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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.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital and 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”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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Dear Pharmaceutical Company, Financial Services Firm or Corporate Medical Vendor

We often serve as Medical Science Liaison [MSL] for pharmaceutical companies, at medical seminars and/or financial services organization meetings. Based on our education, experience and skills, we are confident that we would be a great addition to your team.

My Record

For example, I have a proven record in collaborative leadership with functional healthcare executive management experience to develop and implement coordinated strategies designed to deliver top line growth; drive organizational change and enhance competitive positioning within multiple key markets; enhance relationships and influence physicians; analyze financial, economics, operational and quality measures and ensure health practices are operating within goals and standards.

In this role, I can identify external experts (KOLs), and engage, enhance, and build relationships by listening and understanding the views of these experts.

An Independent Conduit Link

More importantly, I can bring value to external experts through excellent communication of scientific dialogue.  I see this position as a non-promotional conduit link between you and this community. It is one where I fuse scientific knowledge with business acumen to accelerate commercialization success. As a fully independent MSL, I can:

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CV: Dr. David E. Marcinko CV 2017

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Travel is non-problematic from Atlanta. Teaching, speaking, writing and mentoring are areas of expertise.  Thank you in advance for your time. Please do not hesitate to contact me if you have any questions.

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Dr. David Edward Marcinko; FACFAS, MBA, CMP™

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The Science and Some Medicine Behind Seat Belt Use

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It’s All About Saving Lives and Ankle Bones

By Muhammad Saleem, and

By Dr. David Edward Marcinko FACFAS MBA CMP™

[Editor-in-Chief]

Vintage 2000 Jaguar XJ-V8-LWB Touring Sedan

The Ankle Bone is Connected to the Foot [er –ah] Leg Bone

The talus is one of the important bones that makes up the ankle joint. Over one half of the talus is covered with cartilage–it serves as an important link between the leg and the foot. The talus moves not only at the ankle joint, but also below the ankle and in the midfoot. Therefore, injuries to the talus can affect motion of the ankle and foot joints.

‘Aviators Astragalus’

Talus [astragalus ankle bone] fractures were almost unheard of a hundred years ago. The first series of talus fractures was described, by Dr. WD Coltart, in men who were injured in the British Royal Air Force in the early 1900s. The term ‘aviators astragalus’ was used to describe these fractures that happened as old war planes made crash landings.

Original Historic Reference Link: AA

Today, talus fractures are seen in high speed car accidents when you don’t-buckle up that seat belt or shoulder harness. I’ve seen far too many during my days covering the local Emergency Room.

So, here is an infograhic on the science behind seat belts. It contains some interesting and some encouraging facts that we wanted to share with our ME-P readers and subscribers.

Mechanism of Injury: Hawkins classification Talar fractures (C) iMBA Inc

The Facts

  • National seat belt use has increased from 69% in 1998 to 84% in 2010.
  • Automotive fatalities rank third in terms of lives lost per year, behind cancer and heart disease.
  • Seat belts are responsible for saving between12,000 to 16,000 lives each year.
  • Most crash deaths occur within 25 miles of home and at speeds below 40 miles per hour.

Conclusion

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Understanding The Federal Reserve Act

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[By Staff Reporters]

Uncovering The FED

In the early 20th century, a financial crisis led panicked citizens to withdraw all their money at once, damaging banks. By 1913, Congress responded with the Federal Reserve Act, creating 12 regional banks acting as a federal bank to deal in local and global affairs with both private banks and the federal government.

Balancing v. Manipulation

Some say the Fed was meant to create a balanced economy, while others argue its purpose was to inorganically manipulate free enterprise, rescuing banks that we’d be better off without.

Assessment

Is the Fed still doing its job today? What secrets are being kept from us and how are the Fed’s actions impacting our economy?

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Conclusion

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The Integrated Patient-Centered Medical Home Model

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Tools for Transforming Our Healthcare

By Matias A. Klein

[VP, General Manager, Clinical Quality and Collaboration, Portico Systems]

The patient-centered medical home (PCMH) continues to attract increasing attention from many industry stakeholders. The PCMH model has the potential to enhance the US healthcare system by rejuvenating primary care in a way that improves clinical outcomes, lowers costs, promotes wellness, and increases patient and physician satisfaction.

PCMH Pilot Programs

PCMH pilots are currently being tested in almost all states, including a 3-year Medicare medical home demonstration project overseen by the Centers for Medicare & Medicaid Services. However, few organizations have scaled the PCMH across their entire healthcare network, and the existing implementations appear to remain focused on care management at the expense of patient wellness. The value of focusing equally on promoting wellness (although an underappreciated nuance in the implementation of a PCMH) is a critical factor in effectively leveraging the PCMH model to improve clinical outcomes and the US healthcare system.

Centered on the Patient

The PCMH model, as its name suggests, is centered on the patient. The underlying thought is that if a comprehensive, longitudinal view of a patient is taken throughout a patient’s lifespan, the patient’s health could be better “managed” and better aligned with best medical practices. It is well documented that physicians do not consistently or frequently apply evidence based, recommended care to patients. Therefore, a major goal of the PCMH model is to improve the consistent application of evidence-based guidelines and best practices, by making longitudinal information about the patient available to providers and to patients – including any risks and recommended “intervention opportunities.” And although adherence to best practices in disease management is crucial, the PCMH model also focuses on preventing costly episodes by promoting and incentivizing wellness.

PCPs = Medical Homes

To effectively manage a patient’s health and promote wellness, primary care physicians – designated as medical homes – need to act as health “quarterbacks” or “coaches.” In such a role, these physicians will assist in aggregating a patient’s health information, making best practices transparent, offering health education and counseling, as well as coordinating the provisioning of any healthcare services the patient may need. With physicians spending significant time coaching and making critical clinical decisions, these services will be delivered with the support of care management nurses, who will handle the majority of the information processing and operational activity.

An Innovation in Care

The PCMH model is an important innovation in care delivery and has the potential to reduce medical and administrative costs, while improving the quality of care. However, how to implement the PCMH model within a care-delivery system remains unclear. Providers need the requisite infrastructure and capabilities at their locations to meaningfully participate in a PCMH. Patients must be engaged over long periods of time in proactively managing and improving their health. Outcomes and quality must be objectively measured to optimize the delivery of best possible patient care.

Potential Value

To realize the potential value of the PCMH, three distinct stakeholders – patients, providers, and health plans – must work in a collaborative way. Getting these stakeholders synchronized (i.e., aligned in their goals, using interoperable tools, and collaborating on an operational level) is no small feat but can be accomplished with the smart application of technology. Bringing these three stakeholder groups together on a common, collaborative technology platform results in what some are beginning to call the integrated PCMH. The integrated approach to the PCMH can best ensure that implementing a PCMH model does not create additional administrative burdens to health plans or provider organizations.

An integrated PCMH provides a framework for stakeholders to collaborate in a transparent fashion, and where quality, best practices, and outcomes are incentivized. The integrated PCMH also provides a pathway being awarded a medical home designation.

Vertical Integration Deployment

The key to deploying an integrated PCMH is an end-to-end vertical integration of the care-delivery process – that is, a process in which the provider network management, automation, information exchange, and analytics solutions are tightly integrated with patient and provider information. With so much complexity and so many “moving parts” in the delivery of the PCMH model, this end-to-end vertical integration is a practical solution that enables effective coordination of care and accurate measurement of quality: with such system integration, the provider network (e.g., the health plan) can bring economies of scale to even the smallest provider offices to optimize the quality of care delivery.

The 5 Keys

The five key components for such an integrated PCMH are:

  1. A source-of-truth for mapping medical home – designated providers, patients, as well as  the associated relationships with health plans and other medical professionals; a central medical home fact checking is critical for effectively identifying, managing, and communicating with medical home and their networks.
  2. A set of collaborative workflows that align stakeholders with best practices, incentives, and quality measures reporting; these collaborative workflows help each stakeholder understand where a given patient is in the care-delivery process, potential intervention opportunities, why certain interventions are being emphasized, and what incentives are available for executing specific interventions.
  3. An infrastructure for clinical integration and distribution of intervention opportunities, clinical reference content, education, alerts, and reminders. This infrastructure allows all stakeholders to have access to up-to-date, accurate patient information; it aligns stakeholders and helps reduce or eliminate duplication of procedures and tests.
  4. Interoperable clinical applications and collaboration tools to enable patients and physicians to engage in medical home processes; these tools – which include electronic medical records, e-prescribing, e-labs, secure e-mail, personal health records, and document management and exchange technology – can help manage health information, assist with decision-making, and improve communication between patients, providers, and health plans.
  5. Incentive management and analytics tools for modeling, setting, measuring, and rewarding incentives based on quality measures and outcomes; these tools must span the entire PCMH delivery process and are required for objectively evaluating and optimizing the performance of a medical home.

When considering the multiplicity of stakeholders, information, software systems, and knowledge that has to be coordinated in the context of a PCMH model, implementing a medical home pilot and scaling it to a full-blown network may seem a daunting task. The integrated PCMH offers a real-world solution for deploying a scalable and flexible infrastructure for the management of this emerging care-delivery model.

Assessment

Early evaluations of the PCMH model show promising, albeit inconclusive, outcomes. The integrated PCMH model offers a practical road map for deploying a management system that will enable objective measurement of PCMH performance and outcomes.

Conclusion

Although the jury is still out on the ultimate value of the PCMH, deploying an integrated PCMH system can help position PCMH pilots in a way that enhances their flexibility and scalability to support full-scale network transformation.

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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The Financial Impact of Reducing Avoidable Hospital Admissions

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Population Health Models

By Staff Reporters

Most readers are aware that colleague David B. Nash MD, MBA is the population health guru for the ME-P. In fact, he is an ME-P “thought-leader.” And, to use a modern colloquialism, he was into population health before PH was cool.

Link: http://nashhealthpolicy.blogspot.com

Preventing Avoidable Hospitalizations

And so, as hospitals and health systems accelerate towards population health models, there is an increasing focus for physicians and health systems to work together to prevent avoidable hospitalizations.

The Infographic

This infographic shows that an average 300-bed hospital is at risk of losing $9.5 million in annual contribution when inpatient admissions for 11 potentially avoidable conditions are completely reduced. These 11 conditions, identified by AHRQ, represent diagnoses for which coordinated outpatient care and early intervention can potentially prevent the need for hospitalization.

Source: Objective Health [McKinsey & Company]

Assessment

A colloquialism is a word or phrase that is employed in conversational or informal language but not in formal speech or formal writing.

Conclusion

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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The Modern US Monetary System

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On Modern Monetary Realism

By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

In a previous ME-P column I explained why any currency-issuing country, like the US, will never default on its obligations or run out of money with which to purchase goods and services priced in its own currency. Sovereign nations that are currency issuers have no solvency constraints, unlike currency users such as individuals, corporations, and government entities that don’t issue currency.

Why the Government is Not-Like Medical Professionals

On Modern Monetary Realism

To follow up, let’s look at what has become known as Modern Monetary Realism (MMR).  Economist Cullen O. Roche describes it in a 2011 article on his Pragmatic Capitalism website titled “Understanding the Monetary System.”

This theory came into existence in 1971 when President Nixon eliminated the gold standard and allowed the government to print money at will. This was a paradigm shift in our monetary policy that’s gone largely unnoticed for decades by many educators, economists, and politicians.

Guiding MMR Principles

The principles of MMR are:

  • The Federal Reserve works in partnership with the US Treasury to issue currency. All other units of government, private entities, and individuals are users of the currency.
  • The government creates money by minting coins, printing cash, and issuing reserves. The private banking sector creates money by creating loans and bank deposits.
  • The Federal Government cannot “go broke.” It is inaccurate to compare it to households, companies, and local governments, which all are users of money and can go bankrupt.
  • The major constraint on currency issuers (sovereign governments like the US) is inflation. It behooves governments to manage the money supply prudently in order to avoid impoverishing their citizens through devaluing the currency.
  • Floating exchange rates between countries are a necessity to help maintain equilibrium and flexibility in the global economy. Nations that unduly inflate their currency suffer the consequences of devalued currency, shrinking purchasing power, and contracting lifestyles.
  • The debt of a sovereign currency issuer is default-free. The issuer can always meet debt obligations in the currency which it issues.

Cullen O. Roche Speaks

Roche suggests that a functional government supports the country’s financial system in four ways:

  1. The US government was created by the people, for the people. “It exists to further the prosperity of the private sector—not to benefit at its expense.” Roche argues that when government becomes corrupt by obtaining too much power or issuing too much currency that results in high inflation, it then becomes susceptible to a revolt and dissolution.
  2. Government’s role is to be actively involved in regulating and helping to build an infrastructure within which the private sector can generate economic growth. Roche views regulation as not only beneficial, but necessary to temper the inevitable irrationality that can disrupt markets. Still, he emphasizes that it is the private sector, not the public sector, which drives innovation, productivity, and economic growth.
  3. Money, while a creation of law, must be accepted by the private sector while prudently regulated by the federal government, keeping in mind that the purpose of the regulation is to maximize private sector prosperity.
  4. “Because the Federal government is not a business or a household it should not manage its balance sheet for its own benefit,” notes Roche, “but in a way that most benefits the private sector and encourages private sector prosperity, productivity, innovation and growth.”

Assessment

Like me, you may need to re-read this a couple of times to begin to grasp the concepts. Once you throw off the outdated pre-1971 model of the monetary system, understanding the basics of MMR isn’t difficult. Knowing the basics of how our monetary system works will help physicians, and all of us, frame the important issues in the turmoil unfolding in Europe and in our own upcoming elections. 

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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How Do We Improve Collaboration between Physicians and Hospital Administrators?

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An Opinion Poll for Doctors, FAs and Patients

By Jennifer Tomasik MS [Principal: www.CFAR.com]

“It is the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed.”

– Charles Darwin

Beyond institutional mergers and joint ventures, collaboration in healthcare is being driven by other factors; there is a need to move from a healthcare system driven by volume and characterized by fragmentation, waste, high cost, and inconsistent quality to a system where care is coordinated, costs are lower, and quality is higher.

Merger Mania

Merger mania in the 1990’s was driven by similar concerns, including the fear of for-profit competition and the rise of managed care. The results of this earlier round of mergers were unexpected. The 1990s ‘consolidation fever’ raised hospital prices by at least 5%, and did not measurably improve quality.[i] Hospitals purchased physician practices without a great deal of thought about expectations and mutual accountability, and many of those relationships failed—usually with significant financial implications.

Of Savvy Healthcare Leaders

Fearful of history repeating itself, savvy healthcare leaders are thinking differently about how to develop the collaborative relationships they need to succeed today. They see Accountable Care Organizations [ACOs] and Global Payments—where institutions will take on greater risk for the cost and quality of the services a patient requires—as an opportunity to get clear about how they can best position themselves across the full continuum of care. They believe potentials gains are not likely to show up simply as a result of mergers and acquisitions or consolidation per se. Rather than just integrating the bottom lines of their institutions, they are focused on ensuring that those individuals and teams who actually care for patients can productively collaborate with each other, and that they understand the clear and compelling rationale for why that collaboration is necessary.

Nowhere is this relationship more important than between hospital administrators and the medical staff.

What is “Collaboration” Anyway?

Merriam-Webster defines collaboration as “to work jointly with others or together especially in an intellectual endeavor.” While true, we find this definition insufficient for our purposes. Our colleagues at The Rhythm of Business, a consulting firm focused exclusively on collaboration, provide a more productive way to think about collaboration:

“Collaboration is a purposeful, strategic way of working that leverages the resources of each party for the benefit of all by coordinating activities and communicating information within an environment of trust and transparency.”

We add to this definition one additional, yet critical dimension. Collaboration also means working with, and through, differences. Any highly functioning team will, by its very nature, have differences – team members are ideally bringing innovative ideas that compete for “idea space” at the table.

Effective collaboration requires that teams not only value differences, but in fact encourage them to be surfaced. Viewed in this way, collaboration is not an event or an idea. It’s not “agreeing to get along.” Effective collaboration is an ongoing, systematic, strategic process. It is also, we believe, a business imperative – and nowhere more so than in healthcare.

Assessment

Given the often difficult nature of relationships between hospital administrators and medical staff, how do you improve collaboration to increase productivity and performance?


NOTE: [i] Vogt, William B and Robert Town. “How has hospital consolidation affected the price and quality of hospital care?” Robert Wood Johnson Foundation: Policy Brief No. 9. 2006.

Conclusion

And so, how do we improve collaboration between Physicians and Hospital Administrators?

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About the Author

Jennifer Tomasik, Principal,  leads CFAR’s Health and Hospital Systems practice. She works with her clients to solve complex strategic and organizational challenges. Her approach to consulting emphasizes communication and collaboration, supported by a blend of quantitative and qualitative analytics. Jennifer has worked in the health care sector for nearly 15 years, with expertise in public health, clinical quality measurement, strategic management, and organizational change. Her clients include some of the most prestigious hospitals, health systems and academic medical centers in the country. She has a Master’s in Health Policy and Management from the Harvard School of Public Health.

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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New Medical Practice Entrepreneurial Business Rules for Young Physicians [circa 2018]

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Go “Out-of-Box” – OR – Go Employee

By Dr. David Edward Marcinko MBA CMP™ www.CertifiedMedicalPlanner.org

There are more than 950,000 physicians in the United States. Yet, the brutal supply and demand, and demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. More so, going forward with the PP-ACA OR, perhaps not so much after the Trump election.

Furthermore, many large health care corporations, hospitals, and clinical and medical practices have not been market responsive to this change. Some physicians with top-down business models did not recognize the changing health care ecosystem or participatory medicine climate. Change is not inherent in the DNA of traditionalists. These entities and practitioners represented a rigid or “used-to-be” mentality, not a flexible or “want-to-be” mindset.

Yet today’s physicians and emerging Health 2.0 initiatives must possess a market nimbleness that cannot be recreated in a command-controlled or collectivist environment. Going forward, it is not difficult to imagine the following rules for the new virtual medical culture, and young physicians of the modern era.

A. Rule 1

Forget about large office suites, surgery centers, fancy equipment, larger hospitals, and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manners, or competitive advantage can outfox a slew of insurance companies, Certified Public Accountants, or the Associate Management Accountant, while still serving patients and making money. It is now a unit-of-one economy where “ME Inc.,” is the standard. Physicians must maneuver for advantages that boost their standing and credibility among patients, peers, and payers.

Examples include patient satisfaction surveys, outcomes research analysis, evidence-based-medicine, direct reimbursement compensation, physician economic credentialing, and true patient-centric medicine. Physicians should realize the power of networking, vertical integration, and the establishment of virtual offices that come together to treat a patient and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not a magnificent office suite or onsite presence.

B. Rule 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus, and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking.” Do traditionalists or collective health care reform advocates react rationally or irrationally?

For example, some health care competition and career thought-leaders, such as Shirley Svorny, PhD, a professor of economics and chair of the Department of Economics at California State University, Northridge, wonder if a medical degree is a barrier—rather than enabler—of affordable health care. An expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

C. Rule 3

Differentiate yourself among your health care peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors must create and innovate, not blindly follow entrenched medical societies into oblivion.

For example, the establishment of virtual medical schools and hospitals, where students, nurses, and doctors learn and practice their art on cyber entities that look and feel like real patients, can be generated electronically through the wonders of virtual reality units.

D. Rule 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of quick change with fast, but informed decision making. Do what you love, disregard what you do not, and let the fates have their way with you.

Assessment

I receive a couple of phone calls each month from young doctors on this topic. I ask them to decide if they are of the philosophical ilk to adhere to the above rules; or become another conformist and go along … to get along? In other words, get fly!

Or, become an employed, or government doctor.  Just remember … the entity that gives you a job, can also take it away.

Sample fly: http://crossoverhealth.com/

MORE: Marriage Business

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:

LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
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Update on Health Insurance Claims Processing Costs

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Paper versus Electronic

[By Matias Klein]

[Senior VP Technology Portico Systems Integrated Provider Management Solutions]

The average cost of processing a single, clean, paper-based or electronic claim can range from 85 cents to $1.58.

However, according to AHIP, nearly half of all claims (48 percent) were pended due to the submission of duplicate claims (35 percent), lack of complete information or other information needed to justify the claim (12 percent), or invalid codes (1 percent).

The manual adjudication of these duplicate or incorrect claim submissions increases the cost of administration to $2.05. The $2.05 scenario is a best case calculation. In our actual field experience the cost can be as high as $10.00 per claim.

Payment Delays

In addition to the increased administrative cost, one must not forget about the delayed payment to the provider. As stated by AHIP, a duplicate claim can take 9 days to remediate and missing information on a claim can take up to 11 days. This kind of delay damages the relationship between the provider and the health plan, which in terms of costs is priceless.

Enter ID Management

To solve this problem, some healthcare organizations are implementing Master Identity Management (IDM)—a valuable approach to creating an enterprise “source of truth” for provider identity information. But when it comes to payment integrity and claims processing, IDM without a Provider Information Management (PIM) system doesn’t work. Provider relationship and contract data are far too complex, and both types of data are needed to supplement provider identity data in support of claims administration.

Provider Information Management

When IDM is fully integrated with PIM, payers can successfully establish a single, accurate and effective source of truth. An integrated approach also:

  • Ensures quality – by standardizing, cleansing, cross-referencing and consolidating relevant data, while removing duplicate entries.
  • Mitigates risk – reducing the downstream impact of inaccurate data on all claims processing, contracting, credentialing, provider directory and connected systems.
  • Saves millions of dollars – by reducing duplicate entries by even a fraction of a percent, thus ensuring that claims are being processed in an efficient and effective manner.

Assessment

IDM plays a pivotal role in the future of healthcare. As new, collaborative and accountable care delivery models evolve, reliable provider identity management is absolutely critical. Combining IDM with PIM gives payers the most powerful solution for assuring payment integrity while improving provider identity and duplication management.

Conclusion

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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

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A Barclay Bank Ad Campaign Photo

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“For the best fixed rates”

Source: Paul Higgins and Sandy Teagle – Futurists from Melbourne and Brisbane in Australia.

Assessment

Truth in advertising.

Barclay campaign says pic.twitter.com/0XOmyQjg

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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PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Vital iMBA Inc Links for Savvy Doctors and their Financial Advisors

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An Educational Resource Supporting Doctors and their Consulting Advisors 

Healthcare OrganizationsMedical Business AdvisorsCertified Medical PlannerHDS

We are an emerging online and onground community that connects medical professionals with financial advisors and management consultants. We participate in a variety of insightful educational seminars, teaching conferences and national workshops. We produce journals, textbooks and handbooks, white-papers, CDs and award-winning dictionaries. And, our didactic heritage includes innovative R&D, litigation support, opinions for engaged private clients and media sourcing in the sectors we passionately serve.

Through the balanced collaboration of this rich-media sharing and ranking forum, we have become a leading network at the intersection of healthcare administration, practice management, medical economics, business strategy and financial planning for doctors and their consulting advisors. Even if not seeking our products or services, we hope this knowledge silo is useful to you.

In the Health 2.0 era of political reform, our goal is to: “bridge the gap between practice mission and financial solidarity for all medical professionals.”

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ADVISORS:www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

Assessment

Link: Letterhead.iMBA_Inc.

Link: Letterhead CMP

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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Some Cool New Health Care Administration Abbreviations and Terms

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By Ann Miller RN MHA

[Executive-Director]

Abbreviations for 2012

  • AALL American Association for Labor Legislation
  • ACA Accountable Care Organizations (see PPACA)
  • AAMC Association of American Medical Colleges
  • AHA American Hospital Association
  • ALOS Average Length of Stay
  • AMA American Medical Association
  • ANA American Nurses Association
  • ASTHO Association of State and Territorial Health Offi cials
  • CAT Computerized Axial Tomography
  • CCMC Committee on the Costs of Medical Care
  • CDC Centers for Disease Control and Prevention
  • CHC Community Health Center
  • CHSS Cooperative Health Statistics System
  • CME Continuing Medical Education
  • CMS Centers for Medicare and Medicaid Services
  • CPO Combined Provider Organization
  • DHHS Department of Health and Human Services
  • DO Doctor of Osteopathy
  • DOD Department of Defense
  • DRG Diagnosis-Related Group
  • DVA Department of Veterans Affairs
  • EAP Employee Assistance Program
  • ED Emergency Department
  • EMS Emergency Medical Service (or System)
  • EMT Emergency Medical Technician
  • EPA Environmental Protection Agency
  • EPO Exclusive Provider Organization
  • FDA Food and Drug Administration
  • GAO General Accounting Offi ce
  • GPO Government Printing Offi ce
  • GDP Gross Domestic Product
  • GMENAC Graduate Medical Education National Advisory Committee
  • GNP Gross National Product
  • GPEP General Professional Education of the Physician Panel
  • HCFA Health Care Financing Administration
  • HIV Human Immunodeficiency Virus
  • HMO Health Maintenance Organization
  • HRSA Health Resources and Services Administration
  • IDS Integrated Delivery System
  • IPA Individual or Independent Practice Association
  • IPO Independent Practice Organization
  • JCAHO Joint Commission on Accreditation of Healthcare Organizations
  • LCME Liaison Committee on Medical Education
  • LPN Licensed Practical Nurse
  • MC Managed Care
  • MCH Maternal and Child Health
  • MCO Managed Care Organization
  • MEPS Medical Expenditure Panel Survey
  • MHS Marine Hospital Service
  • MMWR Morbidity and Mortality Weekly Report
  • MRI Magnetic Resonance Imaging
  • MVSR Monthly Vital Statistics Report
  • NCHS National Center for Health Statistics
  • NHANES National Health and Nutrition Examination Survey
  • NHIS National Health Interview Survey
  • NIH National Institutes of Health
  • NIMH National Institute of Mental Health
  • NIOSH National Institute of Occupational Safety and Health
  • NLN National League for Nursing
  • NP Nurse Practitioner
  • OMB Offi ce of Management and Budget
  • OPD Outpatient Department
  • OSHA Occupational Safety and Health Administration
  • PA Physician Assistant (or Associate)
  • PPACA Patient Protection and Affordable Care Act of 2010
  • PHO Physician–Hospital Organization
  • PHS Public Health Service
  • POS Point of Service
  • PPGP Prepaid Group Practice
  • PPO Preferred Provider Organization
  • RBRVS Resource-Based Relative Value System
  • RN Registered Nurse
  • SAMSHA Substance Abuse and Mental Health Services Administration
  • UR Utilization Review
  • USDA United States Department of Agriculture
  • USPHS United States Public Health Service
  • VA United States Department of Veterans Affairs
  • WHO World Health Organization
  • WIC Women, Infants, and Children Supplemental Nutrition Program

Assessment

Feel free to send us your own new-wave abbreviations and terms.

SOURCE: Jonas’ US Health Care System

http://www.springerpub.com/product/9780826109309?utm_medium=email&utm_campaign=718+Public+Health+Single&utm_content=718+Public+Health+Single+Version+A+CID_ba75230692a1f4f7e4e896da56f9dff2&utm_source=MyemailFX&utm_term=Jonas+Introduction+to+the+US+Health+Care+System+7th+Edition

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The Tax Man Cometh to Police You on Health Care

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About the New Health Care Tax and IRS Job Creation

WASHINGTON (AP)

The Supreme Court’s decision to uphold most of President Barack Obama’s health care law will come home to roost for most taxpayers in about 2 1/2 years, when they’ll have to start providing proof on their tax returns that they have health insurance.

LINK: New Jobs: IRS to hire thousands more agents to collect new health care taxes

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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Transitioning and Appraising a Podiatry [Medical] Practice

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A Round Table Fair Market Valuation Discussion of One

By Dr. David Edward Marcinko MBA CMP™

[Former – American Society of Health Economists (ASHE) member]

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Recently, I was asked to participate in a roundtable of expert’s discussion on the worth or fair market value [FMV] of a typical podiatric [medical] practice on an “ongoing concern” basis.

Of course, this is the type of engagement we often perform at the www.MedicalBusinessAdvisors.com And, I have written about this topic informally on this blog, and more formally in our white-papers and books: www.BusinessofMedicalPractice.com

So, I was pleased to add my experienced opinion to the discussion sponsored by a trade industry magazine upon the invitation of Editor Dr. Barry H. Block JD.

LINK: Podiatry Mgmt Round Table

Assessment

Due to copyright issues, I posted only my comments to the questions posed to all participants. Nevertheless, they are very representative of most medical practices with the exception of the noted podiatric-specific differences.

Invitation: Letterhead.iMBA_Inc.

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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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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An Rx for Physician’s Financial Health

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Fundamental Principles for all Medical Professionals

Donald M. Roy CFP® CFS www.newealthadvisors.com

SPONSOR: www.PhysicianNexus.com

The demands on medical practitioners today can seem overwhelming. It’s no secret that health-care delivery is changing, and those changes are reflected in the financial issues that health-care professionals face every day. You must continually educate yourself about new research in your chosen specialty, stay current on the latest technology that is transforming health care, and pay attention to business considerations, including ever-changing state and federal insurance regulations.

Like many, you may have transitioned from medical school and residency to being on your own with little formal preparation for the substantial financial issues you now face. Even the day-to-day concerns that affect most people–paying college tuition bills or student loans, planning for retirement, buying a home, insuring yourself and your business–may be complicated by the challenges and rewards of a medical practice. It’s no wonder that many medical practitioners look forward to the day when they can relax and enjoy the fruits of their labors.

Unfortunately, substantial demands on your time can make it difficult for you to accurately evaluate your financial plan, or monitor changes that can affect it. That’s especially true given ongoing health care reform efforts that will affect the future of the industry as a whole. Just as patients need periodic checkups, you may need to work with a financial professional to make sure your finances receive the proper care.

Maximizing your personal assets

Much like medicine, the field of finance has been the subject of much scientific research and data, and should be approached with the same level of discipline and thoughtfulness. Making the most of your earning years requires a plan for addressing the following issues.

Retirement

Your years of advanced training and perhaps the additional costs of launching and building a practice may have put you behind your peers outside the health-care field by a decade or more in starting to save and invest for retirement. You may have found yourself struggling with debt from years of college, internship, and residency; later, there’s the ongoing juggling act between making mortgage payments, caring for your parents, paying for weddings and tuition for your children, and maybe trying to squeeze in a vacation here and there. Because starting to save early is such a powerful ally when it comes to building a nest egg, you may face a real challenge in assuring your own retirement. A solid financial plan can help.

Investments

Getting a late start on saving for retirement can create other problems.

For example, you might be tempted to try to make up for lost time by making investment choices that carry an inappropriate level or type of risk for you. Speculating with money you will need in the next year or two could leave you short when you need that money. And once your earnings improve, you may be tempted to overspend on luxuries you were denied during the lean years. One of the benefits of a long-range financial plan is that it can help you protect your assets–and your future–from inappropriate choices.

Tuition

Many medical professionals not only must pay off student loans, but also have a strong desire to help their children with college costs, precisely because they began their own careers saddled with large debts.

Tax considerations

Once the lean years are behind you, your success means you probably need to pay more attention to tax-aware investing strategies that help you keep more of what you earn.

Using preventive care

The nature of your profession requires that you pay special attention to making sure you are protected both personally and professionally from the financial consequences of legal action, a medical emergency of your own, and business difficulties. Having a well-defined protection plan can give you confidence that you can practice your chosen profession without putting your family or future in jeopardy.

Liability insurance

Medical professionals are caught financially between rising premiums for malpractice insurance and fixed reimbursements from managed-care programs and you may find yourself evaluating a variety of approaches to providing that protection. Some physicians also carry insurance that protects them against unintentional billing errors or omissions.

Remember that in addition to potential malpractice claims, you also face the same potential liabilities as other business owners. You might consider an umbrella policy as well as coverage that protects against business-related exposures such as fire, theft, employee dishonesty, or business interruption.

Disability insurance

Your income depends on your ability to function, especially if you’re a solo practitioner, and you may have fixed overhead costs that would need to be covered if your ability to work were impaired. One choice you’ll face is how early in your career to purchase disability insurance. Age plays a role in determining premiums, and you may qualify for lower premiums if you are relatively young. When evaluating disability income policies, medical professionals should pay special attention to how the policy defines disability. Look for a liberal definition such as “own occupation,” which can help ensure that you’re covered in case you can’t practice in your chosen specialty.

To protect your business if you become disabled, consider business overhead expense insurance that will cover routine expenses such as payroll, utilities, and equipment rental. An insurance professional can help evaluate your needs.

Practice management and business planning

Is a group practice more advantageous than operating solo, taking in a junior colleague, or working for a managed-care network? If you have an independent practice, should you own or rent your office space? What are the pros and cons of taking over an existing practice compared to starting one from scratch? If you’re part of a group practice, is the practice structured financially to accommodate the needs of all partners? Does running a “concierge” or retainer practice appeal to you? If you’re considering expansion, how should you finance it?

Questions like these are rarely simple and should be done in the context of an overall financial plan that takes into account both your personal and professional goals.

Many physicians have created processes and products for their own practices, and have then licensed their creations to a corporation. If you are among them, you may need help with legal and financial concerns related to patents, royalties, and the like. And if you have your own practice, you may find that cash flow management, maximizing return on working capital, hiring and managing employees, and financing equipment purchases and maintenance become increasingly complex issues as your practice develops.

Practice valuation

You may have to make tradeoffs between maximizing current income from your practice and maximizing its value as an asset for eventual sale. Also, timing the sale of a practice and minimizing taxes on its proceeds can be complex. If you’re planning a business succession, or considering changing practices or even careers, you might benefit from help with evaluating the financial consequences of those decisions.

Estate planning

Estate planning, which can both minimize taxes and further your personal and philanthropic goals, probably will become important to you at some point. Options you might consider include:

  • Life insurance
  • Buy-sell agreements for your practice
  • Charitable trusts

You’ve spent a long time acquiring and maintaining expertise in your field, and your patients rely on your specialized knowledge. Doesn’t it make sense to treat your finances with the same level of care?

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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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How to Get Started in Healthcare IT [Video Presentation]

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An Encore Presentation from a ME-P Thought-Leader

By Ann Miller RN MHA [Executive-Director]

In this ME-P, Shahid N. Shah MS shares his best advice for information technology workers looking to get started in the healthcare industry.

Mr. Shah is also known as the Healthcare IT Guy [http://www.healthcareguy.com] informing us about technology issues in the healthcare field.

Link: http://www.physbiztech.com/video/shahid-shah-how-get-started-healthcare-it

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More Expert Advice from Leaders in Healthcare Management

And, sourced below are related interviews with these experts:

  • Todd Linden, President and CEO of Grinnell Regional Medical Center (about rural healthcare management);
  • Paul Levy, former CEO of Beth Israel Deaconess Medical Center; and
  • Dr. Robert Wachter, Professor of Medicine, University of California, San Francisco (author of “Understanding Patient Safety” and the blog “Wachter’s World”).

Link: Health Administration Degrees http://www.healthadministrationdegrees.com

Assessment

Shahid also authored Chapter 13 on eMRs, HIT and Clinical GroupWare [INTEROPERABLE e-MRs FOR THE SMALL-MEDIUM SIZED MEDICAL PRACTICE] in our best-selling book, the “Business of Medical Practice” http://businessofmedicalpractice.com/chapter-13-2/

So, the text and videos are worth a look www.BusinessofMedicalPractice.com Our colleague, and uber hospitalist Robert Wachter MD, is also mentioned in the book.

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.

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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IRA Strategies for Physicians in 2012

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Money Flows-In Even as Volatility Continues in Mid-Year

By Martha J. Schilling AAMS CRP ETSC CSA

http://www.schillinggroupadvisors.com

The amount of money in IRAs is climbing even as the volatility continues.

Most of us have at least one IRA and eventually many people roll over their main retirement assets, 403(b) and 401(k) accounts to IRAs.

Unfortunately, a lot of the value in IRAs isn’t being maximized.

By focusing on a few key strategies you can make an IRA more valuable in your lifetime and beyond.

Now, doctors and all medical professionals should consider the following:

OWN THE RIGHT ASSETS

An IRA has the advantage of tax deferral. Gains and income compound free of taxes until they are distributed. They have the disadvantage of converting long-term capital gains into ordinary income. All taxable distributions from an IRA are taxed as ordinary income. Research reveals that assets that pay high ordinary income are best held in IRAs. High-Yield bonds, Real Estate Investment Trusts and investment grade bonds as well as stocks, mutual funds and other investments that tend to be owned for less than a year generate short-term capital gains. Nontraditional, or alternative investments can be utilized, however know which are prohibited in retirement accounts.

PRACTICE TAX DIVERSIFICATION

No one can forecast how the tax code will alter. Different scenarios are in the works, perhaps one will be put into place late this fall. Different types of accounts have different tax treatments now, and that could change. Instead of forecasting one tax outcome and arranging your finances accordingly, it’s safer to have different types of accounts so you won’t be burned in any scenario. Try to own investments in taxable accounts, traditional IRAs, and Roth IRAs

CONVERT TO A ROTH

Every year, consider whether it makes sense to convert all or part of your traditional IRA into a Roth IRA. Discuss with your Tax advisor factors such as your expected rate of return, the difference between your current tax rate and future tax rates, the source of the cash to pay the taxes and whether future required minimum distributions would exceed your spending needs.

Your CPA/advisor will add other questions as he would know your personal situation and needs.

CONSOLIDATE or SPLIT?

Simplifying your finances often means consolidating all your accounts at one financial institution. Many people have multiple IRAs and simplifying means rolling them over into one IRA when practical. But suppose you have multiple heirs and expect IRAs to be a significant legacy. You could name all heirs as joint beneficiaries and let them decide what to do with the account. On the other hand, you could split the IRA now and name one person as the primary beneficiary for each.

SPEND ACCOUNTS in the RIGHT Order

As a general rule, it’s best to spend taxable accounts first, traditional IRA’s next and ROTH IRAs last. Not in all cases. When you visit your advisor and review what you need in cash flow at retirement, you may find that taking your RMD at 70 ½ puts you into a higher tax bracket. It may be less taxing to take normal distributions on a regular basis after 591/2.

REVIEW your BENEFICIARIES. There are horror stories of people who haven’t changed beneficiaries for decades and find a sibling or a parent is the beneficiary rather than your spouse.

CONSIDER CHARITY. Should you decide to leave part of your estate to charity, the most tax efficient way to do that might be to name the charity as beneficiary of your IRA? Individuals pay tax on distributions, Charities do not.

CATCH-UP CONTRIBUTIONS

When you’re still working and making contributions to IRAs, you can make higher contributions when age 50 or older. In 2012, the maximum for those over 50 is $6000 rather than $5000.

CONSIDER SPOUSE Generally IRA contributions can be made only to the extent you have earned income from a job or business. When filing a joint return, contributions can be made for both spouses up to the maximum of $6000.

REQUIRED DISTRIBUTIONS It appears people continue to make mistakes when taking and computing their RMD after 70 ½. The IRS has been lax on this in the past but is stepping up its tracking and enforcement.

Assesment

Can you think of any others?

Conclusion

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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Why the Government is Not-Like Medical Professionals

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An Endless Supply of US Dollars

By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

Is the United States in danger of bankruptcy? Contrary to what you may read in the media or hear from many politicians, no, it isn’t. The US Treasury will never run out of dollars. Unlike doctors and medical professionals, it’s impossible.

Reasons Why?

The reason is relatively simple. The US government owns a printing press. As long as goods, services, or obligations are priced in US dollars, the supply of dollars to our government to buy those goods and services is unlimited. This is not true of individual physicians, corporations, cities, states, and countries that don’t issue their own currency.

For most people, this is a hard concept to grasp, with good reason. The capacity of our government to create an unconstrained supply of dollars is a relatively new phenomenon.

The Gold Standard

Until 1971, all US currency was theoretically redeemable in gold. This was known as the gold standard. In the early decades of the 20th century, you could actually go to a bank and change your dollars for gold. That ability was terminated in 1933, but the dollar’s value was still tied to gold. This basically meant the only way the US government could create new dollars was by obtaining more gold, the supply of which only increases by the new amount of gold mined.

Nixon

In 1971 we had a paradigm change in monetary policy that many still don’t understand. President Nixon decoupled the dollar from the gold standard [Nixon also wanted to flood the country with MDs, and drive down physician income, by opening up medical school admissions]. It became a fiat currency, which is used as a medium of exchange but has no intrinsic value. Suddenly, the US government was no longer constrained by solvency issues and could never run out of money. It could create as many dollars as it wished ie; inflation].

Constraints

This didn’t mean it had no constraints. The major constraint to an issuer of fiat currency is inflation. However, creating money does not guarantee inflation if the newly created money is not spent. Japan, for example, is still fighting deflation even though they’ve been pumping money into reserves like crazy for 20 years.

What should have caused a massive rethinking and reeducating of the financial sector went relatively unnoticed. Text books, professors, economists, and politicians largely continued to follow many pre-1971 monetary principles that became irrelevant overnight.

Unlike the federal government, US states, cities, and other government entities cannot print money. They have to get it the old-fashioned way—from taxes, fees, or borrowing. It’s entirely possible for these entities to go bankrupt, just like individuals and corporations, if their outflow exceeds their inflow.

Europe

Interestingly, the same is true for member countries of the European Union. When in 1999 they adopted the Euro and gave up their sovereign right to print their own money, they took on the same status as states. Therefore, a country like Greece, which is a user of currency as a member of the European Union, can involuntarily default on its obligations.

This is a significant difference between the United States and Greece. While Greece can (and most likely will) go bankrupt because it doesn’t have an unlimited supply of Euros, the US can’t go bankrupt because it does have an unlimited supply of dollars.

The major threat that sovereign countries face is not running out of money, but devaluing their currency through inflation. A devalued currency is one that loses its purchasing power and often results in a lower standard of living.

Assessment

Just because the US can’t involuntarily default on its obligations doesn’t mean we can keep on over spending and pretend we don’t have any money worries. As a nation, we still need to acknowledge and deal with our serious financial problems. So should our doctors, financial planners and financial advisors.

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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About Next-Gen Bath Salts

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By The DEA Agent

Innocent Name – The Dangerous Consequences of MDPV

The recent media explosion over bath salts is not unwarranted. Over the past two years, the public eye has zoomed in on dangerous drug, still legally sold in some states. And, there’ve been many bizarre cases of violence and psychotic outbursts from users.

About MDPV

But, what exactly are bath salts?

Assessment

Keep reading the above to learn about the history and effects of bath salts.

Source: rehab-international.org

More info: http://en.wikipedia.org/wiki/Methylenedioxypyrovalerone

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Promoting the ME-P Holistic Physician Lifestyle

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Enter the Certified Medical Planners™

By Ann Miller RN MHA

[Executive-Director]

Life planning and behavioral finance, as proposed by physicians and financial advisors, and as integrated by the Institute of Medical Business Advisors (iMBA), emanates from a holistic union of personal financial planning and medical practice management solely for the healthcare space.

Source: https://www.mapsforthat.com/map.php?m=587

The CMP™ Difference

Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science. It has an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ zealous practitioners are called Certified Medical Planners (CMPs).

Assessment

Health 2.0 focused physician baby boomers & modern Gen-X financial advisors can help transition you successfully through medical practice and life changing financial events by exchanging knowledge, experiences and inspiration with industry professionals and peers in the casual and friendly atmosphere of the ME-P. Join us today.

More: https://medicalexecutivepost.com/2009/10/20/understanding-behavioral-finance/

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Doctors Shouldn’t Wait Till Retirement To Act On Travel Dreams

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By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

What’s at the top of your retirement bucket list? If you are like most folks that I help prepare for retirement, travel is high on that list.  As I’ve grown older, my views on retirement travel have changed. I used to buy into the dream of retirement as the “Golden Years.” I thought of it as the time in life when people are free to do what they want, when they want, with whom they want.

Working with older clients has taught me that my younger views of the glory of retirement were a bit naïve. While certainly some people do experience years of unlimited and unfettered travel, many more don’t find it so easy. Doing “what you want, when you want, with whom you want,” assumes three things we often take for granted: good health, adequate finances, and meaningful relationships.

This seems especially true for command-control type medical professionals.

The Three Legs of Retirement Lifesyle

1. Health. When it comes to travel, good health may not be essential, but it will make your experience more fulfilling and enjoyable. Of course, we aren’t typically in either “good” or “poor” health, but fall somewhere on a continuum. With limited mobility, you may be able to shop at the bazaar in Istanbul, but chances are you won’t hike the Grand Canyon or explore the Acropolis.

Like most things, good health typically requires a conscious intention to create and maintain it. Someone who has a money script of, “When I retire I’ll have the time and money to take better care of myself” may be in for a surprise. Most people who chose not to take care of their health before retirement won’t do so in retirement. As one retired friend said, “If you didn’t have the energy to work out when you were young, you sure won’t have it when you retire!”

What’s even more uncontrollable is the health of those with whom you wish to share your travel adventures. Even if you’ve taken care of yourself, your significant other may be unable to travel. Instead of strolling a beach in the Bahamas, you could end up at home being a caretaker.

2. Money. On average, baby boomers have saved less than $100,000 for retirement. That won’t pay for many around-the-world cruises. If you want to travel after you retire, you need a serious commitment during your working years to live frugally and invest as much as you can. Otherwise, you may end up with just barely enough to cover your basic living expenses.

3. Relationships. If you spend your career working 80-hour weeks, you may accumulate enough assets to fund plenty of retirement travel—but by then you may be traveling alone. Saving for the future is out of balance if it’s done at the expense of enjoying life and close relationships today.

Assessment

By now you may think I’m suggesting you have no better choice than to spend your retirement years at home. Not at all. Here’s one possibility: If travel is one of your dreams, what would happen if you did some of it now? Use your vacation time while you can enjoy yourself. Take that motorcycle trip through Europe or go scuba diving in Belize while you’re in top shape. Do the international travel now when you can better negotiate airports, handle travel delays, and power through jet lag. To save on expenses, plan ahead, use a credit card that awards frequent flyer miles (which you pay off monthly), and use cost-saving options like home swaps and off-season travel.

Then, after you retire, when you need more access to medical care and less demanding travel, you can stay closer to home and enjoy the opportunities in your own back yard.

More: http://www.mississippimedicalnews.com/retirement-and-succession-planning-cms-1524

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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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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On Smart Phones, Texting and Doctors Driving‏

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Doctors Beware – A Bad Idea

By Muhammad Saleem

Did you know that almost 60% of drivers use their phones on the road? What about doctors?

The numbers from our piece today could not be clearer on the consequences of using your smartphone while driving. For example:

  • You are 23 times more likely to get into an accident while texting.
  • 18% of distraction-related crashes are from cell phone usage.
  • Distracted driving is the number one killer of American teens.

Assessment

Doctors – Have you ever texted medical orders, or patient instructions etc., while driving? Be honest!

In addition to the above, our infographic discusses statistics on smarthpones and driving, illustrate the dangers, discuss the law, and provide tips to make you and your passengers safer.

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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New IRS Guidance on Health FSAs for Doctors

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On Section 125 Cafeteria Plans

By Children’s Home Society of Florida Foundation

In Notice 2012-40; 2012-25 IRB 1 (29 May 2012), the IRS issued guidance on the changes required in 2013 for Sec. 125 Cafeteria Plans.

Section 125 Plans

Many companies have created healthcare flexible spending accounts under Section 125.  For 2013, the salary reduction contributions are limited to $2,500.  The notice indicates that this limit will be adjusted for inflation in 2014 and later years. If contributions greater than $2,500 are made to the account, the excess funds will not subject the employee to penalties if the funds are distributed as taxable income in the taxable year in which the cafeteria plan year ends.  The $2,500 limit does not apply to non-elective plans.  Many of these plans are described as “flex limit” or similar plans.

New Limits

Written cafeteria plans must be modified to reflect the new $2,500 limit and other provisions.  If the plan follows the proposed regulations issued in 2007, the participants may rely on the plan to be qualified.

Assessment

And so, as more and more medical professionals become employees, FSA rules should be monitored closely by doctors and their FAs.

Conclusion

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The Marcinko Method of Improving Quality while Reducing Medical Errors and Healthcare Costs

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Dr. David Edward Marcinko FACFAS MBA CMP

[Former – Certified Physician in Healthcare Quality]

[Former – Certified Financial Planner]

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

THINK TWICE!

Doctor’s Orders

Life Corollaries:

Marcinko’s Rx for Obesity: Eat less – Exercise more – Avoid noxious lifestyles.

Marcinko’s Rx for Practice Success: Treat sick patients – Be humble – Keep faith.

Marcinko’s Rx for Financial Success: Spend less – Earn more – Be a fiduciary. 

Marcinko’s Rx for Wealth & Happiness: Don’t divorce – Love kids – Practice philanthropy.

Professional Medical Corollary:

The Choosing Wisely® list, which is aimed at cutting down on unnecessary testing by doctors and patients.

Assessment  

I am not an oracle. What else can you ad to the list?

Conclusion

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

Certified Medical Planner

Physicians as “Dr. Money Waster”

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Paging … Doctor Money Waster?

By Rick Kahler MS CFP® ChFC CCIM

www.KahlerFinancial.com

Be frugal. Live on less than you make. Save for the future. It’s my message, and I’m sticking to it.

Just in case you’re getting tired of that message, though, let’s take a look at thrift from a slightly different perspective.

And so, for any medical professional who wants to throw cash around, here are some effective ways to waste your money:

How to Waste Money on Travel:

  • Buy package vacation deals.
  • Buy a vacation home.
  • Get an RV and only use it one or two weeks a year.
  • Buy a timeshare unit.
  • Pay for hotel Internet packages.
  • Eat at hotel restaurants.
  • Use room service.
  • Over-pack and pay checked airline baggage fees.
  • Don’t bother to use a travel credit card that gives you frequent flyer credits.
  • Stay at full-service hotels with amenities you don’t use.

How to Waste Money on Big-Ticket Items:

  • Buy a new car every three years.
  • Buy hybrid cars.
  • Pay for extended warranties.
  • Fail to compare prices and check product reviews.
  • Pay full price for furniture.

How to Waste Money on Insurance:

  • Get a cancer or accidental death policy.
  • Buy credit life insurance.
  • Buy variable universal life insurance.
  • Have life insurance if you don’t need it.
  • Keep your deductibles low.
  • Purchase the cruise line’s trip insurance.
  • Purchase car rental insurance.

How to Waste Money on Investing:

  • Don’t take advantage of a retirement plan with employer matching that doubles your money.
  • Invest outside of a retirement plan instead of fully funding the plan first.
  • Buy variable and fixed annuities that charge you big commissions and high fees.
  • Buy load mutual funds and trade them often.
  • Cash in your 401(k) or 403(b) plan when you leave your job instead of rolling it to an IRA.
  • Cash in your IRA when money gets tight.

How to Waste Money on Health and Fitness:

  • Buy home fitness equipment and use it to hang clothes on.
  • Pay for a fitness center membership but rarely or never use it.
  • Be a sucker for the latest “cure-all de jour” supplement or multi-level marketing product.
  • Pay more for specialized brand-name vitamins even though store brands are just as good.
  • Buy junk food instead of stuff that’s good for you.
  • Skip those regular visits to the doctor and the dentist.

How to Waste Money with Your Everyday Habits:

  • Drive across town to save two or three cents on gas.
  • Buy grocery name brands instead of cheaper store brands.
  • Pay full retail price for clothes, furnishings, or other items instead of waiting for sales.
  • Buy bottled water.
  • Disregard ATM fees.
  • Pay hefty overdraft fees because you don’t bother to keep track of your bank balance.
  • Forget to change your furnace filter.
  • Don’t bother to maintain your car or house.
  • Be disorganized about taking care of bills on time, so you pay late fees.
  • Pay for premium cable TV packages with channels you rarely watch.
  • If you can’t afford something now, pull out the plastic. When you don’t pay a credit card bill in full at the end of the month, high interest rates can quickly double or triple the price of anything you buy.
  • Gamble. Online gambling, slot machines, gaming  tables, and lottery tickets are all good ways to get rid of extra cash.
  • Speed. This is a three-for-one deal. You’ll use extra gas, pay $100 or more for a speeding ticket, and end up with higher car  insurance premiums.

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Assessment

Even practicing a few of these overspending habits will give you more financial stress and less financial security. Just observing half of them will give you an interesting life full of financial chaos.

Follow more than half and you, too, can qualify as a first-class Dr. Money Waster.

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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How a Medical Answering Service Really Works

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The Traditional System

Ever wonder that happens when you call your doctor’s office after hours and someone picks up the phone? The office is not open at midnight if that’s what you were wondering. Most physicians / doctors / medical professionals have their phones forwarded to an answering service after hours!

What does that mean?

Well, it means that no matter what time it is you can always reach your doctor.

Check out the above infographic to learn out how the call routes from your cell phone to the service to the doctor.

Assessment

Now, with all these steps, it is no wonder modern doctors are using cell phones, iPads, direct or open access online patient scheduling systems.

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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How to Calculate your Financial APGAR Score

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Using a Well-Known Medical Model for Personal Financial Planning

By Andrew D. Schwartz CPA

The term “APGAR Score” should already be familiar to people who’ve experienced the birth of a child and to people in the medical community. Immediately after birth, every baby is evaluated by a doctor to determine its medical condition. The evaluation consists of the following five signs: appearance, pulse, grimace, activity, and respiration. The the eponymous Dr. Virginia APGAR score, developed in 1952, ranges from 0 to 10 and serves as an initial indication of the baby’s overall health.

The Financial Affairs Paradigm Shift

Anyone looking to gain control of their financial affairs must first get a sense of where they stand. And so, we’ve developed a variation of the APGAR test to help people make an initial self-evaluation of their financial condition. The five financial attributes of our APGAR test are as follows:

  1. Accumulated Wealth
  2. Payment of Credit Card and Consumer Debt
  3. Got Life and Disability Insurance
  4. Automobile Habits
  5. Residential Equity
Accumulated Wealth

In this first step, you compare your net investments, your age, and your income. You first need to calculate the total fair market value of all of your investments assets, excluding your principal residence and your cars. Make sure to include non-retirement savings, retirement savings, and any other investments that you may own. You should then calculate the total of all of your debts, excluding any loans on your principal residence and your cars. Don’t forget to include your student loans and your credit card debts.

You should then subtract your total debts (excluding loans on your principal residence and your cars) from your total assets (excluding your principal residence and your cars) and:

  • Give yourself 2 points if your net assets divided by your annual household income exceeds
    {[(your age – 30) * .2] +1}. Married couples should use the average of their two ages.
  • Give yourself 1 point if your net assets are greater than $0 but not enough to qualify you for 2 points.
  • Give yourself 0 points if your net assets are less than $0.
Payment of Credit Card and Consumer Debt

In this step, you’ll take a look at your credit card habits. Always maintaining a balance on your credit cards can really cause your financial position to erode significantly.

  • Give yourself 2 points if you generally pay off your credit cards each month.
  • Give yourself 1 point if you owe money on your credit cards, but will have them all paid off within 6 months.
  • Give yourself 0 points if there is no way that you’ll be out of credit card debt within 6 months.
Got Life and Disability Insurance

Life insurance and disability insurance are two key ingredients to a successful financial plan. Generally, a person will obtain life insurance and disability insurance either as part of their benefits package provided by their employer or on their own through an insurance salesperson or financial advisor.

  • Give yourself 2 points if you have purchased life insurance or disability insurance on your own.
  • Give yourself 1 point if you have life and/or disability insurance through the benefits package offered by your employer.
  • Give yourself 0 points if you have no life or disability insurance at all.
Automobile Habits

Besides one’s home, automobiles are generally a person’s largest purchase. The car you drive is also perceived as a status symbol and can be an area where even the most frugal person would consider being extravagant. How long do you generally hold onto your cars for?

  • Give yourself 2 points if you hold onto your cars for more than 5 years, are provided with a company car from your employer, or don’t own a car and spend less than $300 per month on rentals and cabs.
  • Give yourself 1 point if you generally hold onto your cars for less than 5 years, but more than 3 1/2 years or, if you don’t own a car, you spend more than $300 per month but less than $500 per month on car rentals and taxis.
  • Give yourself 0 points if you generally hold onto your cars for less than 3 1/2 years or, if you don’t own a car, spend more than $500 per month on car rentals and taxis.
Residential Equity

Owning a home is an essential component to most financial plans. Home ownership provides a hedge against inflation and a tax-free means of accumulating wealth. For this step, you’ll need to know the fair market value of your home and the current balance of any mortgages and equity loans on that property.

If you own a home, you must calculate the value of your home’s equity by subtracting the current balance of your mortgages and equity loans from the current fair market value of the home.

  • Give yourself 2 points if the equity in your home divided by the home’s fair market value exceeds {[(your age – 30) * 2.5%] +25%}.
  • Give yourself 1 point if the home’s value exceeds the current balance of the mortgage and equity loans but you don’t have enough equity to qualify for 2 points.
  • Give yourself 0 points if you do not own a home, or if the amount that is owed on your home exceeds its fair market value.

Your APGAR Score Card

A: _____________

P: _____________

G: _____________

A: _____________

R: _____________

TOTAL: ______________

 Assessment and Score Interpretation
  • If your score is 8 or higher, you appear to be on the right track with your finances. Take a look at any attribute that didn’t score a 2, and see if you should make any changes.
  • If your score is between 5 and 7, you have a pretty big job ahead of you. You should try to determine which of the financial attributes need work and put together a plan to make improvements in those areas.
  • If your score is 4 or less, you have lots of work to do. Take a deep breath, and make a commitment to get your finances on track. Keep in mind that the challenge you face may be daunting, but it is not insurmountable.

About the Author

Andrew D. Schwartz, CPA is founder and managing partner of Schwartz & Schwartz, PC, in Woburn, MA. Since 1993, Andrew has provided tax, practice management, payroll, and basic financial planning services to healthcare professionals and their practices. Andrew is also the founder of The MDTAXES Network, a national association of CPAs that specialize in the healthcare profession. Andrew is a frequent speaker at national and area conferences (including the Yankee Dental Congress and the 2012 National Audiology Conference), medical and dental schools, and community events.  Andrew is the author of many tax and basic financial planning articles on a variety of issues that impact healthcare professionals. He is frequently interviewed as a tax advisor on current topics in national media, such as ABCNews.com, Washington Post and Wall Street Journal, and local media, such as Greater Boston Radio 92.9 and Boston.com.  Andrew graduated from the Wharton School at the University of Pennsylvania. He is a member of the Massachusetts Society of CPAs (MSCPA) and the American Institute of CPAs (AICPA). Andrew was selected as a 2011 and a 2010 winner of Boston Magazine’s “Five-Star Wealth Manager – Best in Client Satisfaction” award.

Conclusion

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***

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

About the Institute of Medical Business Advisors, Inc

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Championing the Financial Success of

Doctors and their Consulting Advisors

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Alternative Solutions to Medical Malpractice Insurance

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About Captive Insurance Companies

By William Clay Tucker CAP CMFC CRPS

The Woodville Group, LLC wctucker@thewoodvillegroupllc.com

Most states don’t recognize small captive insurance companies (CIC’s) as beneficial holders for required medical malpractice coverage.

Couple this with the fact that most medical practitioners aren’t insurance experts, and the end result is that doctors have only a few (very similar, quite expensive) malpractice insurance options.

So, when it comes time to purchase or renew your medical malpractice insurance, you have three options:

  1. Retail Med-Mal: While this may seem like the simplest solution, it is also the most expensive. With zero returns on premiums paid, you are funneling your money into a “black hole”. Regardless of your claims history, you never see a return on reserves. In the event of a claim, you may have little – or no – say in your defense or the claims negotiation and settlement process.
  2. Normal Risk Retention Groups (RRGs): Although an RRG is a step in the right direction, your medical group will be sharing overall medical malpractice risks with other medical groups insured by the RRG. While you may get back some of what you put in (as a return on equity or a stock repurchase), the amount depends on the claims experience of the RRG’s insureds as a whole and the financial condition of the RRG at the time of your departure from the RRG. Under this approach, the medical group’s financial investment remains 100% in the RRG during the entire insurance coverage period.
  3.  A Single Practice Risk Retention Group: A medical practice can now form its own small Risk retention Group (RRG).  The RRG retains a small percentage of overall insurance risk (an average of ten percent) and therefore your group’s participation in shared risk with all of other insured medical groups remains small.  The primary reinsurance structure is the reinsuring Captive Insurance Company (CIC) which is owned 100% by your  medical group’s owners and only reinsures the physicians in your medical group practice. In the Single Practice RRG model, the majority of your medical group’s financial investment remains in its CIC, which will remain owned and controlled by the owners of your medical group.

Enter the Single Practice Risk Retention Group

Year after year, as rates go up, doctors are funding their med-mal insurance and never seeing a return on the premiums they pay. With this structure you can insure your medical group’s practice and see a significant return on paid premiums by practicing good medicine and good risk management.

Advantages

Here are just a few advantages that a Single Practice Risk Retention Group can offer:

  • The insurance company is owned by the same medical groups it insures
  • Regulated financial and insurance reporting methodologies, no questionable loopholes or practices
  • Return of stock at book value when medical group is no longer an insured or medical practice changes its insured personnel.
  • Recapture lost wealth through practicing good medicine and risk management!
  • After five years, your medical group could get back more than 50% of what it has paid in total premiums
  • After ten years, your medical group could get back more than 100% of what it has paid in total premiums

Assessment

Those with the highest insurance rates, such as surgeons or OB/GYN doctors have the most to gain from self-insurance structures. In order to get started in forming your own Captive Insurance Company (CIC), you must first understand that this is not meant for a short-term solution. Because of the fees due when getting started, a minimum of three years commitment is required. The longer you hold this insurance with fewer claims, the more assets will be available at its completion. Recapture lost wealth—you owe it to yourself to investigate.

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The True Cost of Automobile Ownership for Physicians

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The First Ten Thousand Miles is the Most Expensive

dr-david-marcinko

By Dr. David Edward Marcinko MBA FACFAS CMP™

[Editor-in-Chief]

With the July Fourth Holiday behind us, America’s summer long vacation road-trips begin.

But, anyone looking to buy a new car should be well aware that the cost of a car doesn’t end at the purchase price.

Other Factors

For example, you must consider additional concerns such as: depreciation, fuel costs, insurance, maintenance and repair, invoicing and sales tax.

***

***

To help potential buyers with their purchases, we’ve put together the above infographic that outlines the real cost of ownership of various types of cars.

Source: www.insurancequotes.org

And, always let some other fool take the depreciation hit; buy previously owned [a.k.a. used] cars.

Assessment

Anyone who is a regular reader of the ME-P knows about my vintage 2000 Jaguar XJ-V8-LWB European touring sedan built in Coventy, England. She is a beauty who has never known rain, winter or snow. Mostly highway miles, always garaged. She not only clicks – she ROARs!

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Transparency Emerges in Dentistry

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Cavities Blamed on Patients

[By D. Kellus Pruitt DDS]

If your car repeatedly requires costly repairs because you never change the oil, would you blame your mechanic?

PBS Frontline

Dentists are justifiably upset because the recent PBS Frontline documentary “Dollars and Dentists” blames them for our nation’s deteriorating oral health.

http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/

When in reality, good oral hygiene habits are the very basics of personal accountability – reinforced by painful and embarrassing lessons as needed.

Tradition Dentists Usually Silent

Traditionally, dentists seldom speak up. But at a time when they are finding it difficult to keep their chairs filled, even by discounting their fees, “Dollars and Dentists” struck an inflamed nerve – causing dentists to publicly react in defense of the profession like never before.

As an example, here is Dr. Alan Mead’s blunt response which he posted for his patients to read on his Mead Family Dental website:

“If you have dental problems, it’s mostly your fault. And if you want to have less dental problems, it’s your responsibility. It’s not the fault of the dental insurance company. It’s not the government’s responsibility. It’s on you.”

http://meadfamilydental.com/2012/07/preventable/

Responses

According to other responses, apparently far fewer blameless people are born with “soft teeth” than one might be led to believe by people with lots of cavities. Dentists have politely, but futilely reminded people for decades that it’s refined sugar, bacteria and poor brushing habits that rots teeth.

Assessment

I think the demand for truth in healthcare is going to continue. Over the next few months watch for one or more recognized leaders in the dental profession to actually mention the word “transparency” for the first time since 2008 when an ADA President-elect candidate from California used the word in his campaign platform. He lost. But now that dentists are finally becoming sufficiently annoyed by reporters’ broad accusations of greed and malfeasance, it could be interesting to watch the predictable emergence from obscurity of this perky little healthcare niche – one agitated dentist at a time.

Conclusion

If openness were popular, someone would have long ago told Grandpa his breath smells like death.

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A Review of LP / LLC Transfer Hazards for Physicians

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Can standard boilerplate and default corporate law provisions inadvertently disinherit your family from controlling the business or cost millions in additional estate/gift tax?

By Ed Morrow, JD, LL.M. (tax), MBA, CFP®

[Manager, Wealth Strategies Communications, Key Private Bank]

Many physicians use limited liability companies, limited liability partnerships or limited partnerships (“LLCs”, “LLPs” and “LPs”) to operate a trade or business, to hold real estate, or even to hold investment assets.  When only immediate family are owners, these are often referred to as family limited partnerships or limited liability companies (“FLPs” and “FLLCs”).  There are numerous business, asset protection and estate planning reasons for using these entities (hereinafter lumped together for simplicity as “LLCs”).  In many cases, these are preferable to old-fashioned corporations (see separate companion article on LP/LLC Advantages).

As a doctor – you must be very careful, however, when transferring LLC shares during lifetime or at death, to your spouse, children, trusts or others.  Especially when there are co-owners outside the immediate family.  This is due to a stark difference between LLC/partnership law and corporate law and the concept known as “assignee interests”.  Understanding this is even more crucial in 2012 because of the overwhelming demand and interest in transferring LLC interests to irrevocable trusts to exploit the $5.12million gift tax exclusion, which is slated to reduce to only $1 million in 2013.

An LLC owner (called a “member”, not a “stockholder”) has two bundles of rights:

  1. Economic rights – which are the rights to receive property from the LLC both during existence and upon liquidation, along with tax attributes and profit/losses; and
  2. Management rights – the right to vote, participate in management and receive reports and accountings.

It is the latter category that can cause problems when transferring LLC interests by gift or at death.

Members of an LLC usually establish an Operating Agreement to set the rules for transfer of interests.  State statutes (such as the Uniform Limited Liability Company Act) usually provide default rules where the document is silent.

The problem occurs when an LLC member transfers a portion of his or her ownership interest in the LLC to another person, either during lifetime or at death.  At that point, the transferee may become a “mere assignee” of the LLC interest, and not a full “substitute member.”  Under the laws of most states, unless the Operating Agreement provides or parties otherwise agree, an assignee only receives the transferor’s economic rights in the LLC, but not the management rights.

In fact, some court cases require member consent even if the operating agreement seems to otherwise permit such transfers (Ott v. Monroe, 719 S.E.2d 309, 282 Va. 403 (2011).  These state laws were enacted to protect business owners from unwillingly becoming partners with someone they never intended or contracted to be partners with.

This treatment is completely different from transferring C or S corporation stock – when you buy P&G stock, you get the same rights as the previous owner.  S Corporation stock is not even allowed to have differing classes of ownership interests (although voting/non-voting is permitted).  Usually, this quirk in the law has numerous asset protection benefits to LLC owners (discussed in the companion article), but it can cause havoc to one’s business planning in unforeseen circumstances.

Examples of Inadvertent Loss of Control

#1- Doctors Able and Baker, unrelated parties, form and operate an LLC.  Able owns 49% and Baker owns 51%.  Baker has a controlling interest in the LLC.  Baker dies and his 51% interest in the LLC is transferred to his revocable living trust.  Now, the trust is a “mere assignee” and while the trust receives 100% of Baker’s economic rights in the LLC (51% of the total LLC economic rights), it has none of the management rights.  After Baker’s death, Able will have 100% of the LLC’s management rights.  The trustee may have serious difficulty even getting books and records of the LLC, much less have any say on reviewing Able’s business decisions (including new hire and new salary expectations).

#2 – Same ownership structure as above, but Baker leaves assets via Transfer on Death designation or via Will to his spouse, children or others directly.  Same result.

#3 – Same ownership scenario as above, but Baker gifts his membership interests during life to his spouse, children, UTMA account or an irrevocable grantor trust.  Same result.

#3a – Same scenario as above, but Baker simply transfers his shares to his revocable living trust (called “funding”) via Schedule A attached to trust or other assignment.  Same result.

#4 – Same scenario, but Dr. Baker got express permission of Able to transfer his LLC interest to his revocable living trust and have it remain a full substitute member.  No issue – until Baker dies and the LLC interests pass to a new subtrust, such as a bypass, marital, QTIP, or other irrevocable trust, or to beneficiaries outright.  Able must have agreed to this subsequent transfer as well, otherwise the transfer to the new subtrust will be a mere assignee interest and the Baker family loses control.

Creditor Issues

Again, Able and Baker own 49%/51%.  Baker has some creditor issues from a tort claim and co-signed loans unrelated to the LLC.  He files bankruptcy to reorganize or get a clean start (or perhaps the creditor forces a bankruptcy).  This is probably another trigger that causes Baker to lose all of his management rights in the LLC.

Incapacity Issues

Again, Able and Baker own 49% and 51% economic and management rights respectively.  This time, Baker has a stroke or an accident and his wife or one of his family takes over as guardian or conservator.  Similar result.  Able now has 100% controlling management rights, even though Baker still keeps the same economic rights.  He can fire Baker and raise his own salary.

Estate/Gift Tax Issues 

Able and Baker’s company is worth $10Million.  Baker’s 51% interest gets marketability discount, but a controlling premium, so valuation experts and the IRS agree it is worth $4Million.  Able’s 49% interest gets a marketability and lack of control discount, so his interest is only worth $3 million.  Yet when Baker dies, he leaves this 51% interest to his spouse (or marital trust) as a mere assignee, and because the interest has no voting control or management rights, it may be worth only about $3 million in the hands of the spouse/trust (because there is no “control” or management rights, the 51% is worth considerably less).  Thus, Baker’s 51% interest is taxed at $4 million, but only gets a $3 million marital deduction (this same discrepancy is true for charitable gifts, which is why physicians should also be careful gifting LLC interests to charities or charitable trusts).  Did $1 million in value inadvertently pass to Able?  At best, this wastes Baker’s estate tax exemption.  At worst, it may lead to an additional 55% tax (and probably penalties, since it would unlikely be reported and caught on audit) on $1million, or $550,000 additional tax that could easily be avoided.

This same issue arises in gifting shares to a spouse or to a trust for a spouse that is intended to qualify for the marital deduction (or to charities or charitable trusts).

In addition, gifting a mere “assignee” interest risks disqualifying any LLC/LP gifts for the “present interest” annual exclusion under IRC 2503(e) ($13,000 per donor per donee) pursuant to the recent IRS wins in the Hackl, Fisher and Price cases.

Furthermore, it adds grist to a favorite line of attack that the IRS uses to add to taxpayers’ estate tax bill.  If a taxpayer has a “retained interest” in a gift, the IRS has been successful in pulling such gifts back into a taxpayer’s estate (therefore causing additional 35-55% estate tax).

What Can Physicians Who Own LP/LLCs Do?

If you want to transfer both economic rights and management rights in your LLCs, similar to shares of stock of a corporation, then the LLC’s written Operating Agreement should be reviewed and/or revised to admit certain transferees or assignees (like a guardian/conservator, spouse, children, trust, subtrusts, etc) as full “substitute members”, while other transferees (like creditors, ex-spouses) can remain “mere assignees”, with no management rights.

LLC owners may decide on other variations on the above solution if desired.  For instance, some owners might prefer to exclude a surviving spouse or children from management rights, but be perfectly comfortable with having an independent or agreed upon trustee of a marital trust accede to those rights.  The key to good planning is to know the consequences of gifts/bequests beforehand to adequately plan.

Make sure your entire wealth management team is on the same page when orchestrating your wealth planning.  Ask whether they use a checklist of any sorts in their planning, or even if they do, whether they communicate the checklist with other advisors on your team – many do not.

Assessment

As noted in Atul Gawande’s The Checklist Manifesto, simple checklists can often prevent mistakes and miscommunications among even the most educated of professionals – this is certainly true for asset protection and tax planning for LLC interests, and at no time more than in 2012 with all of the anticipated tax changes and proposals threatening to snare any missteps in planning.

ABOUT THE AUTHOR

© 2012 Edwin P. Morrow III and KeyBank, NA.  The author holds the following designations:  J.D., LL.M. (masters in tax law), MBA, CFP® and RFC®.  He is a Board Certified Specialist in Estate Planning, Probate and Trust Law through the Ohio State Bar Association.  He is an approved arbitrator for the Financial Industry Regulatory Association (FINRA).  He currently provides educational and consultative services nationwide for the financial advisors and clients of Key Private Bank.  Contact:  (937) 285-5343 or:  Edwin_P_Morrow@KeyBank.com Ed is also a friend of the ME-P and designated “thought-leader”. 

Conclusion

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Do Clients Trust Financial Advisors More than Doctors or CPAs?

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I Think … Not in My Universe

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Survey after survey has shown that the public does not trust the financial services industry; it was – in fact, the least trusted industry in a recent Rick Edelman survey.

John Hancock?

But, perhaps they were looking at the wrong industries, or maybe investors just don’t trust your firm. A new survey by John Hancock shows that investors with assets of $200,000 or more, trust their financial advisor [FA] more than their primary doctor, accountant, contractor/handyman, boss and real estate agent. It was penned by one young staff writer named Diana Britton.

Link: http://wealthmanagement.com/blog/clients-trust-you-more-doctors-cpas?NL=WM-04&Issue=WM-04_20120611_WM-04_597&YM_RID=marcinkoadvisors%40msn.com&YM_MID=1318408

My View Point is Pretty Unique

Now, I am a doctor and board certified surgeon who held Series #7, #63 and #65 securities licenses, and was a Certified Financial Planner® for more than a decade. I was registered with a BD, SEC and NASD/FINRA, and held life, health and PC insurance licenses. This is the so-called “dual registration” to earn commissions and fees.

And, I’ve got a current partner who is a doctor-CPA who has a Master’s Degree in Accounting.  So, I know from whence I speak.

An Insurance Company!

Now, I resigned all of the above financial services monikers because of their lack of education and fiduciary accountability. These are sales licenses, certifications to hold a certification, and related gimmicks, all. Insurance agents have a duty to the company, not the client. Always ask them to put your best interests ahead of their own – in writing before hire – and watch them run.

Assessment

I suspect this study from an insurance company is less than accurate. How do I know? My gut heuristics tell me. Agency law tells me. No surveys needed or damn statistics for me. How about you? OR, are the marketing and PR gurus winning the public opinion battle with their insurance company advertising chicanery? ie., Hancock’s the future is yours!

If really so, here is my razzy for them.

 
Note: It is for the above reasons, and more, that we started the www.CertifiedMedicalPlanner.org online education program for financial advisors and management consultants that truly want to be trusted.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Diana – call me.  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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How Health Reform Could Expand Medicaid

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PP-ACA Results State-by-State

By Lena Groeger
ProPublica

Experts estimate that nearly 16 million Americans could be added to the Medicaid rolls by 2019 under an expansion in the Affordable Care Act. But, the Supreme Court ruled last Thursday that states can opt out without risk of losing federal support for Medicaid, raising the stakes that some may do so.

The Big Picture

Here is a look at forecast growth in state Medicaid rolls under the expansion. Twenty-six challenged the act in court.

IMAGE LINK: http://www.propublica.org/special/state-by-state-how-health-reform-could-expand-medicaid

Related: Mystery After the Health Care Ruling: Which States Will Refuse Medicaid Expansion?

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Are Doctors Withdrawing Enough for Retirement OR Too Much?

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Retirement Planning www.KahlerFinancial.com

By Rick Kahler MS CFP® ChFC CCIM

One of the biggest adjustments for doctors, and all medical professionals, when they retire is making the switch from saving to spending. For years and years, they’ve been putting money away for the future. It’s hard to accept that it’s time to start taking that money out because “the future” has arrived.

How Much – The Big Question

Financial planners can help retired clients make this transition more comfortably by helping them decide on a reasonable withdrawal rate to answer the crucial question, “How much can I take out of my portfolio every year?” That rate needs to balance the need to have enough money to live comfortably and the need to make sure there is enough money for the rest of the clients’ lives.

Pessimism Rules

This is one area of financial planning where pessimism is a virtue. If an advisor claims you can withdraw eight or ten percent, or even more, that’s a red flag that you’re getting bad financial advice. For most people, rates that high are simply not sustainable. A few planners are comfortable recommending withdrawal rates of five or six percent. The more standard rate is four percent. Conservative planners, me among them, tend to recommend three percent.

The Four Percent Anchor

Over my years as a financial planner, however, I’ve come to realize the futility of anchoring on a set withdrawal rate. This is a number that needs to be established based on each client’s needs and circumstances. Because so many variables affect safe withdrawal rates, planners need to keep up on the latest research and continually refine their thinking in this area.

Every time we change the investment mix in clients’ portfolios, it changes the standard deviations, which in turn affect withdrawal rates. For example, at Kahler Financial Group we historically have used a cost-of-living estimate for Social Security of 3%. This was even with our long-term projected increase for the Consumer Price Index (CPI). With some of the current turmoil and lack of confidence that Congress will put Social Security on a firm footing without some type of crisis, we have lowered our COLA expectations to 1% under the CPI, or 2%. Of course, this affects the withdrawal rate we recommend to clients.

The Frugal Types

Most financial planners have some clients who withdraw significantly less than they could. These frugal types are extremely unlikely to run out of money before the end of their lives. They will almost certainly “leave some money on the table.” This is fine if they want to leave money to their heirs. The possible downside is that they could have used some of that money to live more comfortably during their retirement years.

The Spendthrift Types

At the other extreme are those who, for various reasons, take out the maximum that the planner recommends or even more. The higher the withdrawal rate, the lower the probability that they will have enough money to last as long as they live. Only the clients themselves can decide whether their comfort level is at a 99% chance of having enough and even leaving money on the table, a 95% chance, or even down to a 60% or 50% probability of having enough.

Assessment

A projected withdrawal rate is just that, a projection. It’s an educated guess. Markets change, economies change, and unplanned events happen in life. All of those circumstances will affect portfolios and withdrawal rates.

And so, what type of medical professional drawdown participant are you?

Conclusion

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Some Starting Salaries for New Under-Graduates

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Jobs Outlook

Many doctors and medical professionals have offspring about to enter the job market. While the current economy can certainly make job hunting frustrating for some recent grads, it’s not all bad news.

Source: Online Colleges Guide

Assessment

Nearly 60% of employers surveyed rated the current job market good to excellent, and many plan to increase their number of hires this year.

Conclusion

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The Supreme Court Permits Healthcare Taxation “Penalty”

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On the PP-ACA

By Children’s Home Society of Florida Foundation

In 2010 Congress passed the Patient Protection and Affordable Care Act (PPACA). A key part of the Act is an individual mandate for health insurance. All individuals must have health insurance by 2014 or pay a tax-penalty.

The Tax Penalty

The tax-penalty starts at the greater of $285 per family or 1% of income in 2014. However, by 2016, the tax-penalty increases to $2,085 per family or 2.5% of income, whichever is larger.

Commerce Clause

Many states sued the federal government and asked that the individual mandate be held invalid. While the various courts had different positions on the issue, some federal judges were concerned that requiring a person to purchase insurance could be a violation of the Commerce Clause of the U.S. Constitution.

CJSC John Roberts

Chief Justice of the Supreme Court John Roberts wrote the opinion for a 5-4 majority in the PPACA case. First, he determined whether or not the Court was prohibited from ruling on the case under the Anti-Injunction Act. He decided that the required payment would be a “penalty” for purposes of that Act and not a tax. Therefore, the Supreme Court could issue a ruling.

Second, Chief Justice Roberts reviewed the powers of government under the Commerce Clause. He agreed with the other four justices opposing PPACA that Congress had the right to regulate commerce, but does not have the right to regulate non-activity. Therefore, requiring individuals to purchase health insurance is not a permitted power under that provision. PPACA could not be approved under the Commerce Clause.

However, Roberts observed that it is permissible for the Court to consider the validity of PPACA under the power of the government to tax. He determined that the individual mandate to purchase insurance or pay a penalty-tax is permitted under that power. Roberts stated, “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” He carefully approved the use of the power without discussing the appropriateness of PPACA provisions.

Roberts found several reasons for permitting the taxing power. The tax-penalty will be paid when filing IRS Form 1040. As is true with other tax provisions, lower-income individuals are excluded from this tax-penalty. The tax-penalty is part of the Internal Revenue Code and will be collected by the IRS.

Dissenters

The four dissenting Justices would have determined that PPACA fails to meet the requirements of the Commerce Clause and would have invalidated the entire bill.

Editor’s Note: The taxes to pay for PPACA include a new tax on medical devices that will increase costs to individuals and healthcare providers. There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains. If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%. The increase in capital gains rate may influence charitable gifts of appreciated property in 2013.

Conclusion

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Taxes and the SCOTUS ACA Decision

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My Synopsis for Physician Investors

By Dr. David Edward Marcinko FACFAS MBA CMP™

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

I was at Emory University this past weekend for an unrelated colloquium. But all the chatter, of course, was about SCOTUS, taxes and the just announced ACA decision.

Most doctors I know – just don’t like paying needless taxes. So, what’s the buzz for physicians and other medical professional investors, and their financial advisors [FAs]?

The Synopsis

The taxes to pay for the Affordable Care Act include a new tax on medical devices that will increase costs to individuals and healthcare providers.

There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains.

If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%.

In addition to dividend seeking investors, the increase in capital gains rate may also influence charitable gifts of appreciated property in 2013.

Assessment

Please weigh-in all you FAs and healthcare focused CPAs. What is a physician investor supposed to do, now?

Conclusion

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Events Planner: July 2012

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Events-Planner: JULY 2012

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“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:

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