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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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By Hope Rachel Hetico RN MHA

[Managing Editor]

Professor Hope HeticoAccording to the www.BusinessofMedicalPractice.com, a copyright is a body of legal rights that protect creative works – like those seen on this ME-P – from being reproduced, performed, or disseminated without permission. The owner as the exclusive right to reproduce a protected work; to prepare derivative works that only slightly change the protected work; to sell or lend copies of the protected work to the public; to perform protected works in public for profit; and to display copyrighted works publicly.

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Copyright does not protect the idea or concept; it only protects the way in that an author has expressed an idea or concept. If, for example, a doctor publishes an article explaining a new process for making a medicine, the copyright prevents others from substantially copying the article, but it does not prevent anyone from using the process described to prepare the medicine. In order to protect the process, the doctor must “fix” the work and obtain a patent. For works created after January 1, 1978, copyright becomes the property of the author the moment the work is created and lasts for the author’s life plus 50 years. When a work is created by an employee in the normal course of a physician’s job however, as with an HMO or employed physician, the copyright becomes the property of the employer and lasts for 75 years from publication or 100 years from creation, whichever is shorter.  The 1978 act extends the term of copyrights existing on January 1, 1978, so that they last for about 75 years from publication.

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What Physician-Investors Need to Know about the Shiller PE Ratio

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What it is – How it works

By Michael Zhuang MS www.MZCap.com

This Shiller PE index is a stock market metric invented by Yale University Professor Robert Shiller, PhD.

Basically, it is the average PE ratio of all S&P 500 stocks for the last ten years. The Shiller PE is also called PE10. Professor Shiller found it to be a reasonably good measure of valuation of the whole market.

IOW: The higher the Shiller PE, the more expensive the market. So, with Shiller PE at 24, we can call this market relatively expensive.

Assessment

Here is what I know currently.

  1. The  higher the Shiller PE – the lower the one-year and three-year return propensity.
  2. Return variability is so high as to render the Shiller PE’s predictive power very weak.
  3. Only when Shiller PE is over 35 are the three-year forward returns overwhelmingly negative.

So, the market may or may not be headed for a fall immediately, but we do need to temper our expectation of future returns.

About the Author

Michael Zhuang is founder and principal of MZ Capital, a fee-only registered investment advisor firm located in the Greater Washington D.C. metropolitan area.

Conclusion

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Cell Phone Usage In Car Crashes Massively Underreported

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Are Doctors NOW Members of the Middle Class?

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  • By Dr. David Edward Marcinko MBA CMP®
  • By Rick Kahler MS CFP® ChFC CCIM

Rick Kahler CFPThe middle class Marketers target it. Politicians champion it. Economists talk about it. Most of us consider ourselves part of it. FAs want to serve it.

Yet, when I’ve asked for a clear definition, I have not found anybody yet that really can tell me what “middle class” is.

Definition

I recently posted on Twitter that $90,000 was a middle-class household income and that it would take a nest egg of $3 million to generate that income in retirement.

A couple of my colleagues responded that my figures were way too high and accused me of being out of touch. As a lifelong South Dakotan, I’m used to being seen as “out of touch,” but the idea that $90,000 was beyond a middle-class income intrigued me.

I figured a few minutes with Google would point me to a definition of “middle class.” It wasn’t that simple. I soon discovered that neither politicians, nor economists, sociologists, nor financial advisors can agree on what makes someone middle class. It is a little easier to define a middle class income.

USA Today

I did find an excellent article in USA Today by Dan Horn of the Cincinnati Inquirer. He cited three surveys that attempted to define the middle class by income. The Pew Charitable Trust describes it as the middle 20%, an income range from $32,900 to $64,000. The U.S. Census Bureau disagrees.

They say a middle class income is the middle 60%, an income range of $20,600 to $102,000. The U.S. Department of Commerce begs to differ with both and says an income between $50,800 and $122,000 puts you in the middle class. Combining the income range of the three studies ($20,600 to $122,000) puts two-thirds of all income earners in the middle class.

My Personal POV

For me, defining middle class with such a broad income range just raises more questions than it answers.

First of all, the same income that will provide a comfortable middle-class lifestyle in a place like the Black Hills of South Dakota won’t necessarily do the same in San Francisco or Boston.

Second, if you want to assure yourself of a middle-class income throughout your lifetime, you apparently have to get rich.

Concept of expensive education - dollars and diploma

Case Model

Let’s assume a young couple, both allied healthcare professionals, earn $45,000 each for a household income of $90,000. Let’s assume they want to save enough to provide a similar income in retirement without counting on Social Security. To generate that income, with a 99% certainty they will never run out of money, how much will they need to save?

While financial advisors’ responses will vary, most will agree this couple would need between $2 million and $4 million in today’s dollars. Let’s settle on $3 million. If they each saved $1,000 monthly to 401k’s (about 25% of their salaries), our young couple could save $6,600,000 million ($3 million in today’s dollars adjusted for inflation) by the time they reached age 65.

However, while a couple needs $3 million to produce a middle-class income, someone with a net worth of $3 million is in the financial top 2% of Americans. That’s hardly middle class.

And to complicate things further, Gallup polls have shown that most Americans think anyone with a net worth of $1 million is rich. Yet having $1 million when you retire will generate a secure lifetime income of $30,000. So the net worth that we define as wealthy provides an income that we define as barely middle class.

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Assessment

Confused yet? I certainly am. There’s just one thing I’m still sure of. If you want a middle-class lifestyle after you retire, what you’d better do now is live a modest middle-class lifestyle so you can save enough to qualify as rich.

Conclusion

And so, are doctors members of the middle class – in potential retirement income under this model? 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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A Hospital Industry Outlook for 2013

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By Ann Miller RN MHA

[Managing Editor]

The ME-P and nation recently celebrated National Hospital Week for 2013. And so, what better time than now to ask health economist and financial expert Robert James Cimasi MHA, ASA, AVA, CMP for his take on the industry outlook. www.HealthCapital.com

cimasiHistory Background and Overview

The U.S. Healthcare Delivery System is facing what is perhaps its greatest challenge in the expected demand for increased health services from the aging of the “baby-boom” generation, the fastest-growing segment of the population.

The enactment of healthcare reform in March 2010, requiring increased insurance coverage requirements for individuals and employers, will also increase patient demand for hospital inpatient and outpatient services in the coming years.

Hospital Industry 

The hospital industry continues to face many challenges in the changing healthcare environment, including workforce shortages, rising healthcare costs to provide care, and difficulty acquiring needed capital. With consistent financial stresses, hospitals in some areas appear to be struggling.

However, general acute-care hospitals recorded record high profits of $35.2 billion in 2006, an increase of over 20% from 2005.  Total net revenues for general acute-care hospitals were $587.1 billion, resulting in an average profit margin of 6% (the highest since 1997, when the average profit margin was 6.7%).

While the demand for healthcare continues to rise, the site of service also continues to evolve as more procedures are performed on an outpatient basis and by freestanding facilities rather than by inpatient acute care hospitals.  As evidence of this trend, the number of freestanding ambulatory care surgery centers increased from 2,864 in 2000 to 5,197 in 2006.

U.S. healthcare costs are again increasing after their rate of growth slowed in the mid-1990s.

In 2009, total national health expenditures (NHE) in the U.S. grew to $2.5 trillion, a 5.7% increase from 2008.  Meanwhile, the nation’s gross domestic product (GDP) shrank by 1.1%, and as a result, NHE increased from 16.2% to 17.3% of the GDP: the largest one-year increase-in history. Additionally, healthcare spending has been projected to grow to 19.6% by 2016. The potential impact of the 2010 healthcare reform legislation to reduce rising healthcare expenditures is yet uncertain.

According to a 2002 study conducted by the Blue Cross and Blue Shield Association (BCBSA), inpatient costs are responsive to hospital market organization.  Each 1% increase in for-profit hospital market share is associated with a 2% increase in inpatient expenditure per person.  Conversely, each 1% increase in network hospital market share corresponds to a 1% decrease in inpatient expenditures.

Risk Sharing

As healthcare costs again continue to rise faster than inflation in the overall economy in 2013, driven by advances in technology and treatment (as well as the growing baby-boomer population), pressures to reduce costs, such as those included in the ACA will result in a changed paradigm for healthcare delivery.

Reimbursement mechanisms are increasingly designed to control costs and access, and hospitals must continually adjust to deal with increasing pressure to contain reimbursement and utilization levels; ie., share financial risks.

The Marketplace

The healthcare marketplace continues to experience dramatic change as the business of healthcare becomes increasingly competitive, particularly in the outpatient ancillary services arena.  Providers and payors continue to seek to control costs and markets. Legal and regulatory issues also affect change as providers adapt to new opportunities and restrictions.

In particular, there are a wide variety of cost, operational, and regulatory pressures impacting the specialty and surgical hospital industry.

Of course, these pressures are offset by the stable and increasing demand for hospital services, particularly for those hospitals already in operation.

national-hospital-week

Assessment

Bob feels that hospitals that are operationally efficient will continue to be successful within this environment; others will not. How about you?

More: Financial Management Strategies for Hospitals and Healthcare Organizations : Tools, Techniques, Checklists and Case Studies

More: Arkansas Medical News Interviews Dr. Marcinko

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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Doubting the Accountable Care Organization B-Model

New Healthcare Business Model or Edsel Model?

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By David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

Dr. Marcinko with ME-P FansDefined by Professor Michael Porter at Harvard Business School, value is defined as a function of outcomes and costs. Therefore to achieve high value we must deliver the best possible outcomes in the most efficient way, outcomes which matter from the perspective of the individual receiving healthcare and not provider process measures or targets.

Sir Muir Gray expanded on the idea of technical value (outcomes/costs) to specifically describe ‘personal value’ and ‘allocative value’, encouraging us to focus also on shared decision making, individual preferences for care and ensuring that resources are allocated for maximum value.

Healthcare Value and ACOs

According to our Medical Executive-Post Health Dictionary Series of administrative terms http://www.HealthDictionarySeries.org  and health economist and colleague Robert James Cimasi MHA, ASA, AVA CMP™ of www.HealthCapital.com; an ACO is a healthcare organization in which a set of providers, usually large physician groups and hospitals, are held accountable for the cost and quality of care delivered to a specific local population.

ACOs aim to affect provider’s patient expenditures and outcomes by integrating clinical and administrative departments to coordinate care and share financial risk.

ACO Launch

Since their four-page introduction in the PP-ACA of 2010, ACOs have been implemented in both the Federal and commercial healthcare markets, with 32 Pioneer ACOs selected (on December 19, 2011), 116 Federal applications accepted (on April 10, 2012 and July 9, 2012), and at least 160 or more Commercial ACOs in existence today.

Federal Contracts

Federal ACO contracts are established between an ACO and CMS, and are regulated under the CMS Medicare Shared Savings Program (MSSP) Final Rule, published November 2, 2011.  ACOs participating in the MSSP are accountable for the health outcomes, represented by 33 quality metrics, and Medicare beneficiary expenditures of a prospectively assigned population of Medicare beneficiaries.

If a Federal ACO achieves Medicare beneficiary expenditures below a CMS established benchmark (and meets quality targets), they are eligible to receive a portion of the achieved Medicare beneficiary expenditure savings, in the form of a shared savings payment.

Commercial Contracts

Commercial ACO contracts are not limited by any specific legislation, only by the contract between the ACO and a commercial payor.

In addition to shared savings models, Commercial ACOs may incentivize lower costs and improved patient outcomes through reimbursement models that share risk between the payor and the providers, i.e., pay for performance compensation arrangements and/or partial to full capitation.

Although commercial ACOs experience a greater degree of flexibility in their structure and reimbursement, the principals for success for both Federal ACOs and Commercial ACOs are similar.

###

Eidsel

Dr. David E. Marcinko with 1960 Ford Edsel

[© iMBA, Inc. All rights reserved, USA.]

[The Edsel was an automobile marque that was planned, developed, and manufactured by the Ford Motor Company during the 1958, 1959, and 1960 model years. With the Edsel, Ford had expected to make significant inroads into the market share of both General Motors and Chrysler and close the gap between itself and GM in the domestic American automotive market. But, contrary to Ford’s internal plans and projections, the Edsel never gained popularity with contemporary American car buyers and sold poorly. The Ford Motor Company lost millions of dollars on the Edsel’s development, manufacturing and marketing].

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Update

Junking the Merit-Based Incentive Payment System (MIPS) would undoubtedly let the proverbial air out of the MACRA balloon, dealing a significant blow to the value-based reimbursement shift; right?

Assessment

Although nearly any healthcare enterprise can integrate and become an ACO, larger enterprises, may be best suited for ACO status.

Larger organizations are more able to accommodate the significant capital requirements of ACO development, implementation, and operation (e.g., healthcare information technology), and sustain the sufficient number of beneficiaries to have a significant impact on quality and cost metrics.

Conclusion

But, will this new B-Model work? Isn’t leading doctors in a shared collaborative effort a bit like herding cats? And, what about patients, HIEs, outcomes management, data analytics and … Population Health via our colleague David B. Nash MD MBA of Thomas Jefferson University, often considered the “father” of Pop Health?

OR, what about the developing IRS scandal and full PP-ACA launch in 2014? Will it affect federal funding, full roll-out, or even repeal of the entire Act?

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

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So now, for the first time, all this information – and more – has been codified, updated, copy-righted and copy-protected in print form for your purchase and use. All have been edited by our Publisher – Dr. David Edward Marcinko and Professor Hope Rachel Hetico.

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Assessment

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Finding Emotional Freedom [Access the Truth Your Brain Already Knows]

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Book Review

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

Rick Kahler CFP“It’s not about the money.” This saying has become almost a cliché among financial planners and therapists who help clients address the emotional aspects of their relationships with money.

We keep using this phrase because it is so true. Overspending, taking unreasonable risks, money conflicts that strain marriages, failing to learn from money mistakes, and a host of other problematic money patterns are not about money. They are about emotions. And since brain researchers tell us that 90% of all decisions are made emotionally, it literally “pays” to pay attention to your emotions.

Because money affects so many aspects of our lives, it’s only natural that destructive behavior around money is one of the ways people try to cope with emotional pain. Money dysfunction is really no different from other destructive behaviors like addiction or codependency. Like them, it can have high physical, emotional, relationship, and financial costs.

The more I learn about the relationship between our emotions and our money choices, the more I understand why financial knowledge alone isn’t enough to help people change unhelpful behaviors that keep them stuck. I am convinced of the value of financial therapy and other forms of counseling to help people create financial and emotional balance in their lives. It’s clear to me that psychotherapy offers clear financial benefits as well as emotional ones.

The Book

A new book by Dave Jetson, Finding Emotional Freedom: Access the Truth Your Brain Already Knows, addresses these issues in one of the more clear and succinct manners I’ve encountered.

Dave is one of the few counselors in the nation who understands and practices financial therapy. In his practice and workshops, he uses experiential therapy techniques that access both the conscious and unconscious parts of the brain to help people recover from any type of abuse and trauma, including financial. I’ve seen first-hand how effective this work is.

I also know that Dave is one of those rare guides who’s actually done and succeeded at what he teaches. He is one of those who walks the walk. Now he has written a book describing that walk.

Finding Emotional Freedom includes a clear, readable description of how our brains process emotions. This is useful, even critical information for anyone who wants to make wiser money choices.

Finding Emotional Freedom: Access the Truth Your Brain Already

Co-Dependency

Dave also describes how codependency develops and some of the patterns it takes. Many of these patterns—from addictions, to shopping as “retail therapy,” to excessive taking care of others—have financial as well as emotional costs.

Even though Dave offers financial therapy and has created a workshop on Financial Recovery, he doesn’t specifically discuss financial codependency in this book. This doesn’t mean the issue is not important. In fact, it serves to underscore the principle that that many money issues really are not about the money.

Assessment

Finally, this book explains how experiential therapy works and the deep changes it can make. Finding Emotional Freedom shows the possibilities for not only healing emotional wounds, but for increasing your emotional intelligence. It’s a powerful book, and I highly recommend it.

When I was starting out as a financial planner 30 years ago, I wouldn’t necessarily have even picked up a book like this, much less have felt comfortable recommending it to clients. Now I know better.

What I have learned over those years is that real financial planning is about much more than just the money. Providing investment advice that helps people achieve financial health is certainly important. But the larger role of a financial planner is to help clients prosper. Real prosperity includes not only financial health, but also emotional health and happiness.

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How the IRS’s Nonprofit Division Got So Dysfunctional

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The IRS Controversy

By Kim Barker and Justin Elliott

ProPublica, May 17, 2013, 5:14 p.m.

The IRS division responsible for flagging Tea Party groups has long been an agency afterthought, beset by mismanagement, financial constraints and an unwillingness to spell out just what it expects from social welfare nonprofits, former officials and experts say.

The controversy that erupted in the past week, leading to the ousting of the acting Internal Revenue Service commissioner, an investigation by the FBI, and congressional hearings that kicked off Friday, comes against a backdrop of dysfunction brewing for years.

Moves launched in the 1990s were designed to streamline the tax agency and make it more efficient. But they had unintended consequences for the IRS’s Exempt Organizations division.

Checks and balances once in place were taken away. Guidance frequently published by the IRS and closely read by tax lawyers and nonprofits disappeared. Even as political activity by social welfare nonprofits exploded [1] in recent election cycles, repeated requests for the IRS to clarify exactly what was permitted for the secretly funded groups were met, at least publicly, with silence.

All this combined to create an isolated office in Cincinnati, plagued by what an inspector general this week described [2] as “insufficient oversight,” of fewer than 200 low-level employees responsible for reviewing more than 60,000 nonprofit applications a year.

A Major Mistake

In the end, this contributed to what everyone from Republican lawmakers to the president says was a major mistake: The decision by the Ohio unit to flag for further review applications from groups with “Tea Party” and similar labels. This started around March 2010, with little pushback from Washington until the end of June 2011.

“It’s really no surprise that a number of these cases blew up on the IRS,” said Marcus Owens, who ran the Exempt Organizations division from 1990 to 2000. “They had eliminated the trip wires of 25 years.”

Of course, any number of structural fixes wouldn’t stop rogue employees with a partisan ax to grind. No one, including the IRS [3] and the inspector general [4], has presented evidence that political bias was a factor, although congressional and FBI investigators are taking another look.

But what is already clear is that the IRS once had a system in place to review how applications were being handled and to flag potentially problematic ones. The IRS also used to show its hand publicly, by publishing educational articles for agents, issuing many more rulings, and openly flagging which kind of nonprofit applications would get a more thorough review.

All of those checks and balances disappeared in recent years, largely the unforeseen result of an IRS restructuring in 1998, former officials and tax lawyers say.

“Until 2008, we had a dialogue, through various rulings and cases and the participation of various IRS officials at various ABA meetings, as to what is and what is not permissible campaign intervention,” said Gregory Colvin, the co-chair of the American Bar Association subcommittee that dealt with nonprofits, lobbying, and political intervention from 1991 to 2009.

“And there has been absolutely no willingness in the last five years by the IRS to engage in that discussion, at the same time the caseload has exploded at the IRS.”

IRS

Stone Walling

The IRS did not respond to requests for comment on this story.

Social welfare nonprofits, which operate under the 501(c)(4) section of the tax code, have always been a strange hybrid, a catchall category for nonprofits that don’t fall anywhere else. They can lobby. For decades, they have been allowed to advocate for the election or defeat of candidates, as long as that is not their primary purpose. They  also do not have to disclose their donors.

Social welfare nonprofits were only a small part of the exempt division’s work, considered minor when compared with charities. When the groups sought IRS recognition, the agency usually rubber-stamped them. Out of 24,196 applications for social welfare status between 1998 and 2009, the exempt organizations division rejected only 77, according to numbers compiled from annual IRS data books.

Into this loophole came the Supreme Court’s Citizens United decision in January 2010, which changed the campaign-finance game [5] by allowing corporate and union spending on elections.

Sensing an opportunity, some political consultants started creating social welfare nonprofits geared to political purposes. By 2012, more than $320 million in anonymous money poured into federal elections.

A couple of years earlier, beginning in 2010, the Cincinnati workers had flagged applications of tiny Tea Party groups, according to the inspector general, though the groups spent almost no money in federal elections.

Main Question

The main question raised by the audit is how the Cincinnati office and superiors in Washington could have gotten it so wrong. The audit shows no evidence that these workers even looked at records from the Federal Election Commission to vet much larger groups [6] that spent hundreds of thousands and even millions [7] in anonymous money to run election ads.

The IRS Exempt Organizations division, the watchdog for about 1.5 million nonprofits, has always had to deal with controversial groups. For decades, the division periodically listed red flags that would merit an application being sent to the IRS’s Washington, D.C., headquarters for review, said Owens, the former division head.

In the 1970s, that meant flagging all applications for primary and secondary schools in the south facing desegregation. In the 1980s, during the wave of consolidation in the health-care industry, all applications from health-care nonprofits needed to be sent to headquarters. The division’s different field offices had to send these applications up the chain.

“Back then, many more applications came to Washington to be worked — the idea was to have the most sensitive ones come to Washington,” said Paul Streckfus, a former IRS lawyer who screened applications at headquarters in the 1970s and founded the industry publication EO Tax Journal [8] in 1996.

Because this list was public, lawyers and nonprofits knew which cases would automatically be reviewed.

“We had a core of experts in tax law,” recalled Milton Cerny, who worked for the IRS, mainly in Exempt Organizations, from 1960 to 1987. “We had developed a broad group of tax experts to deal with these issues.”

In the 1980s, the division issued many more “revenue rulings” than issued in recent years, said Cerny, then head of the rulings process. These revenue rulings set precedents for the division. Revenue rulings along with regulations are basically the binding IRS rules for nonprofits.

“We would do a revenue ruling, so the public and agents would know,” Cerny said. “Over the years, it apparently was felt that a revenue ruling should only be published at an extraordinary time. So today you’re lucky if you get one a year. Sometimes it’s less than that. It’s amazing to me.”

Other checks and balances had existed too. Not only were certain kinds of applications publicly flagged, there was another mechanism called “post-review,” Owens said. Headquarters in Washington would pull a random sample every month from the different field offices, to see how applications were being reviewed. There was also a surprise “saturation review,” once a year, for each of the offices, where everything from a certain time period needed to be sent to Washington for another look.

So internally, the division had ways, if imperfect, to flag potential problems. It also had ways of letting the public know what exactly agents were looking at and how the division was approaching controversial topics.

For instance, there was the division’s “Continuing Professional Education,” or CPE, technical instruction program. These articles were supposed to be used for training of line agents, collecting and putting out the agency’s best information on a particular topic — on, say, political activity [9] by social welfare nonprofits in 1995.

“People in a group would write up their thoughts: ‘Here’s the law,’” said Beth Kingsley, a Washington lawyer with Harmon, Curran, Spielberg & Eisenberg who’s worked with nonprofits for almost 20 years. “It wasn’t pushing the envelope. It was, ‘This is how we see this issue.’ It told us what the IRS was thinking.”

The system began to change in the mid-1990s. The IRS was having trouble hiring people for low-level positions in field offices like New York or Atlanta — the kinds of workers that typically reviewed applications by nonprofits, Owens said.

In Cincinnati

The answer to this was simple: Cincinnati.

The city had a history of being able to hire people at low federal grades, which in 1995 paid between $19,704 and $38,814 a year — almost the same as those federal grades paid in New York City or Chicago. (Adjusted for inflation, that’s between $30,064 and $59,222 now.)

“That was well below what the prevailing rate was in the New York City area for accountants with training,” Owens said. “We had one accountant who just had gotten out of jail — that’s the sort of people who would show up for jobs. That was really the low point.”

So in 1995, the Exempt Organizations division started to centralize. Instead of field offices evaluating applications for nonprofits in each region, those applications would all be sent to one mailing address, a post-office box in Covington, Ky. Then a central office in Cincinnati would review all the applications.

Almost inadvertently, because people there were willing to work for less than elsewhere, Cincinnati became ground zero for nonprofit applications.

For the time being, the checks remained in place. The criteria for flagged nonprofits were still made public. The Continuing Professional Education text was still made public. Saturation reviews and post reviews were still in place.

But by 1998, after hearings in which Republican Senator Trent Lott accused the IRS of “Gestapo-like” tactics, a new law mandated the agency’s restructuring. In the years that followed, the agency aimed to streamline. For most of the ‘90s, the IRS had more than 100,000 employees. That number would drop every year, to slightly less than 90,000 [10] by 2012.

Change Will Come

Change also came to the Exempt Organizations division.

The IRS tried to remove discretion from lower-level employees around the country by creating rules they had to follow. While the reorganization was designed to centralize power in the agency’s Washington headquarters, it didn’t work out that way.

“The distance between Cincinnati and Washington was such that soon Cincinnati became a power center,” said Streckfus, the former IRS lawyer.

Following reorganization, many highly trained lawyers in Washington who previously handled the most sensitive nonprofit applications were reassigned to focus on special projects, he said.

Owens, who left the IRS in 2000 but stayed in touch with his old division, said the focus on efficiency meant “eliminating those steps deemed unimportant and anachronistic.”

In 2003, the saturation reviews and post reviews ended, and the public list of criteria that would get an application referred to headquarters disappeared, Owens said. Instead, agents in Cincinnati could ask to have cases reviewed, if they wanted. But they didn’t very often.

“No one really knows what kinds of cases are being sent to Washington, if any,” Owens said. “It’s all opaque now. It’s gone dark.”

By the end of 2004, the Continuing Professional Education articles stopped [11].

Recommendations [12] from an ABA task force for IRS guidelines on social welfare nonprofits and politics that same year were met with silence.

Even the IRS’s Political Activities Compliance Initiative, which investigated [13] complaints of charities engaged in politics — primarily churches — closed up shop in early 2009 after less than five years, without any explanation.

Both before and after the changes, the Exempt Organizations division has been a small part of the IRS, which is focused on collecting money and chasing delinquent taxpayers.

US capitol

IRS Employee Count in 2012

Rulings and Agreements, the division that handles applications of all nonprofits, accounted for less than 0.5 percent of all IRS employees in 2012.

Source: IRS Data Books [14], IRS Exempt Organizations Annual Report [15]

Of the 90,000 employees at the agency last year, only 876 worked in the Exempt Organizations’ division, or less than 1 in 1,000 employees.

Of those, 335 worked in the office that actually handles applications of nonprofits.

Most of those — about 300 — worked in Cincinnati, Streckfus estimates. The rest were at headquarters, in Washington D.C.

In Cincinnati, the employees’ primary job was sifting through the applications of nonprofits, making determinations as to whether a nonprofit should be recognized as tax-exempt. In a press release [16] Wednesday, the IRS said fewer than 200 employees were responsible for that work.

In 2012, these employees received 60,780 applications. The bulk of those — 51,748 — were from groups that wanted to be recognized as charities.

But the number of social welfare nonprofit applications spiked from 1,777 in 2011 to 2,774 in 2012. It’s impossible to say how many of those groups indicated whether they would engage in politics, or why the number of applications increased. The IRS said Wednesday that it “has seen an increase in the number of tax-exempt organization applications in which the organization is potentially engaged in political activity,” including both charities and social welfare nonprofits, but didn’t specify any numbers.

Total 501(c)(4) [17] Nonprofit Applications from 2002 to 2012

From 2011 to 2012, applications increased by more than 50 percent.

Source: IRS Data Books [14]

On average, one employee in Cincinnati would be responsible for going through roughly one application per day.

Some would be easy — say, a local soup kitchen. But to evaluate whether a social welfare nonprofit has social welfare as its primary purpose, the agent is supposed to use a “facts and circumstances” test. There is no checklist. Reviewing just one social welfare nonprofit could take days or weeks, to look through a group’s website, track down TV ads and so forth.

“You’ve got 60,000 applications coming through, and it’s hard to do that with the number of agents looking at them,” said Philip Hackney [18], who was in the IRS’s chief counsel office in Washington between 2006 and 2011 but said he wasn’t involved in the Tea Party controversy. “The reality is that they cannot do that, and that’s why you’re seeing them pick stuff out for review. They tried to do that here, and it burned them.”

As we have previously reported, last year the same Cincinnati office sent ProPublica [19] confidential applications from conservative groups. An IRS spokeswoman said the disclosures were inadvertent.

The Commissioner Speaks

Mark Everson, IRS commissioner for four years during the George W. Bush administration, said he believed the fact that the division is understaffed is relevant, but not an excuse for what happened. “The whole service is under-funded,” he pointed out.

And Dan Backer, a lawyer in Washington who represented six of the groups held up because of the Tea Party criteria, said he doesn’t buy the notion that low-level employees in Cincinnati were alone responsible.

“It doesn’t just strain credulity,” Backer said. “It broke credulity and left it laying on the road about a mile back. Clearly these guys were all on the same marching orders.”

The inspector general’s audit was prompted last year after members of Congress, responding to complaints by Tea Party groups, asked for it.

Like former officials interviewed by ProPublica, the audit suggests that officials at IRS headquarters in Washington were unable to manage their subordinates in Cincinnati. When Lois Lerner, the Exempt Organizations division director in Washington, learned [20] in June 2011 about the improper criteria for screening applications, she instructed that they be “immediately revised.”

But just six months later, Cincinnati employees changed [21] the revised criteria to focus on “organizations involved in limiting/expanding government” or “educating on the Constitution.” They did so “without executive approval.”

“The story people are overlooking is: Congress is complaining about underpaid, overworked employees who are not adequately trained,” said Bryan Camp, a former attorney in the IRS chief counsel’s office.

Assessment

In the end, after all the millions of anonymous money spent by some groups to elect candidates in 2012, after all [22] the groups [23] that said in their applications that they would not spend money to elect candidates before doing exactly that, after the Cincinnati office flagged conservative groups, the IRS approved almost all the new applications. Only eight applications were denied.

Source: http://www.propublica.org/article/how-irs-nonprofit-division-got-so-dysfunctional

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Need a Manager of Surgical Nurses and Operating Rooms

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Seeking A Direct Hire in Kansas

By Kathy Williams kathyw@thorgroup.com
Resource Manager
Thor Group, Inc.

Dear Dr. David E Marcinko,

Hello!  We are looking for a Manager of Surgical Nurses and Operating Rooms.

Our client has a wonderful opportunity to have a work balance life style.  If one of your ME-P readers would like the peace and quiet of a small town plus a great opportunity for your career, this opportunity is for them!

This position will manage and supervise functions related to patient care in the operating rooms; ensure effective delivery of patient care and compliance with administrative and facility policies and procedures.  This position will pay $60-75K depending in experience.  Direct Hire in Kansas.

Responsibilities:

• Guides and directs nursing staff regarding safe, effective patient care, problem-solving and decision making according to patient needs, staff capabilities and facility resources.
• Maintains up-to-date knowledge of new procedures, products and equipment used in the OR.
• Interviews, orients, assigns work schedules, conducts and reviews evaluations and disciplines personnel to manage performance.  Oversees OR staff in conducting annual performance evaluations and competency documentation.
• Ensure proper daily staffing levels in all operating rooms.
• Assist in investigating and initiating follow-up and corrective action when necessary in response to complaints and/or concerns from patients, families, physicians or employees.  Develops, implements and monitors, methods and strategies to achieve high patient satisfaction results.
• Is familiar with, and maintains compliance within the OR Department, on all regulatory agency requirements.
• Maintains compliance with accreditation/licensure requirements.
• Identify operational needs; manage appropriate level of equipment and supplies and monitors equipment maintenance.  Assess the environment and make recommendations to ensure optimal patient comfort, safety and compliance with various regulatory bodies.

Qualifications:

• Diploma from accredited nursing program.
• Current Licensure as Registered Nurse and able to obtain a Kansas license.
• Minimum of 3 years management experience in hospital setting preferred.
• Certification in area of specialization.
• Demonstrated excellent communication skills.

###

Healthcare Jobs

Assessment

THOR, Inc. is a cutting-edge business solutions firm that has been working with some of the top companies throughout the United States for nearly 40 years.

If you are interested in the Manager of Surgical Nurses and Operating Rooms position, please send your updated resume along with salary history to kathyw@thorgroup.com. If you are not interested in this opportunity, perhaps you know someone who might be, please have them forward their resume to me!

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A Red-Neck Doctor

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You know you are a red-neck doctor, when ….?

By Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

Recently, an ME-P subscriber who knows of my vintage Jaguar restoration project, sent me this photograph. We do not own it or have copyrights to it; still it is presented here in the interest of humor and collegiality.

###

Jaguar

Assessment

With all due respect to my Atlanta neighbor, and comedian, Jeff Foxworthy.

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Healthcare Promises [aka ACA]

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On the Affordable Care Act

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

Rick Kahler CFP“I’m not sure what’s wrong or what kind of surgery you need, but we have to operate right now.”

If you heard this from your doctor, you’d jump off the examination table and run for the door. Yet that’s essentially the approach the President and Congress used three years ago to pass a bill, optimistically called the Affordable Care Act, which was the largest transformation of the U.S. health care system in our lifetime.

The Debate

During the frenzied debate our elected leaders made many promises as to the amazing benefits this legislation would bestow on Americans. After listening to speeches from President Obama, Speaker of the House Nancy Pelosi, and President of the Senate Harry Reid, I recounted those promises in this blog on March 21, 2010.

The Promises

Let’s revisit those promises.

  1. All Americans will now receive affordable, or free, quality health care.
  2. No one will ever be denied coverage.
  3. No one will ever go into bankruptcy because of the costs of health care.
  4. There will be increased access to health care for 95% of Americans.
  5. There will be no decline in the quality of health care.
  6. Health care costs will go down.
  7. Health insurance coverage will be affordable to the middle class.
  8. There will be no decline in Medicare benefits.
  9. Insurance premiums will decline for the middle class.
  10. It will unleash unprecedented entrepreneurial opportunity for the economy.
  11. The deficit will decline, saving taxpayers $1.3 trillion.
  12. It will cut $500 billion of waste, fraud, and abuse out of Medicare.
  13. No government funds will be used to fund abortion.

Are these promises coming true? Many of them are pending full implementation of the act in 2014. Others have fallen flat or encountered the law of unintended consequences.

Obama Care

Business Owner’s

I’ve heard recently from several owners of small businesses about their increased health insurance costs. In addition to premium increases of nearly 50% over the past two years, they are seeing increased administrative costs from what one person called the “insanity and complexity” of the new regulations.

Businesses with fewer than 50 employees aren’t required to provide health insurance. The incentive for owners of businesses close to that threshold is to keep employee numbers below 50, which means curtailing growth or even laying people off.

Those without employer-provided insurance are supposed to be able to shop for coverage in new health care exchanges, beginning this October. However, half the states have chosen to rely on the federal government instead of setting up their own exchanges.

This has brought criticism even from former supporters like Democratic Senator Max Baucus of Montana, who helped write the health care bill. He is concerned that the exchanges will not open on time and consumers won’t have the information they need to use them. He told the Huffington Post that Obamacare is headed for a “train wreck.”

ACA Cost Estimates

The proponents said the ACA would cost $938 billion over 10 years. In addition to the promised Medicare savings, this was to be covered by a total tax increase of $562 billion over 10 years. This included a Medicare tax of 3.8% on dividends, rents, interest, and investment income on individuals and small business earning over $250,000.

The Office of Management and Budget, however, places the cost at $1.8 trillion over 10 years, resulting in a shortfall of around $900 billion.

Assessment

Whether Obamacare becomes the wild success the proponents guaranteed is yet to be seen. However, what we’ve seen so far isn’t promising. We as consumers would be well advised to pay close attention and ask tough questions before we accept this drastic surgery.

More

Conclusion

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When did you last Review your Insurance Coverage – Doctor?

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Why shopping around periodically is a smart move

By Lon Jefferies, MBA CFP™  http://www.NetWorthAdvice.com

Lon JeffriesWhen is the last time you compared rates on your home and auto insurance policies – doctors and all ME-P readers? Unfortunately, a stellar safety record doesn’t always translate into lower insurance rates. Even if you think you have a good rate, shopping around periodically is smart.

A Reader’s Query

After attempting to follow my advice of maintaining an umbrella insurance policy, one of our ME-P readers contacted his insurer to add coverage. This reader was shocked when his insurer informed him that he didn’t qualify for an umbrella policy because he didn’t carry sufficient liability insurance on his auto policy. (Minimum auto liability insurance – frequently $500,000 – is required in order to purchase umbrella coverage.) Although this individual had owned his policy for eight years, he was unaware that the policy only provided $50,000 of liability coverage. This amount was clearly insufficient for an individual approaching retirement.

In addition to realizing that he was severely under-insured, this individual discovered he was also paying excessive premiums. For only $50,000 of auto liability coverage, this person was paying $914 per year. Moreover, the individual realized he was paying $351 per year for the $350,000 of liability coverage the individual had on his condo. Consequently, in total, this person was paying $1,265 per year for $50,000 of auto liability and $350,000 of home liability coverage.

Case Model

This individual then spoke with an independent insurance agent to increase auto liability coverage to an amount that enabled him to obtain an umbrella policy. This was critical, as it dramatically decreased the individual’s liability exposure, a risk an individual with accumulated assets clearly shouldn’t have. Even better, the individual was able to obtain dramatically improved rates on his policies. For a total of $1,207 (less than he was previously paying!), the individual was able to secure $1,000,000 of auto liability coverage, $350,000 of home liability, and an additional $1,000,000 umbrella policy.

policy insurance

Assessment

Clearly, it can be beneficial to occasionally review and compare rates on your insurance policies. People tend to believe that policies that have been owned for extended periods of time are efficiently priced, but it may be the opposite. If you haven’t verified that you are adequately insured and conducted a cost comparison recently, speak to an independent insurance agent and minimize your exposure with cost-effective policies.

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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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ProPublica Launches Prescriber Checkup [Interactive Database]

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The Doctors and Drugs in Medicare Part D

By Jeff Larson, Jennifer LaFleur, Charles Ornstein, Tracy Weber and Lena Groeger

ProPublica, Updated at May 10, 2013

Medicare’s popular prescription-drug program now serves more than 35 million people, but the names of prescribers and the drugs they choose have never previously been public … Until now.

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Medicare and Medicaid drug capsules
Assessment

Use this tool to find and compare doctors and other top prescribers in 2010.

Link: http://projects.propublica.org/checkup/

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Conclusion
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Seeking Director of Hospital Accounting

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For an East Coast Facility

By Kathy Williams kathyw@thorgroup.com
Resource Manager
Thor Group, Inc

Dear Dr. David E Marcinko,

Hello!  We are looking for a Director of Accounting for Hospital client located on East Coast. This is a Direct Hire position.  The position will oversee 3 Managers and 15 FTE’s.  This position will report to the VP of Accounting.

POSITION SUMMARY

The purpose of the position is to provide primary oversight, supervision and strategic direction to the General Accounting Department. This position ensures the accuracy of hospital’s consolidated financial statements in accordance with Generally Accepted Accounting Principles (GAAP) and system-wide policy.

Job Requirements

1. Previous Director / Manager experience in Hospital / Healthcare Accounting role
2. CPA or MBA required.
3. 7 to 10 years of experience.
4. The knowledge and ability to direct, control and supervise the activities of the General Accounting Department at a level generally acquired through 7 to 10 years of progressive experience in healthcare accounting
5. Experience formulating business and accounting policies and procedures
6. Extensive experience using computerized accounting systems and Microsoft Office.

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jobs

Assessment

If any ME-P reader is interested in this Director of Accounting position, please forward their resume to me at kathyw@thorgroup.com.  If you are not interested in this opportunity, perhaps you know someone who might be … please have them forward their resume to me!

Conclusion

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

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Events Planner: May 2013

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Events-Planner: MAY 2013

By Staff Writers
Calendar Calculator“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:

  • NAPFA National Meeting: Paris Hotel, Las Vegas, NV.
  • FRA Advisor Forum: Harvard Club, Boston, MA.
  • May 08: Public Safety Congress: New Orleans, LA.
  • May 16: Hospital Medicine: National Harbor, MD.

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Value Focused Frugality for Medical Professionals

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Authentic versus Misguided Frugality?

By Rick Kahler MS CFP® ChFC CCIM

http://www.KahlerFinancial.com

Rick Kahler CFPMedical professionals and those who successfully build wealth have one trait in common: they understand the art of frugality.

The Millionaires Next Door

These unassuming millionaires know how to live on much less than they make, and they know how to save money. But those behaviors alone aren’t enough. Why? Because not spending money today does not always result in having more money tomorrow!

On Frugal Types

Frugality for its own sake can result in doing without things that matter to you, failing to take care of basic needs like your health, and living with a sense of deprivation. It can also lead to spending more money, not less, in the long run.

Frugality for the sake of enhancing your life, on the other hand, features an eye for value. Most people who build wealth are masters at the art of getting value.

Thinking Savings        

There are many ways we might think we are saving money, but actually the opposite is true. We end up spending more money in the long term. Here are a few of the ways we can fail to get value:

1. Not spending the money to have legal documents drawn. A poorly-worded agreement—or even worse, no written agreement at all—can cost you a bundle in future legal fees or even result in your losing a business or other asset.

2. Doing your own taxes. Unless your finances are so simple you can file the 1040-EZ, you’re better off to pay a professional who will find deductions you’re likely to miss.

3. Buying a new car to save money on repairs. An occasional repair bill for a few hundred dollars is still a lot cheaper than a monthly payment.

4. “Saving” money by spending on bargains you don’t need or want. This includes settling for what’s cheapest instead of looking for the best price on what you really want.

5. Going without insurance. At a minimum, you should have homeowner’s or renter’s insurance, car insurance with maximum liability amounts, and a high-deductible health insurance policy. A loss or liability that isn’t covered can cost you everything you have.

6. Not getting regular medical checkups. “An ounce of prevention is worth a pound of cure” is a cliché because it’s so true.

7. Looking only at the initial price tag without comparing long-term costs. A more expensive but higher-quality item, whether it’s a car or a pair of shoes, might last much longer and be a better value than something cheaper.

8. Not focusing on value for services when purchasing investments. A discount broker, for example, isn’t always a better deal than a full-service broker. For “A” shares of mutual funds, you may pay the same in commissions without getting any personalized help. If you use a discount broker, be sure to purchase “no-load” funds, which don’t have commissions.

9. Paying hidden costs for financial advice. Writing a check to a fee-only planner may seem too expensive. Yet Bob Veres, editor of Inside Information, says that investors who don’t pay directly for the financial advice they get often pay two times more in hidden costs for the “free” advice. If you buy investments products from a financial salesperson, keep asking questions until you know exactly what you’re paying in commissions and fees.

10. Paying off a low-interest loan instead of putting the money into a retirement account. If you can earn more than you pay in interest, it may be wiser to keep making loan payments.

Fiscal Cliff

Assessment

Frugality that focuses on value is an essential wealth-building tool. Those who use it well do more than just save money. They know how to get the most value for the money they do spend. Do you, doctor?

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

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Understanding the Domestic “Shadow Economy”

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Is the US Economy Strong OR Not?

By Dr. David Edward Marcinko MBA

www.CertifiedMedicalPlanner.org

Dr David E Marcinko MBARecently, new highs for the DJIA and some better than expected jobs numbers pointed an outward sign of the US  economy’s continued — though sluggish — recovery from the Great Recession.

Workers in the Shadows

But, there may be another explanation for why consumers keep spending more despite higher payroll taxes and more pain at the gas pump.

Edgar Feige PhD Speaks

That reason is a thriving shadow economy, estimated to have reached as much as $2 trillion last year, according to a study (.pdf file) co-written by Edgar Feige, an economist at the University of Wisconsin-Madison.

Assessment

A shadow economy is one where workers turn to employment that pays under-the-table. While that sometimes includes illegal activity, such as drug dealing, much of the shadow economy today appears to be in areas like service work such as babysitting; medicine, eye, foot and dental care; and working construction jobs for cash.

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Conclusion

And so, are new medical practice business models like retainer and concierge medicine, direct/private pay, or cash care more or less prone to participation in the underground healthcare economy?

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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Moonlighting and Deducting Professional Expenses [video]

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For Healthcare Accountants

By Andrew Schwartz CPA

http://schwartzaccountants.com/

Andrew Schwartz

Content: Video (mp4) – 122.48MB
Title: Andrew Schwartz Webinar 1.16.13 Moonlighting and Professional Expenses

Video: http://www.screencast.com/t/Zksfdssln

Andrew D. Schwartz, CPA, received his B.S. in Accounting and Finance from the Wharton School at the University of Pennsylvania. Prior to forming Schwartz & Schwartz, P.C. in 1993, he worked at KPMG Peat Marwick, LLP.  Andrew is the author of many tax and financial articles on a variety of issues that impact healthcare professionals.  He is frequently quoted as a tax advisor on current topics in national publications, such as the Washington Post and Wall Street Journal.   Andrew is also the founder of The MDTAXES Network,  a national association of CPAs that specialize in the healthcare profession.

Conclusion

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Physician Advisors: www.CertifiedMedicalPlanner.org

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Ten Methods of Maximizing Medical Practice Income

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On Overhead and Practice Efficiency

By Neal Baum MD

Dr. BaumAs I meet with doctors, other urologists and office managers throughout the country, I am frequently told, “Neil, we don’t need more patients. We need to increase our reimbursement, decrease our overhead, and improve the efficiency of care.”

Introducing Neil H. Baum MD

I will leave the reimbursements to the experts, but now I would like to focus on overhead and practice efficiency.

The Past

In the past we enjoyed the luxury of seeing a relatively few patients and enjoying very juicy, fat profit margins. Today, the situation is reversed. Many of us are seeing a lot more patients and we all know about those razor thin profit margins. As a result we are motivated to become more efficient.

The List

So, in this ME-P article, I will provide you with ten ideas to make your practice more efficient:

  1. Have the lab results on the patients chart or in the patients electronic medical record before the patient arrives for hisor her appointment. Nothing can slow down your patient flow than to have a patient who had a prostate biopsy in the exam room and not have the pathology report on the chart. Now your nurse or patient coordinator calls the pathologist for the report and has the report faxed to the office. This can 15-30 minutes and a very anxious patient is waiting in the exam room for the report. Or, a worst case scenario is the pathology slides have not been read and the patient makes an unnecessary visit. All of this can be solved by checking the charts the day before the patients arrive to see that all lab and x-ray reports are on the chart.
  2. Use a scribe. My accounting practice consultant advised me that all of my efforts should be dedicated to doing only what a physician can do and not any other activity that can be accomplished by someone with less training, skills, or compensated a lesser fee than a physician. With that advice, I decided I should not be taking the history of the chief complaint, the review of systems, and past medical history. I have now trained a “scribe” who does all of that for me before I conduct the physical examination. I then report to her the few findings I have found on the physical exam and what are my treatment recommendations which are carried out by the scribe or the nurse. As a result I spend far fewer minutes with each patient but the time that is spent with them is quality, eyeball to eyeball time.
  3. Effective scheduling. I don’t know of a urology practice that doesn’t have one or two emergencies or urgencies where the patients need to be seen the very  day they contact the office. Every morning or afternoon my practice receives a call from an existing patient that needs to be seen immediately or a call from a referring doctor who has a patient in their office that needs immediate urologic care. In the past the patient was told to come in and that they would be worked into the schedule. As a result, patients with scheduled appointments were delayed 15-30 minutes. Today we leave a 15 minute time slot at 10:30 A.M. and another open slot at 2:45 P.M. and these urgencies or emergencies are told to come at those designated times or at the very end of the day. These slots are referred to as “sacred time” and cannot be filled until after 8:30 A.M. on the day we are seeing patients. I have yet to encounter a patient or referring doctor that won’t accept that scheduling option. Now that late morning or late afternoon scheduled appointment is seen in a timely fashion.
  4. Answer all of  your patient’s questions at the time of their visit. It was not uncommon for me to think I was finished with a patient, close their chart, and start to walk out of the room and as soon as my hand touched the door knob, the patient would say, “Dr. Baum, I have one more question.” Frequently, I would have patients interrupt me as I was about to see another patient or they would call to take to me or my nurse after they left the office. Now patients are given a card when they check in which allows them to write down what questions they would like to ask the doctor on this visit. Patients will frequently start thinking about what they want to ask during the visit while they are in the reception (not waiting) room or when they are taken to the exam room. This now avoids the door handle questions and ensures that the patients’ most pressing concerns are answered when the chart or EMR is opened.
  5. Use videos to explain common urologic conditions and procedures. There are days when I might discuss a topic such as vasectomy three or four times. I found that I could considerably improve my efficiency by making a 5-7 minute video of me explaining the procedure, the complications, the risks, and the post-procedure caveats. After examining the patient, I tell them I would like them to view a video on vasectomy and I would like them to open the door when the video is completed and I will return to provide them with a written summary and to answer any questions that they may have on the procedure. While they are watching the video, I am able to see 1-2 patients. I also write in the chart that the patient has seen the video which makes good medical-legal documentation that patient was informed of the risks, complications, and alternatives of treatment.
  6. Educate patients before, during, and after their visit to your office. Today there is an abundance of educational materials available to your patients from pharmaceutical and device companies, the Internet, and software companies specializing in patient education. (I use DialogMedical at www.dialogmedical.com.) When a patient calls for an appointment, they are asked the purpose of their visit and they are encouraged to go to our website for educational material or we are happy to send them educational material before they come to the office on the medical condition or problem they may have. They are also provided with educational material during their visit as well as additional information in the “thanks for  being our patient” letter that they receive from our office after they have left our office. It has been my experience that an educated patient makes a better patient and less time needs to be delegated to explaining their medical condition. These educational materials are also available in other languages and usually are written at the 10th grade level.
  7. Never touch a piece of paper or mail twice. So many times I will look at the mail or reports and then place them in another pile to take action on later. It is far more efficient to look at the mail and reports and take action on the paper immediately. You can use Post-It notes if you plan to delegate the action to another staff member.
  8. Leave your office with all paper work completed. Try to avoid allowing paper work to become a mountain of charts on the back of your desk. You become more efficient if you can do the dictation real time in front of the patient or immediately after each patient encounter. Now you don’t have to rely upon your memory when you review the chart days or weeks later.
  9. Schedule time for patient call backs. Have your office tell patients that you will be calling them at a designated time at the end of your working day or ask for the number where they can reached at a time when you plan to return calls. Now you avoid playing telephone tag with your patients and avoid them waiting for extended periods of time for you to return their call.
  10. Use drive time to call patients at home. Most of us live 15+ minutes from our practices. You can make good use of this time by contacting patients that you or your office staff were not able to reach during your business day. I have my staff tell the patient that I will be calling between 6-7 P.M. and would they please be at home and keep the line free so that we avoid telephone tag. Most patients are eager to hear from their doctor and will make themselves available at a time convenient for you.

Healthcare Workers

Assessment

There you have it; a few ideas that can help make you more efficient and allow you to see more patients and improve your bottom line. By the way if you have any other ideas that you have used successfully and would like to share with your colleagues, please let me hear from you.

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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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Did You Survive the [Fleeting-Tweeting] “Flash-Crash” of 2013?

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The Day the Dow Jones Industrial Average Lost 150 Points

By Lon Jefferies, MBA CFP™  http://www.NetWorthAdvice.com

Lon JefferiesThe stock market just reached an all time high, crossing 15,000 for the first time.

But, within three minutes during last April 23, 2013, the Dow Jones Industrial Average lost nearly 150 points, and approximately $136 billion of market value was wiped out. The recovery was just as fast, and markets returned to having a profitable session (both the Dow and the S&P 500 were up over 1% for the day). The crash and recovery both happened so fast that many Americans, and physician-investors, weren’t even aware of the events.

So what happened?

On Tweeting

Believe it or not, the crash was caused by a tweet – a 140 character message posted on Twitter. The Associated Press Twitter account — which has nearly 2 million followers — was hacked and a false tweet of “Breaking: Two Explosions in the White House and Barack Obama is Injured” was posted. The message was quickly debunked by the President’s staff and markets corrected themselves. Both the crash and recovery took place in less than five minutes.

Lessons Learned

Several lessons were learned that day.

First, the power of social media is now undeniable. This was caused by a simple twelve-word lie on the internet. Further, information about the market collapse and recovery were widespread via Twitter and Facebook instantaneously, while the whole episode was over before television networks had a chance to report the events.

Second, it’s amazing how fragile our world is these days. News regarding terrorism has the potential to dramatically affect the market as well as other important aspects of our lives. It’s concerning how the world might respond if the President really was injured. (Interestingly, however, the market didn’t suffer after the Boston Marathon tragedy.)

Third, it is fascinating to examine how different asset categories responded in a time of perceived crisis. Investors build diversified portfolios hoping that when one asset category collapses, another asset class will rally. Some investors swear that gold will be the asset to own when the world struggles. Yet, when the market experienced a flash crash, gold did not rally but treasury bonds and the Japanese Yen did. Gold investors shouldn’t be as confident in their investment after this experience.

Finally, automated trading platforms have become more prevalent in the stock market. These tools execute mandatory, instant sell orders in defined market environments. When the crash occurred, algorithms read headlines and saw the initial market reaction and computers created automatic sell orders at what turned out to be the worst possible time. Traders utilizing automatic trading mechanisms with stop-loss orders suffered exaggerated losses, as they sold right after the market dip and didn’t participate in the recovery. This is a potential weakness of automatic trading that many didn’t recognize.

College Tuition Rising as Stocks are Dropping

Assessment

Why are many physician-investors unaware of this unusual market event? In reality, this drastic swing didn’t affect most investors hoping to improve their retirement. Individuals with a long-term investment strategy built around their risk tolerance don’t need to worry about these types of short-term market errors. At the end of the day, “buy-and-hold” investors had nothing to worry about and came out ahead. Perhaps we should be bragging via Twitter…

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Conclusion

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Physician Advisors: www.CertifiedMedicalPlanner.org

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Seeking Vice-President of Medical Management

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Advocate BroMenn Medical Center and Advocate Eureka Hospital in Normal, Illinois

By Paul Esselman
Executive Vice President, Managing Principal
Cejka Executive Search
4 CityPlace Dr., Ste. 300
St. Louis, MO 63141
pesselman@cejkasearch.com

Dear Dr. Marcinko,

Cejka Executive Search has been retained to recruit a physician executive to be the Vice President, Medical Management of Advocate BroMenn Medical Center and Advocate Eureka Hospital.

The Opportunity

Advocate BroMenn Medical Center, a 221-bed full-service, not-for-profit, Level II trauma center and teaching facility located in Normal, Illinois, is one of the most advanced acute care facilities in central Illinois.  Last year, Advocate BroMenn opened a new 136,000 sq. ft. hospital addition housing state-of-the-art diagnostic and therapeutic services as well as opened a new 84,000 sq. ft. outpatient center, housing imaging, therapy and laboratory services and physician practices.

Advocate Eureka Hospital is a 25-bed critical access facility located 25 miles north of Normal.  With their affiliation with Advocate Health Care in 2010, Advocate BroMenn and Advocate Eureka are now part of the largest integrated healthcare system in Illinois and one of the Top 10 health systems in the country. Advocate BroMenn has been consistently recognized for high performance and awarded the Consumer Choice Award as the “Most Preferred Hospital for Overall Quality and Image” in its region.

Leadership Team

As a key member of the senior leadership team, the VPMM will serve as the clinical strategist to drive improvement in hospital-wide services and quality measures for the two hospitals.  The VPMM will be instrumental in working with the medical staffs and Advocate Health Care’s Clinical Integration division to implement its nationally-recognized approach to patient care utilizing the best practices in evidence-based medicine, advanced technology and quality improvement techniques.  The VPMM will lead the organization in achieving a high level of quality, service, and outcomes and align the culture of physician providers and the hospitals in preparation for healthcare reform.

The VPMM will also coordinate medical affairs and implement consistent policies and practices; manage and develop physician education initiatives; and oversee clinical utilization, case and risk management, and physician satisfaction at both facilities.

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jobs

Candidates

Successful candidates will have at least five years of experience in clinical practice and at least three years of demonstrated success in a senior medical executive role within a hospital, preferably serving in a similar position.  Current board certification is required.  An MBA/ MMM degree is highly desirable.

Information Requests

For more information or to nominate candidates, kindly contact me. Thank you.

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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The Cost of [Healthcare] Data Storage Through-Out the Years

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A Hard Drive History Infographic

By Mike Thomas historyofharddrives@gmail.com

425 N Prince St
Lancaster, PA 17603
7172079980

Data storage wasn’t as inexpensive as it is today. Technology is always advancing and doing bigger and better things that seemed impossible at one time. With that being said, the price of data storage has only decreased while the size of the storage overall has vastly increased.

The following infographic delves into the price of data storage throughout the years beginning with the first hard drive on the market, the RAMAC 305 that was available in 1956. Follow the timeline throughout history and read about the transformation of these data storing devices. Whether you’re a computer geek, a technology hoarder, or new to the computer world we live in, this infographic is one you will enjoy. Share this on your social media profiles, email it to the IT department at the office, or blog about these outrageously priced data storage devices to gain a new appreciation for the storage capacity we have today.

MD and financial literacy

History Of Data Storage Devices

They just don’t build things quite like they used to. This statement may seem clichéd, but it greatly applies to data – and not in a bad way. Through the years, technology becomes more and more advanced, exceeding expectations and pushing toward new and innovative products and capabilities.

In the case of this infographic, computer memory and data storage have increasingly changed since their beginnings in 1956. If we hadn’t learned how to make memory and data storage servers smaller, then we’d still have rooms solely dedicated to these large machines like the RAMAC 305 that was the size of two large refrigerators. Computers would still be gigantic and immobile, unlike our sleek and portable laptops. Nowadays, our laptops, cell phones, and desktop computers are smaller than years past but are equipped with larger memory capabilities that it once had.

Advances in Computer Data Storage Devices

To gain a better appreciation for the advances in technology, we’ve created an infographic that highlights the data storage throughout the years. Beginning with the RAMAC hard drive, we outline all types of storage devices from 1956 to present. Learn how much money these products cost at the time as well as what the price would be like with inflation factored in. It’s interesting to understand these data storage solutions, particularly how they became smaller in size yet bigger in storage capabilities. Millions of people from school students to business professionals rely on the memory in their computer to save documents, presentations, and other important information.

How crazy would it be if one megabyte of storage still cost $10,000 like in 1956? If that were still the case, laptop prices would be out of this world, and many companies and schools wouldn’t have computers to work on. Sprinkled throughout the infographic are interesting facts on how much a megabyte of storage has cost throughout the years. These amazing statistics demonstrate jut how much the price of storage has decreased since 1956.

RocklandIT Infographic

infographic on the cost of data storage

[click to enlarge]

Save, Store, and Share

Whether you’re an MD, FA, CPA, JD, student, computer geek or just interested in learning more about [medical] data storage devices, feel free to share this information with friends, family, and others. We hope that you enjoy reading this content and we encourage that you blog, tweet, pin, and share this graphic with the world.

Assessment

And, your HIT department, hospital, clinic or office coworker might appreciate viewing this infographic and possibly recollect using one of these storage devices of the past.

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
Financial Advisors: http://www.CertifiedMedicalPlanner.org

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Why President Nixon Signed the Controlled Substances Act in 1970

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The DEA History

[By Staff Reporters]

Doctors prescribe harmful and potentially addictive drugs, and they all hold a DEA license to do so.

But, did you know that one of the foundations upon which the Drug Enforcement Administration was created is the Controlled Substances Act (CSA)? It was signed into law as part of a broader set of laws called The Comprehensive Drug Abuse Prevention and Control Act of 1970.

The CSA

As all doctors and nurses know, the CSA created five schedules for controlled substances ranging from Schedule I, the most restrictive classification to Schedule V, the least so.

Schedule I drugs have a 1) High potential for abuse 2) No currently accepted medical use in treatment in the United States and c) Lack of accepted safety for use under medical supervision.

Medicare and Medicaid drug capsules

Definition of Controlled Substance Schedules

An updated and complete list  of the schedules is published annually in Title 21 Code of Federal Regulations  (C.F.R.) §§ 1308.11 through 1308.15.

Substances are placed in their respective schedules based on whether  they have a currently accepted medical use in treatment in the United States,  their relative abuse potential, and likelihood of causing dependence when  abused.  Some examples of the drugs in  each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted  medical use in the United States, a lack of accepted safety for use under  medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are:  heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote,  methaqualone, and 3,4-methylenedioxymethamphetamine (“Ecstasy”).

Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse  which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone  (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone  (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).  Other Schedule II narcotics include:  morphine, opium, and codeine.

Examples of Schedule II stimulants include: amphetamine  (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate  (Ritalin®).

Other Schedule II substances include: amobarbital,  glutethimide, and pentobarbital.

Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less  than substances in Schedules I or II and abuse may lead to moderate or low  physical dependence or high psychological dependence.

Examples of  Schedule III narcotics include: combination products containing less than 15  milligrams of hydrocodone per dosage unit (Vicodin®), products containing not  more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and  buprenorphine (Suboxone®).

Examples of Schedule III non-narcotics include:  benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such  as Depo®-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse  relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam  (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate  (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®),  temazepam (Restoril®), and triazolam (Halcion®).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse  relative to substances listed in Schedule IV and consist primarily of  preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough  preparations containing not more than 200 milligrams of codeine per 100  milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and  ezogabine.

The Nixon Connection

CSA as part of the Comprehensive Drug Abuse Prevention and Control Act was signed into law by President Richard Nixon on October 27, 1970.

RMN

[President Nixon Signs the Controlled Substances Act] 

Assessment

This picture was taken on that day at the White House. Behind the president is Attorney General John Mitchell and next to the president is BNDD Director Jack Ingersoll.

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:

DICTIONARIES: 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
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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Workers Memorial Day 2013

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Workers Celebrate on May First This Year

By Matthew Pelletier

[Director of Public Relations]

Compliance and Safety LLC

marry-harris

“Pray for the dead and fight like hell for the living”

Marry Harris “Mother” Jones

[1837 – 1930]

Dear ME-P,

We’ve just published a page for workers memorial day 2013 (falls on Sunday April 28th, 2013) that I thought you might be interested in posting on the ME-P.

Link: http://complianceandsafety.com/blog/workers-memorial-day-2013/

Assessment

You’re also more than welcome to use any of the content from our memorial page on your website.

Workers Also Celebrate on May First This Year: International Workers’ Day

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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“Pound Foolish” [Book Review Video on Personal Finance]

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Exposing the Dark Side of the Personal Finance Industry

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

By Professor Hope Rachel Hetico RN, MHA, CPHQ, CMP™

www.CertifiedMedicalPlanner.org

David and HopeHere are the first four video segments of an interview with Helaine Olen, by Harold Pollack, regarding her new book, Pound Foolish.

This essay first appeared on the The Incidental Economist [TIE]; an electronic forum by colleague Austin Frakt PhD:

The VIDEOS:

Part IV: http://www.youtube.com/watch?v=0cSmrH6FUvU&feature=youtu.be

Part III: http://www.youtube.com/watch?v=QTEGaTg9pQE&feature=youtu.be

Part II: http://www.youtube.com/watch?v=xNPX7kft5oM&feature=youtu.be

Part I: http://www.youtube.com/watch?v=WPanXaLvTTI&feature=youtu.be

You can see a more extensive interview with Olen, with arguably better production values, on Frontline’s the retirement gamble last week.

About the Author

HELAINE OLEN is a free­lance journalist whose work has appeared in The New York Times, The Washington Post, Slate, Salon, Forbes, Business­Week, and elsewhere. She wrote and edited the popu­lar Money Makeover series in the Los Angeles Times. She lives in New York City with her family. Follow her on Twitter at @helaineolen.

More:

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Assessment

This book reinforces the R&D efforts of our governing board of physician-directors, accountants, financial advisors, academics and health economists who [years ago] identified the need for integrated personal financial planning and medical practice management as an effective first step in the survival and wealth building life-cycle for physicians, nurses, healthcare executives, administrators and all medical professionals.

Now – more than ever – desperate doctors of all ages are turning to knowledge able financial advisors and medical management consultants for help. Symbiotically too, generalist advisors are finding that the mutual need for extreme niche synergy is obvious.

But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now!

Enter the Certified Medical Planner™ charter professional designation

 Certified Medical Planner

NOTEWORTHY:

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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