/dependents, death of (a) breadwinner can lead to poverty)
–  investment/market (especially near the start of de-accumulation, when volatility around retirement can result in significant reduction in retirement income and/or delay in the start date of retirement)
– longevity (not only are people retiring earlier, but life expectancy has increased to 19 and 12 years, for 65 and 75 year olds and is growing; of course about 50% of individuals live past the life expectancy indicated.

For example, a 65 year old medical professional couple, there is about a 50%, 25% and 10% probability to one of them living to 90, 95 and 100, respectively).The net effect is that people are spending more time in retirement).

– inflation (this is scourge throughout the life-cycle, but it especially severe during retirement, eating away at your predominant financial capital).

Other risks are: are you saving enough? Are you annuitizing at the ‘right’ time (interest rates, mortality credits, costs)?

The Solution / Implementation

Now let’s look at some of the solutions proposed for each of these risks:

– disability and disability insurance AND/OR death and life insurance
– market/investment: diversification/asset-allocation (including futures and options), hedging (including options), single vs. multi-period investment horizon (i.e. in the long-run you appear to be OK, but on the way, as you are withdrawing funds annually during a succession of negative returns, you may become insolvent), cap investment in employer
– longevity: DB plans, (delayed) SS/CPP, immediate or deferred annuities (especially if inflation indexed), estate/bequest plan
– inflation: inflation indexed bonds, inflation indexed annuities.

Other solutions may be reverse mortgages, life settlements (assuming the need is dire and costs are not prohibitive).

Diversification

So you will note that diversification is part of the plan, but it is only a small part of the story in this framework. In addition the mechanisms (insurance and hedging) that are used to reduce/eliminate these various risks, introduce new problems: higher costs (e.g. insurance is not free) and counterparty risk (e.g. will the insurance company be solvent when the claim must be paid). So we’ll have to figure out what is the right mix of saving/investing, insuring and hedging and perhaps, as professor Bodie seems to suggest, a smaller but more certain piece of cake is what we should settle for! Pretty tough to swallow, considering that we’ve gotten used to believe that we can have it all if we do the right things.

Assessment

This new framework is more complex (not that today’s planners don’t worry about inflation, insurance and longevity), but it also make life-time sustainable income (not assets) as the focus of wealth, and it makes everything more explicit. Much of the ‘financial engineering’ mechanisms proposed as the solution are already used for HNWI, the challenge will be to get it delivered to doctors and the average investor.

References

You can learn more about life-cycle investing in the following:

1. In the FPA Journal of Financial Planning, Paula Hogan in “Life-cycle investing is rolling our way” discusses what life-cycle planning is about and the implications for planners.

2. Zvi Bodie in “Retirement investing: a new approach” appearing in Financial Engineering News, illustrates application of life-cycle investing principles using inflation protected bonds, determining suitable asset allocation based on investors’ willingness to postpone retirement and call options to protect downside while maintaining upside opportunity.

3. Still on the conference, there is Anna Rappaport’s post-conference update on “Expanding solutions for retirement income management- risks, barriers and dreams” where she looks at the various implications/perspectives of the stakeholders in retirement benefit delivery: individuals, insurer/financial services company, employer and regulatory.

4. And finally the related “Lifetime financial advice: human capital, asset allocation and insurance” by Ibbotson, Milevsky, Chen and Zhu tackles an integrated view of life-cycle finance. They also have an excellent presentation on annuities and show the principles of how to create an asset allocation composed of risk-free and risky assets, and annuities; they also show the impact of risk aversion and the bequest motive will affect the resulting mix.

Conclusion

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Injured War Contractors Sue Over Health Care

And … Disability Payments

By T. Christian Miller
ProPublica, September 27, 2011, 10:11 am

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Private contractors injured while working for the U.S. government in Iraq and Afghanistan filed a class action lawsuit [1] in federal court on Monday, claiming that corporations and insurance companies had unfairly denied them medical treatment and disability payments.

The Law Suit

The suit, filed in district court in Washington, D.C., claims that private contracting firms and their insurers routinely lied, cheated and threatened injured workers, while ignoring a federal law requiring compensation for such employees. Attorneys for the workers are seeking $2 billion in damages.

The Defense Base Act

The suit is largely based on the Defense Base Act, an obscure law that creates a workers-compensation system for federal contract employees working overseas. Financed by taxpayers, the system was rarely used until the wars in Iraq and Afghanistan, the most privatized conflicts in American history.

Hundreds of thousands of civilians working for federal contractors have been deployed to war zones to deliver mail, cook meals and act as security guards for U.S. soldiers and diplomats. As of June 2011, more than 53,000 civilians have filed claims for injuries in the war zones. Almost 2,500 contract employees have been killed, according to figures [2] kept by the Department of Labor, which oversees the system.

An investigation by ProPublica, the Los Angeles Times and ABC’s 20/20 [3] into the Defense Base Act system found major flaws, including private contractors left without medical care and lax federal oversight. Some Afghan, Iraqi and other foreign workers for U.S. companies were provided with no care at all.

Assessment

The lawsuit, believed to be the first of its kind, charges that major insurance corporations such as AIG and large federal contractors such as Houston-based KBR deliberately flouted the law, thereby defrauding taxpayers and boosting their profits. In interviews and at congressional hearings, AIG and KBR have denied such allegations and said they fully complied with the law. They blamed problems in the delivery of care and benefits on the chaos of the war zones.

Conclusion

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STD Risk Factors to Consider in Public Health

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There are many factors that affect those at risk for contracting an STD. Many times individuals don’t know or understand which things put them at risk of infection. Some STD’s can be transmitted in surprising ways. For those at risk, regular comprehensive testing can help prevent unintended transmissions. Furthermore, early diagnosis of some STD’s can greatly improve treatment options and avoid hassles associated with full blown infection.

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If you’re concerned about STD’s or want to know more, see please your physician or visit the STD Testing page for additional information.

Assessment

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Conclusion

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Knowledge Doctors Need to Survive the Financial Crisis on Wall Street

Dictionary of Health Economics and Finance 

 

Dictionary of Health Economics and Finance

 
 

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

 

The Legal eHR [Extreme Caution Ahead]

Is there such a thing?

By Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

Electronic medical and healthcare records [eMRs and eHRs] are a hot topic and the subject of many positive and negative posts and comments on this ME-P; and around the healthcare space. Personally, I am agnostic on the subject – trending against – for most physicians at this point in time.

In other words, the technology is just not there yet regarding “ease of use”, inter-operability, common transmission and security standards, and common platform, etc. This is reminiscent of the early days of the word processing industry, when I first used Edix-Wordex, Leading Edge, Word Perfect, Word Star, ASCII, PFR-Write, PC-Write, etc.  It was both exciting and confusing, being a writer and editor, at that time. Sorta like working in an electronic Tower of Babel; or using the many disparate eHR systems existing today?

I am not a Luditte, however. I’m a former American Health Information Management Association (AHIMA), and Healthcare Information and Management Systems Society (HIMSS), member. And, I’m certain that eHRs will be pervasive one day, but I’ll reserve my opinions, my money and information security, and my patient’s data until then. After all, I am a MSFT-Word® guy today as I thank Bill Gates for consolidating the formerly competitive, and chaotic, word processing software space. Yes, sometimes monopolies are a good thing! 

Malpractice Issues

Moreover, it seems I have been a Cassandra [the daughter of King Priam and Queen Hecuba of Troy] of sorts, crying aloud about the professional liability and medical malpractice issues of eMRS; here on this ME-P, during my speeches and lectures, as wells as in our books and CDs. All to no avail; until now!

Links: https://medicalexecutivepost.com/2009/12/23/will-electronic-records-raise-the-legal-standard-of-care-and-increase-malpractice-risk/

I suppose this is a product of my prior work as a licensed insurance agent for the State of Georgia, a malpractice reviewer, a court approved medical-legal expert witness, and author of the book: “Risk Management and Insurance Planning for Physicians and their Advisors”.

Link: http://www.jbpub.com/catalog/9780763733421

Assessment

Q: And so, is there a legal eHR and is it different from traditional eHRs?

A: You bet there is!

Read Link: http://www.himss.org/content/files/LegalEMR_Flyer3.pdf

Conclusion

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