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    As a former Dean and appointed Distinguished University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    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 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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Medical Office Fee Strategies for Disgruntled Patients

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Adroitly Handling a Tough but Common Office Situation

[By Dr. Gary L. Bode MSA CPA]

A common scenario, in medical practice, is patient disgruntlement over professional fees.

The Scenario

This scenario should not occur in front of other patients. Many receptionists find that genuine, cute little quips like, “I know it seems high, but (wink), I’m expensive to maintain,” defuse the situation by gentling pointing out the overhead factor.

The Balk

When a patient balks at fees, gently and politely imply that we could inquire if the local plumber was available to do the exam, procedure or surgery.

Assessment

This brings training and relative cost issues into play while making them smile.  Costs are high, but justifiable.

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Is Retirement Today a Game Changer for Mature Physicians?

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Understanding Succession and Exit Planning for Physicians

By Michael J. Searcy, ChFC, CFP®, AIFA®

www.SearcyFinancial.com

Doctors who once planned to rely on the sale of their practice to fund their retirement are now finding it more difficult to recruit younger physicians for their succession plan.  If you are a mature doctor today who owns a smaller medical / dental practice (one or two doctor groups), you may be finding that both the economy and desires of younger doctors are changing the game for developing an exit strategy.

The Plan

In preparing a succession plan, a major key to success is starting the process early.  Waiting until you near retirement to begin thinking about selling your practice may leave you with limited (often unfavorable) options.  While some doctors choose to fund a buy-out vehicle during the early stages of their practice with the end goal of selling and retiring in mind, the majority are not in a position where they have a longstanding plan in place.  For doctors who are more than 5-7 years out from retirement, making time to consult with professionals and come up with an enticing purchase proposition for a younger doctor can lead to receiving maximum value for the practice.

Understand the Obstacles

Several factors lead to younger doctors not purchasing existing practices.  These include the heavy competition from hospitals that are competing for more doctors, their desire to set up their own practice, or their aversion to the responsibilities of running a business.  By understanding the obstacles you may face in finding a successor, you can plan ahead to overcome them and get your practice in optimal operating order to increase its attractiveness to potential successors.

The Questions

Questions to consider during the process include:

  • Do I know my practice’s worth?  Getting an accurate valuation is important for you and your successor.  Valuation companies that specialize in medical and dental practice valuations will consider your tangible assets, accounts receivable and the goodwill/brand of your practice to give you an accurate picture of your worth.  By overvaluing your practice, you may repel potential buyers.
  • Are all operations running smoothly?  There may be areas of your practice that need strengthened before a sale.  This can make things smoother as you prepare for a sale, and also make the practice more attractive.
  • Can I/we sustain another doctor’s salary while they are being groomed to take over?
  • If not, is there a hospital affiliate who can hire the doctor to work in my practice until we build the financial base to sustain another salary?
  • Am I protecting my patients?  Aside from adhering to any patient notification laws of your state, you want your patients to understand any upcoming transitions.  Creating a plan to protect your clients may help retain them after the transition.

Build an Alternative Nest Egg

While the sale of your practice may be a wonderful addition to your retirement fund, it is important to build a nest egg as you work and not rely on that big chunk from a sale at the end of your career.  No sale or purchase price is guaranteed and economic changes or new regulations could make your practice unsellable.  By building a nest egg for retirement throughout the course of your career, you can have greater peace of mind that you can experience financial freedom in retirement.

Assessment

Developing your exit strategy will take time, organization and careful planning.  Avoid adding additional stress by viewing the sale of your practice as your financial freedom for retirement.  When it comes time to transfer your ownership out of your practice, make sure you are able to focus solely on a successful outcome!

The Author

Michael J. Searcy, ChFC, CFP, AIFA, is President of Searcy Financial Services, Inc., a registered investment advisory firm in Overland   Park, KS, offering integrated wealth management solutions to doctors.  Searcy has been listed by Medical Economics as one of the “Top 150 Financial Advisors for Doctors” in 2002-2006 and 2011.  For additional information, visit www.SearcyFinancial.com

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A Glimpse into Lean Medical Management Tools and Techniques

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A Very Brief Review

By Mark Matthews MD

As most medical and healthcare executives and consultants are aware, there are a few tools and techniques that are unique to the world of Lean process improvement and management.

These  include: Kaizen Events, The 5-S Technique, Standard Work, Visual Controls and Human Factors Engineering.

We will review the first two techniques in this ME-P. Of course, the last three are reviewed in much greater detail in our new book complete with checklists, figures, tables, drawings, graphs and other illustrations.

Kaizen Events

Kaizen is one of the most powerful tools in the Lean methodology. These events involve intense work sessions aimed at making concrete decisions in a short time period without the need for much data collection. Kaizen events are fairly narrow in scope, ideally concentrating on making one or two decisions at the most.

For example, there may be competing improvement ideas that require more exploration. Using a Kaizen event can provide the necessary structure to make the decision needed to move forward with implementation. The steps in a typical Kaizen Event often include:

  • Determine and define the objectives
  • Determine the current state of the process
  • Determine the requirements of the process
  • Create a plan for implementation
  • Implement the improvements
  • Check the effectiveness of the improvements
  • Document and standardize the improved process
  • Continue the cycle

The 5-S Technique

This technique was developed to allow employees to visually control their work area around visual management techniques. The principles involved in visual management include:

  • Improving workspace efficiency and productivity
  • Helping people share workstations by providing standard layouts
  • Reducing the time required to look for needed supplies or tools
  • Improving the work environment

Each “S” in 5S stands for a step in the process:

  • Sort – classify every item in the designated area as either needed or not needed
  • Set (Straighten) – put “everything in its place”
  • Shine (Sweep) – clean all work environments for order and organization
  • Standardize  – document what goes where, who will clean and who will inspect and on what schedule
  • Sustain-design a system for monitoring process, providing feedback, and rewarding good outcomes

Assessment

Prior to conducting a 5S event, a significant amount of planning is vital. It is important to scope the target area as something that is manageable, draw a physical map of the area under consideration [hospital, ED, OR, clinic, office, etc], and assemble a list of current items in that area. This is usually accomplished by taking photographs (both before and after) of the area.

Conclusion

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Death Takes a [Variable Annuity] Insurance Policy

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How a Lawyer Exploited the Fine Print and Found Himself Facing Federal Charges

By Jake Bernstein / @Jake_Bernstein / ProPublica

The Industry

The life insurance industry tried to make variable annuities irresistible to investors and was enraged when a Rhode Island lawyer exploited the fine print for his own profit.

The Story

This story was co-reported with This American Life from WBEZ Chicago and NPR’s Planet Money.

Video: Excerpts of Video Depositions in the Case Against Joseph Caramadre

Link: http://www.propublica.org/article/death-takes-a-policy-how-a-lawyer-exploited-the-fine-print

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Conclusion

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On Hospital Tax-Exempt Debt

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An important means of external financing for hospitals

By Calvin W. Wiese CPA CMA

By Dr. David Edward Marcinko MBA

www.CertifiedMedicalPlanner.org

Tax-exempt debt has become an important means of external financing for hospitals, primarily because its cost is very attractive. Interest rates on tax-exempt financing are lower than interest rates on financing that is not tax-exempt because the interest income earned by the holders is exempt from federal income tax. In some states, it is also exempt from state income tax and in some cities; it is also exempt from city income tax. Thus, the holders of these debt instruments (usually bonds) are willing to accept lower rates of interest.

State and Local Governments Only

Hospitals themselves are not capable of issuing tax-exempt debt. Only state and local governments are. A state or local government issues tax-exempt debt for hospitals and then loans the proceeds to hospitals. This is called “conduit” financing: the state or local government acts as a conduit through which hospitals can access tax-exempt debt markets. State and local governments are authorized to loan proceeds of their bond issues to hospitals through state statutes, and each state statute is different. Some states authorize any state or local government to issue bonds to loan to hospitals. Other states restrict such power to special purpose governmental entities only. And some states restrict this power to a single governmental entity that is specially formed for the sole purpose of issuing tax-exempt bonds on behalf of hospitals.

The IRS

The Internal Revenue Service (IRS) regulates the issuance of tax-exempt financing. While the IRS code nominally provides that debt instruments issued by state and local governments are exempt from federal income tax, it imposes special rules on conduit issues. Thus, tax-exempt issues whose proceeds are loaned to hospitals must comply with special IRS rules. Although very complex, these rules primarily regulate the use of proceeds, restricting the use of tax-exempt proceeds to the acquisition of property, plant components and equipment.

Given state statutes, IRS code and applicable security laws (both state and federal), issuing tax-exempt bonds is legally complex. Many lawyers get paid handsome fees every time tax-exempt debt is issued. The quarterback of the legal team is the bond counsel who represents the interests of the bondholders; the bond counsel issues the critical tax opinion that investors rely upon to claim tax-exemption on the interest from these instruments. Everything revolves around getting this opinion.

The Underwriter’s

Given its critical nature, only highly qualified lawyers are accepted by the market to provide this opinion. Underwriter’s counsel represents the interests of the investment bankers; their primary concern is compliance with security laws. Issuer’s counsel represents the interests of the state or local government, and hospital counsel represents the interests of the hospital; both have relatively minor roles. In the event credit enhancement is involved, credit enhancement counsel represents their interests and has significant influence on the process.

The Trustees

Another unique party to most tax-exempt bond issues is the bond trustee. The bond trustee is usually a bank who performs a fiduciary duty on behalf of the bond holders throughout the life of the bonds. The face of the faceless bond holders, they act on their behalf. And they, too, are represented by counsel in the bond issuance process.

State or local government typically appoints bond counsel. In many cases, they work with only a single firm. Not unusually, these relationships are quite cozy, and often result in fees being paid that are well in excess of what otherwise would be paid.

The Documents

An excess of documents is involved in most tax-exempt financings. The heart of the documents is the indenture, which is the agreement between the bond trustee (on behalf of the bond holders) and the state or local government issuer. It contains the promises made to the bond holders, and it describes the work of the bond trustee. The bond trustee will only perform actions on behalf of bond holders that are explicitly set forth in the bond indenture. The bond indenture is the security given to the bond holders, describing all their recourses.

Assessment

The bond indenture is typically supported by the loan agreement between the state or local government that issues the bonds and the hospital to which the proceeds are loaned. Its terms complement the terms of the bond indenture, which together, form the conduit.

Conclusion

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

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IRS Tips for Charity Minded Medical Professionals

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IRS Help for Charitable Taxpayers

[By Children’s Home Society of Florida Foundation]

The IRS has published a series of six tips that are designed to help charitable taxpayers.  Both the Department of the Treasury and the IRS hope to enable donors to support various charities.  The six recommendations will help donors to be certain that their gifts are deductible.

1.  Tax Exempt Status

A charity must be qualified under the IRS guidelines for a gift to be deductible.  At www.irs.gov there is an “Exempt Organization Select Check” that allows donors to be certain the charity is qualified to receive deductible gifts.

2.  Itemizing

Your charitable gifts are deductible only if you itemize deductions on IRS Form 1040, Schedule A.

3.  Fair Market Value

Gifts of cash are deductible at face value.  Gifts of appreciated stock, land and many other types of property are often deductible at fair market value.  There are special rules for cars, boats, clothing and household items.  If the charity gives value in return, such as goods, services, admission to a charity banquet or sporting event, that amount will reduce the value of your charitable deduction.

4.  Good Records

You need to maintain records of all donations.  All cash gifts must be documented even if they are quite small.  You should keep cancelled checks, bank or credit card statements, payroll deductions or a statement from the charity with its name, contribution, date and amount for your gifts.

5.  Larger Gifts

If your gift is $250 and above, you must receive a receipt or written acknowledgement from the charity.  The acknowledgement should state the amount of the gift and may include a description and fair market value for property gifts.  It must state whether the charity provided goods or services for your gift.  Non-cash gifts over $500 require you to file IRS Form 8283, Non-Cash Charitable Contributions, with your Form 1040.  If the non-cash property is over $5,000 and is not a public stock, bond or mutual fund, you usually must obtain a property appraisal from a qualified appraiser who holds himself or herself out to the public for that purpose.  In some cases, the appraisal must be attached to the return with a signed Form 8283.

6.  Timing

If you make a pledge, the gift will be deductible only when it actually is made.  For example, a donor may make a pledge in November and then make the gift the following March.  The gift is deductible in the year it is made.  End-of-year donations by check or credit card are generally deductible in the year that they are made or placed in the U.S. mail.

Editor’s Note:  In nearly all cases, your charitable gifts will qualify for a substantial reduction in your taxes.  For specific information, go to www.irs.gov and search for IRS Publication 526, Charitable Contributions.  Valuation rules are available in IRS Publication 561, Determining the Value of Donated Property.

Conclusion

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On Vacation Cruises for Doctors

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Something for Everyone

By Rick Kahler MS CFP® ChFC CCIM

www.KahlerFinancial.com

My family and I recently took our 20th cruise-ship vacation. Obviously, we’ve found that cruising offers something for each of us. Perhaps more medical professionals can too?

First Time

I was reluctant to go on my first cruise, both because I’m prone to motion sickness and because I couldn’t see why anyone would want to spend a vacation cooped up on a boat. I quickly learned two things that changed my mind. First, a number of drugs, patches, and shots are available to prevent or cure seasickness. Second, if you get bored on a cruise ship, it’s only because you choose to.

Benefits

A major asset of cruising is the 18 hours a day of tailor-made, supervised activities available for kids of various ages, even when the ship is in port. This allows parents plenty of time to tour ports of call unencumbered by cranky kids who couldn’t care less about museums or ancient ruins. Our kids are now old enough that they enjoy most of the shore excursions, but this still leaves them the option to opt out of any port that doesn’t call to them.

Bargains

Most people assume cruising with a family must be prohibitively expensive. We’ve found it to be a highly affordable way to vacation if you follow a few rules.

You can get some incredible cruising bargains, but it does take a little legwork. You will want to get on the email lists of the major cruise lines; my top picks are Cunard, Celebrity, Holland America, and Princess. They send out sales and last-minute offers continuously.

One of the best places to shop and compare deals is Cruise.com. However, when I’ve run into issues like an incorrect booking or an issue with the cruise company, Cruise.com wasn’t much help. I was left pretty much on my own to resolve the problems. I’ve found it’s better to shop the deals online with sites like Cruise.com or Cruisecritic.com, but to place the order with my local travel agent or directly with the cruise company.

Food

It will come as no surprise that one of the main features I look for in a ship is really good food. Many of the newer ships offer alternative dining rooms, where for an additional $25 to $40 per person, you can dine in true gourmet fashion. Some of the best specialty dining is found on Cunard and Celebrity.

Cost Balance

To balance the cost of my specialty dining habit, I select the least expensive stateroom, typically an inside cabin. It’s the same size as 80% of the cabins on the ship; it just doesn’t have a window. You can enjoy the same view—water and sky—from a lounge on deck while you relax with a cool drink. And the cheaper cabin leaves several hundred extra dollars to spend on food and shore excursions. For our latest 12-day cruise, our inside cabin cost $800 per person.

Rates

You typically get the best rates by booking the cruise as far in advance as possible. A small deposit is due upon booking but is totally refundable until about 60 days prior to the cruise date. Often, the prices rise the closer you get to that 60-day deadline, when the cruise must be paid in full and your deposit becomes non-refundable. If you are flexible, another great time to shop for cruises is about 30 to 60 days prior to sailing.

Assessment

A cruise isn’t what we typically think of as a middle-class family vacation. Yet when you figure in lodging, food, and admission fees for visiting major US vacation destinations, cruising can be just as affordable and just as much fun.

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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