Safe Driving Tips all Doctor’s May Learn from Bus Drivers

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On Physicians Driving Safely

By Dr. David Edward Marcinko MBA

By Nalley Collision Center

Dr. MarcinkoBus drivers take their lives into their hands every day on city streets and interstate highways. Despite challenging traffic conditions and the responsibility of a large vehicle and numerous passengers, bus drivers find ways to stay safe while keeping up with demanding routes and schedules. These unsung heroes of the road universally command respect, but they also offer important lessons to ordinary drivers who share busy roads with buses every day.

So – as summer is upon us – and in the spirit of safe driving – allow our ME-P team at to share a few bus-driver inspired driving tips with you.

Distracted Driving

Modern technology has caused an addiction for many bus drivers as they struggle to communicate while safely driving a bus.

An Italian bus driver was caught on video simultaneously using two cell phones while steering his bus with his elbows. This talent showed the world that cell phone use behind the wheel might not present the extreme danger most people expect.

Seriously, bus drivers can provide some good examples of how not to drive. Although many states have laws in place restricting the use of electronic devices while driving, many states do not. All drivers, and every doctor, should avoid risking their lives and the lives of passengers by reserving cell phone use to emergencies while driving.

Road Rage

A New York City school bus driver named Juan DelValle side-swiped a car on a crowded city street and was subsequently attacked by the offended driver. DelValle was within days of his long-awaited retirement and died from severe injuries to his brain.

This one example shows how a minor traffic incident can quickly escalate into a life-changing event for unprepared drivers. Drivers should exercise extreme caution every time they have an incident with another driver. After an accident, drivers who feel threatened can call police and wait in their cars until help arrives.

Rest                                             

Bus drivers illustrate why no one should sit behind the wheel of a vehicle when fatigued.

Investigators determined that a tour bus crash in New York that killed 15 passengers was caused by a sleepy driver. The bus driver, Ophadell Williams, was charged with criminally negligent homicide. His life might never return to its previous state.

Drivers who spend time getting the sleep they need might arrive late at their destination, but they also arrive with a clear conscience, an alert mind, and living passengers.

Defensive Driving

A Transit bus in Los Osos, California rolled down an embankment after colliding with a car on a dark and wet stretch of road. Bus drivers know they cannot count on the driving skills of other motorists for safety, so they drive defensively. In the Los Osos case, the bus driver managed to stay alive after the Mercedes crossed the center line.

Although the driver of the automobile died in the wreck, all the bus passengers lived.

DEM's Jag XJ-V8-LMore

Assessment

Every driver should periodically take time to review defensive-driving tactics or to attend a defensive driving class to improve their ability to respond to unexpected circumstances on the highway.  

Conclusion

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On Inherited Money

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The “money scripts” of inheritances

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

Rick Kahler CFP“I’ve never seen money passed from one generation to another in a manner that actually benefited the recipient.”

When a psychologist said this to me several years ago, I was dumbfounded.

Many parents, like some doctors, scrimp, save, and sacrifice so they can “leave something to the kids” with the intention of doing them good. It’s hard to accept that inheritances may actually do harm instead. Most of us have money scripts that don’t support this idea.

Money Scripts

Typically, I used to hold several money scripts around inheritances. One was that leaving money to your children is a loving thing to do. Another was that parents should always leave their money to their children. A third was that anyone who received an inheritance would invest it wisely, using only the earnings to improve their lives.

Today I know those money scripts were not universal truths. I have more understanding of the problems involved in giving money away in a manner that is beneficial to the receiver. It isn’t as easy as I once thought.

Seed Money?

Many parents envision inheritances for their kids as “seed money” that will be used for the health, education, and welfare of their offspring for many generations. Research shows that is rarely the case; instead, inherited wealth does not last long. Missy Sullivan summarizes some of the research in “Lost Inheritances,” a Wall Street Journal article published online March 7, 2013. According to this article, 70 percent of those who receive an inheritance of any size spend it all in their lifetimes.

http://online.wsj.com/article/SB10001424127887324662404578334663271139552.html

For the 30 percent that do have something left to pass on, 70 percent of their kids also blow everything they get. That means by the end of the third generation, 90% of the money originally passed down is gone.

While it’s easy to understand how an inheritance of $10,000 may evaporate, it’s difficult to understand that inheritances in the hundreds of millions evaporate just as quickly. How is that possible? Is the average American just incompetent at managing money?

The Research

According to Sullivan, a study done by the Williams Group found that poor investment decisions were not the culprit. About 60 percent of large inheritances disappeared because of a lack of trust and communication between family members. Another 25 percent of the time, money evaporated because the parents failed to prepare the next generation to handle their impending inheritance. Poor investment advice and high fees were the cause in less than 15% of cases.

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Money

Options

If more high net worth parents knew that only 10% of their hard-earned estates would be around at the end of their grandchildren’s lives, I wonder if they might do a few things differently.

One option would be to address the two biggest issues—lack of communication and preparation for heirs—head-on during their lives. Parents wanting their money to benefit their kids could engage the services of a financial therapist who could help the family address their communication and trust issues long before they pass on their wealth. Preparing their children to manage wealth and use it wisely would be the best way to increase the odds of making an inheritance a blessing rather than a burden.

Another option would be to secure their own retirement, then forget all the scrimping and saving and just have fun blowing the money on themselves.

Still another option would be to give their wealth to worthy causes during their lifetimes or upon their deaths.

Assessment

This would leave the kids to make their money by ingenuity, hard work, wise money management, frugality, and a little bit of luck. The same way, in fact, their parents did. Are medical professionals any different?

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On the Future of Dentistry?

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Not good for the profession … as we know it!

By D. Kellus Pruitt DDS

1-darrellpruittIf you have not yet noticed, the future doesn’t look good for the dental profession as we know it.

Like far too many neighborhood primary care physicians who can no longer make a profit on their own, managed care is having its way with dentists as well.

Unfortunately, our patients remain clueless about downsides to discounted care sold by huge, insensitive corporations manned by executives who cannot be held accountable for their favorite providers’ level of care.

Since as a dentist I am somewhat transparent anyway, I would like to share some feelings with friends about an awkward subject that is on the minds of more dentists than one might expect, yet (almost) none feel comfortable revealing it: Regardless of the public’s perception of dentists’ wealth for the last few decades, it does not look like the anticipated economic recovery is likely to include the small dental practice down the street.

Schadenfreud

Not unlike Schadenfreude, I am certain at least some of dentistry’s disappointed customers may find this news addictingly pleasing to savor – up until one needs a dentist for a problem that cannot be handled safely by their designated dental therapist preferred by insurance MBAs.

I watch the dental news closer than most dentists, and sadly, my studied predictions have always proven to be very accurate, even if unpopular. Today I confidently predict that the profitability most dentists enjoyed for decades will not return for years – perhaps a decade or more.

On the other hand, as it becomes increasingly difficult to find dentists who allow time for gentle injections, patients should expect to pay them better than most. When an imbalance in the free market becomes unsustainable by artificial means such as managed care’s pay-for-performance algorithms, this is the way competition regulates quality in a natural way.

Personally, I’ve dealt with the downturn by working part time as an associate of another practice to make ends meet, and I feel fortunate to have found such a wonderful opportunity with a wonderful, patient-centered team. Marci, my wife, seems to be happier as well.

Assessment

Sorry if today’s news was a bummer, Doc. Maybe it is time others spoke up as well. Our leaders’ obvious lack of interaction on the internet exposes a tremendous vacuum, and they are incapable of rescuing the profession with silence… and neither will rushed therapists in huge dental clinics.

It’s up to you and me, Doctor. Come on out. The air is fine.

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Will Future Doctors Need a Medical License?

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Licensing Doctors – Do Economists Agree?

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Dr. MarcinkoChallenging conventional wisdom is something I like to think … that I do.

After all, I am considered a healthcare ‘thought-leader”, and to the extent possible, we publish outside traditional box thinking on this Medical Executive-Post.

It’s all Relative

But, I am a piker compared to Shirley Svorny PhD.

Who is she?

Dr. Shirley Svorny is chair of the economics department at California State University, Northridge, and she holds a PhD in economics from UCLA

Medical Licensure Issues

Now, remember the old saying, “if everyone is thinking alike, then nobody is thinking”.

Well, a while back, Dr. Svorny wondered if a medical degree is a barrier – rather than enabler – of affordable healthcare. Enter the PP-ACA of 2010.

As an expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argued that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

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

Her Published Abstract

“Despite the wide reach of medical licensing in health care production through its impact on the nature and cost of care, it has been all but ignored in debates over health care reform.

This paper pulls together statements made by economists whose expertise is in the area of health economics or, more specifically, medical licensure and discipline. Economists who have examined the market for physician services in the United States generally view state licensing as a means by which to enforce cartel-like restrictions on entry that benefit physicians at the expense of consumers. Medical licensing is seen as a constraint on the efficient combination of inputs, a drag on innovations in health care and medical education, and a significant barrier to effective, cost efficient health care.”

Full paper link:  2004-08-svorny-reach_concl

jester_hat

Am I Thought-Leader?

Am I a thought leader? Well, I don’t rightly know; that’s for others to decide. But, I do know that this essay was published a decade ago; in 2004, and at a time before the ME-P’s existence.

And so, based on this essay, Dr. Svorny is surely a “thought-leader” in my opinion

More about Dr. Svorny

In 1986-87, Dr. Svorny managed an industry risk group at Security Pacific Bank. She was a Milken Institute Affiliated Scholar and served as director of the San Fernando Valley Economic Research Center at Cal State Northridge. She has published articles in Economics of Education Review, Contemporary Economic Policy, Urban Affairs Review, Public Choice, Regional Science and Urban Economics, Cato Journal, Applied Economics, The Journal of Medical Licensure and Discipline, The Energy Journal, Economic Inquiry, and the Journal of Labor Research. Her opinion articles have appeared in the Los Angeles Times and the Los Angeles Daily News. Her research interests are in the areas of urban, labor, and health economics.

Assessment

Do traditionalists or collective healthcare reform advocates and health economists react rationally; or irrationally on this issue? What do you think?

Conclusion

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***

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Just “Say No” to Drugs

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A Flash-Back in History

[By Staff Reporters]

This photo was sent in by one of our ME-P readers for your enjoyment.

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Nancy

[First Lady Nancy Reagan at a “Just Say No” to Drugs Rally at the White House in the 1980’s]

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Ambulance, Hearse or Both?

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“Now and Then”

Dr David E Marcinko MBABy Dr. David Edward Marcinko MBA

[Editor-in-Chief]

I was recently at a car show and could not help but snap a photo of the beautiful black 1955 vehicle; below.

Ambulance Defined [Wikipedia]

An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient. The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care to those with acute medical problems.

The term ambulance does, however, extend to a wider range of vehicles other than those with flashing warning lights and sirens. The term also includes a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition (see functional types, below) and a wide range of urgent and non-urgent vehicles including trucks, vans, bicycles, motorbikes, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships (see vehicle types, also below).

The term ambulance comes from the Latin word ambulare, meaning to walk or move about which is a reference to early medical care where patients were moved by lifting or wheeling. The word originally meant a moving hospital, which follows an army in its movements. During the American Civil War vehicles for conveying the wounded off the field of battle were called ambulance wagons. Field hospitals were still called ambulances during the Franco-Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War.

There are other types of ambulance, with the most common being the patient transport ambulance (sometimes called an ambulette). These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. Such vehicles are called fly-cars. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.

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Ambulance DEM

[The Editor in Marquette, MI]

Hearse Defined [Wikipedia]

Originally, a hearse was an elaborate framework that was erected over a coffin or tomb to which memorial verses or epitaphs were attached. It was then put on the top of horse-drawn carriages, looking much like a luggage rack. Today, the original hearse remains acknowledged by the bit of scroll work or stretched-out “S” on the side of a funeral coach, called Landau bars.

Hearses were originally horse-drawn, but silent electric motorized carts were introduced as horses began to be phased out as transportation. Examples that were used in Paris were reported in the pages of Scientific American May 1907 and petrol-driven hearses began to be produced from 1909 in the United States.  Motorized hearses became more widely accepted in the 1920s.

The vast majority of hearses since then have been based on larger, more powerful car chassis, generally retaining the front end up to and possibly including the front doors but with custom bodywork to the rear to contain the coffin. Some early hearses also served as ambulances, owing to the large cargo capacity in the rear of the vehicle. A few cities experimented with funeral trolley cars and/or subway cars to carry both the casket and mourners to cemeteries, but these were not popular.

The only exception was Chicago, IL which operated 3 different funeral trolley cars over the elevated tracks in downtown Chicago to outlying cemeteries in the western suburbs. A special funeral bureau handled the funeral trains which sometimes operated 3-4 funeral trains a week over the ‘L’.

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2013-05-18 14.21.19

[Courtesy Rucker Funeral Homes, Lawrenceville, GA. © iMBA, Inc.]

Combination Utility

Back in 1955, this Cadillac performed double-duty for a small town in North East Georgia. Both as ambulance for the still living, as well as hearse for the newly deceased. Notice the dual red [“cherry”] light and siren on the roof  A very utilitarian approach to both functions, don’t you think?

History [Wikipedia]

A combination car was a vehicle built upon a (usually Cadillac) “professional car” chassis which could be employed either as a hearse or as an ambulance, and had the capability of being swapped between those roles without much difficulty. These vehicles were upgraded by coachbuilders such as Superior, Miller-Meteor, and Cotner-Bevington, and were typical of the era when funeral homes offered emergency ambulance service in addition to their primary trade.

Even if a “combo” has no flashing lights (mounted or concealed), siren, or two-way radio installed, an experienced vehicle collector can recognize it as such by it having systems to carry either a gurney or a casket, one or more foldable seats on one side in the rear compartment where a first-aid person can sit while looking after a patient on their way to the hospital, and a cabinet where first-aid supplies can be stored.

Also, the presence of ambulance technology made combos useful in the first call role, as a gurney is also used in that function.

Some combos were equipped with rotating roof beacons that could flash either yellow lights in processional mode, or both red and yellow lights in emergency response mode. Alternately, a hole on the roof was often supplied where a beacon could be bolted on an intermittent basis, a wire passing through to the driver’s compartment where it could be plugged in when needed.

Combos employed more often or exclusively as ambulances were often fitted with ambulance markings and additional lighting. However, usage of passenger car or station wagon derived vehicles as ambulances became impractical in the US after c. 1980 due to upgraded equipment and interior measurement requirements imposed by US government regulators. Many such vehicles were donated or otherwise found their way to developing nations.

The Cadillac combination unit was made famous in Ghostbusters as the Ecto-1, a modified 1959 Miller-Meteor coach.

Note: The Hess & Eisenhardt company also produced luxury Jaguar automobiles; my favorites.

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jag346_SWHT

[My vintage 2000 Jaguar XJ-V8L Touring Sedan]

 

Conclusion

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What Physician Investors Need to Know about Monte Carlo Simulation

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Probability Forecasting and Investing

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief] www.CertifiedMedicalPlanner.org

dr-david-marcinko1Recently, I had a physician-client ask me about Monte Carlo simulation. You know the routine: what it is and how it works, etc.

From Monaco

Named after Monte Carlo, Monaco, which is famous for its games of chance, MCS is a technique that randomly changes a variable over numerous iterations in order to simulate an outcome and develop a probability forecast of successfully achieving an outcome.

In endowment management, MCS is used to demonstrate the probability of “success” as defined by achieving the endowment’s asset growth and payout goals.  In other words, MCS can provide the endowment manager with a comfort level that a given payout policy and asset allocation success will not deplete the real value of the endowment.

Quantitative Tools Problematic

The problem with many quantitative tools is the divorce of judgment from their use. Although useful, MCS has limitations that should not supplant the endowment manager’s, FA or physician-investor’s, experience.

MCS generates an efficient frontier by relying upon several inputs: expected return, expected volatility, and correlation coefficients. These variables are commonly input using historical measures as proxies for estimated future performance. This poses a variety of problems.

  • First, the MCS will generally assume that returns are normally distributed and that this distribution is stationary.  As such, asset classes with high historical returns are assumed to have high future returns.
  • Second, MCS is not generally time sensitive. In other words, the MCS optimizer may ignore current environmental conditions that would cause a secular shift in a given asset class returns.
  • Third, MCS may use a mean variance optimizer [MVO] that may be subject to selection bias for certain asset classes. For example, private equity firms that fail will no longer report results and will be eliminated from the index used to provide the optimizer’s historical data.

Healthcare Investment Risks

A Tabular Data Example

This table compares the returns, standard deviations for large and small cap stocks for the 20-year periods ended in 1979 and 2010.

Twenty Year Risk & Return Small Cap vs. Large Cap (Ibbotson Data)

[IA Micro-Cap Value 14.66 17.44 24.69 0.44]

1979

2010

Risk

Return

Correlation

Risk

Return

Correlation

Small   Cap Stocks 30.8% 17.4% 78.0% 18.1% 26.85% 59.0%
Large   Cap Stocks 16.5% 8.1% 13.1% 15.06%

[Reproduced from “Asset Allocation Math, Methods and Mistakes.” Wealthcare Capital Management White Paper, David B. Loeper, CIMA, CIMC (June 2, 2001)]

The Problems

Professor David Nawrocki identified a number of problems with typical MCS in that their mean variance optimizers assume “normal distributions and correlation coefficients of zero, neither of which are typical in the world of financial markets.”

Dr. Nawrocki subsequently described a number of other issues with MCS including nonstationary distributions and nonlinear correlations.

Finally, Dr. Nawrocki quoted financial advisor, Harold Evensky MS CFP™ who eloquently notes that “[t]he problem is the confusion of risk with uncertainty.” Risk assumes knowledge of the distribution of future outcomes (i.e., the input to the Monte Carlo simulation). Uncertainty or ambiguity describes a world (our world) in which the shape and location of the distribution is open to question.

Assessment

Contrary to academic orthodoxy, the distribution of U.S. stock market returns is “far from normal.”[1] Other critics have noted that many MCS simulators do not run enough iterations to provide a meaningful probability analysis.

Conclusion

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[1]   Nawrocki, D., Ph.D. “The Problems with Monte Carlo Simulation.” FPA Journal (November 2001).

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Understanding the Impact of Regulations, Laws, and Healthcare Reform

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Consequences of the Accountable Care Act [PP-ACA]

By Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

Dr David E Marcinko MBAThere is a fair amount of activity that will take place in the next 24 months in response to ICD-10 transition, healthcare reform, Accountable Care Act (ACA), meaningful use compliance and its financial incentives, and other regulatory issues that will require system or software upgrades to support the new efforts.

Some ACA Examples

As an example, The Affordable Care Act is sure to significantly alter reimbursement structures and delivery of care.

Below are several areas that will be affected:

  •  With the projected increase in patient volumes, the associated cost of about 62% will emanate from Medicare cuts: $162 Billion through reducing fee-for-service Medicare payments; $136 Billion from setting Medicare Advantage rates based on Fee-for-Service payments; and $36 Billion from cutting hospital Medicare/Medicaid disproportionate share.
  • Compliance reviews will be increased through the Recovery Audit Contractors (RACs) where Centers for Medicare and Medicaid Services (CMS) expect to obtain $2.9 Billion in additional savings. With the RAC in place, hospitals and providers need to increase their focus and attention in improving documentation quality and validating medical necessity to substantiate their reviews.
  • Reduced payments for readmissions and Medicare penalties for poor outcomes can and will affect the bottom line for both hospitals and providers in the future.
  • By 2015, more than 19 million uninsured will receive coverage and in 2016, another 11 Million uninsured will be insured.  This will create more patients per hospital/provider and will require more full-time equivalents to support the revenue cycle process of registration, documentation, billing and collection.
  • With the ICD-10 conversion will create a more complex requirement for documenting diagnoses and will require software modifications for hospitals and providers as well as significant training.

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Conclusion

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Events Planner: June 2013

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Events-Planner: JUNE 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:

  • June 16-19: HFMA Institute Meeting. Orlando, FLA
  • June 25-27: AHA Health Forum Summit. San Diego, CA.

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Does the U.S. Supreme Court decision resolve the gene-patenting issue?

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Human Genes are NOT Patentable

By Karen Matthias RN MBA

[Vice-President of Marketing]

Hayes, Inc kmatthias@hayesinc.com

Yesterday, the U.S. Supreme Court unanimously agreed that human genes are not patentable, making a distinction between “natural” DNA found in the human body and the laboratory-created “synthetic” DNA. This opinion reinforces those of many in the genetics community who have argued for years that genes are products of nature rather than inventions.

A Resolution?

But, does the Supreme Court decision completely resolve the gene-patenting issue?

Dr. Diane Allingham-Hawkins, Senior Director, Genetic Test Evaluation Program and Technical Editing at Hayes, Inc., doesn’t think so.

“The Justices compromised somewhat in their decision that while human genes as they exist in nature were ruled not patentable, the opinion allowed that synthetic copies – so-called complementary DNA or cDNA – may be”.

The Court did not rule, however, that cDNA meets all requirements of patent eligibility, just that cDNA would not be considered a ’product of nature’.

Issues Not Addressed

In addition, Dr. Allingham-Hawkins points out what the decision does not address.

“Notably, the opinion clearly stated that it was not ruling on any methods patents related to the two genes or on any applications regarding what Myriad had learned about the genes, leaving the door open for narrower genetic testing patents.

Nevertheless, this is a major victory for the plaintiffs in the case and for patients, who will now have choices related to who performs their genetic testing and options to seek second opinions from independent laboratories.”

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US supreme court building

More 

Our new white paper on the history of gene patenting in the United States can be an excellent resource as you search for background information on this topic.

Download a complimentary copy here:  http://www.hayesinc.com/hayes/resource-center/white-papers/gene-patenting-in-the-united-states/.

Assessment  

Thanks for considering.

Conclusion

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Possible Causes of The Military Suicide Epidemic

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Erosion of Protective Factors

By Roy Miller roydotmiller@gmail.com

Hey Dr. Marcinko,

I’m one of the guys that reads you day by day. I come from a family with a military tradition, but unfortunately I couldn’t follow this path due to an eye problem. Instead, I became very passionate about army related stuff and I tend to bookmark and save as much material I can find.

I just came across this worrying material about suicide in the army and I’d like to share it with you, maybe you’ll find it interesting:

It’s quite a huge problem that unfortunately hasn’t made it on the public agenda and it’s continuously ignored, so I’m trying to create some buzz around it.

There are 3 protective factors to prevent suicide:

1. Belongingness:

The cohesion and camaraderie of a military unit can induce intense feelings of belonging for many service members. Time away from the unit, however, may result in a reduced or thwarted sense of belonging, as individuals no longer have the daily support of their units and feel separate and different from civilians. This is especially true for Guardsmen and Reservists.

2. Usefulness:

The responsibility inherent in military service, the importance of tasks assigned to relatively junior personnel and the high level of interaction among unit members establish the importance and usefulness of each unit member, particularly in an operational environment. In contrast, the experience of living in a garrison environment (for active component personnel) or returning to a civilian job (for Guardsmen, Reservists and veterans) or, worse, unemployment, can introduce feelings of uselessness.

3. Aversion to pain or death

Repeated exposure to military training as well as to violence, aggression and death dulls one’s fear of death and increases tolerance for pain. Thus, the very experience of being in the military erodes this protective factor, even for service members who have not deployed or experienced combat, in part because service members experience pain and discomfort from the beginning of their training.

military-suicide

Erosion of moral certainty

Moral injury: “damage to your deeply held beliefs about right and wrong. It might be caused by something that you do or fail to do, or by something that is done to you – but either way it breaks that sense of moral certainty.”

• Failing to protect their ‘brothers’
• Friendly fire
• Deaths of civilians, particularly women and children
• Discharged from the military

Assessment

It is not the fear and the terror that service members endure in the battlefield that inflicts most psychological damage, but feelings of shame and guilt related to the moral injuries they suffer.

Sources:

Conclusion

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National Time Out Day Recognized by The Joint Commission and AORN

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Wrong-Site Surgery Avoidance

via Hope Rachel Hetico RN MHA

[Managing Editor]

Professor Hope HeticoWhat it is?

According to Elizabeth Eaken Zhani, Media Relations Manager, in a letter sent to thousands of peri-operative nurses across the country, The Joint Commission and the Association of peri-operative Registered Nurses (AORN) are urging health care practitioners and organizations to recognize National Time Out Day to help draw attention to the time out as a tool for the prevention of wrong-site, wrong-side, wrong-procedure or wrong-person surgery.

National Time Out Day

In honor of National Time Out Day, AORN and The Joint Commission ask all immediate members of the surgical team and the organizations where they work to commit to conducting a safe, effective time out for every patient, for every surgical procedure.

Why

A wrong-site surgery should never happen and when it does it can be devastating for the patient, the surgical team and the health care organization.

National Time  Out Day, an annual event is meant to heighten awareness of the importance of the “time out,” the process a surgical team utilizes prior to the start of a surgical procedure to prevent a wrong-site, wrong-side, wrong-procedure or wrong-person surgery.

When

National Time Out Day will be celebrated in hospitals and ambulatory surgery centers [ASCs] on this June 12th, 2013.

How

Resources for celebrating National Time Out day are available on the AORN website

More:

Conclusion

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Contribute to the Medical Executive-Post and Tell Us What You Think

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Call for Guest Medical Executive-Posts!

By Ann Miller RN MHA

[Executive-Director]

MarcinkoAdvisors@msn.com

ME-P

Now that we’ve wrapped up our newest textbook, we thought it would be fun to keep everybody writing to share your best posts and comments with our ever-growing online community.

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We’re open to all kinds of related subjects on the business of medical practice, healthcare economics and finance, HIT and personal financial planning and investing for doctors and all medical professionals.

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So, if you’d like to comment or be a featured guest on our blog, or know of a great post we should feature or re-print, just let us know by emailing me! BROADCAST yourself.

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On the “Selling Points” for Whole-Life and Universal-Life Insurance

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De-Bunking Conventional Sale Wisdom

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

Rick Kahler CFP“You need to protect yourself and your family with life insurance that you won’t outlive.”

This is one of the common selling points for whole life or universal life rather than term life insurance. At first glance, it seems to make a lot of sense. Of course you don’t want to outlive your life insurance. Having it pay benefits upon your death is the reason you buy it.

This statement, however, misses one essential fact. Many people don’t need to worry about outliving their life insurance, because they outlive their need for life insurance.

Outliving the Need

We don’t all need life insurance throughout our entire lives, any more than we do auto or homeowners’ insurance. If you no longer drive a car, you don’t need auto insurance. If you no longer own a home, you don’t need homeowners’ insurance.

For example, in circumstances like the following, you may no longer need life insurance:

  • First;  when you and your spouse have accumulated enough assets and income streams to independently care for yourselves.
  • Second;  when your children are self-sufficient adults.
  • Third;  when your estate is too small to owe estate taxes or liquid enough to pay the estate taxes.

Primary Purpose

The primary purpose of life insurance is to replace the future income of a primary breadwinner. Two groups most likely to need it are middle-aged couples saving for retirement and parents of minor children. Ideally, most young families should have over $-1 million in life insurance to provide for the children if either parent should die prematurely.

Yet many of them are unable to afford the higher premiums for this much “permanent” insurance. Their choices are to underfund their needs with a smaller permanent policy or purchase an affordable 30-year term policy.

As we age, the probability of dying becomes greater. Therefore, a $1 million life policy costs much less for a 25-year-old than a 75-year-old. It doesn’t matter if the policy is cash value, whole life, universal life, or level term, the cost of providing the life insurance component increases every year.

Psychological Aversions

Yet most human brains have a psychological aversion to price increases. In order to please their customers with life insurance premiums that didn’t increase every year, insurance companies came out with level term policies. Essentially, the premiums are averaged out by overcharging in the early years of the policy and undercharging in the later years.

insurance

Higher  Premiums

Whole life and universal life insurance policies don’t have that same averaging. To be “permanent,” the premiums must be much higher in order to fund a savings account that grows over time and is often used to offset a significant portion of the death benefit in the later years of the insured’s life. Usually, if the insured cancels the policy, a portion of the premiums will be refunded.

Cash Value

A cash value policy may occasionally be a good estate planning tool, generally for those with substantial wealth. It might be used to fund an irrevocable life insurance trust upon the second spouse’s death, perhaps to pay taxes on an illiquid estate like a family farm or other property. It also can be used for those wanting to leave the bulk of an estate to charity and still provide income to their children. These strategies rarely apply to those whose primary goal is basic income replacement for their families.

Assessment

One of the ironies of insurance in general is that we all know it’s essential and we all hope never to need it. For most people, life insurance is not really an exception to this. Its primary purpose is not to provide us with investment income, but to provide our families with income if we aren’t there.

More:

Conclusion

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Celebrating “National Get Outdoors Day”

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National Get Outdoors Day is June 8th, 2013

By Staff Reporters

National Get Outdoors Day is a new annual event to encourage healthy, active outdoor fun.

Participating partners will offer opportunities for American families to experience traditional and non-traditional types of outdoor activities.

Prime goals of the day are reaching first-time visitors to public lands and reconnecting our citizens and youth to the great outdoors.

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get_outdoors

Assessment

So, leave the couch behind today.

More: www.NationalGetOutdoorsday.org

Conclusion

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Are Doctors Bad Investors?

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A Longboard Assessment Management Study for Lay Investors

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stock_investing_cashsherpa-812x1024

Assessment

And so, are doctors and other medical professionals really bad investors?

More:

Conclusion

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Physician-Investors and the “F” Word

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“Fiduciary”

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

Rick Kahler CFPOkay, I did it again in a recent column. And, I got into trouble again. That’s what I get for using the F-word.

Mea Culpa

My most recent transgression was to point out the simple fact that insurance agents are compensated by commissions on the products they sell. They have no fiduciary duty to legally act in the best interests of their customers.

Every time I remind readers that sellers of financial products do not have a fiduciary duty to their customers, I get indignant responses from financial salespeople who seem to think I have accused them of being unethical.

Ethics

Not so. Someone who sells financial products may well operate with integrity. In fact, their licenses typically require that they be “fair” and “honest.” These salespeople may care about their customers and be committed to selling only products that they believe will meet their customers’ needs.

But being a fair, honest, and ethical salesperson is not the same thing as having a legal fiduciary duty to the consumer. The word “fiduciary” has a specific meaning in our legal system. It describes those in positions of trust or authority who are required by law to act in the best interests of those they represent. A fiduciary is an advocate for the consumer, who is legally termed a “client.”

Of Doctors and Attorneys

Doctors and attorneys have fiduciary relationships with their patients and clients. The executor of an estate is a fiduciary. So is a trustee, someone acting under a power of attorney, or an agent hired to represent you. Real estate agents can be fiduciaries if they are engaged to represent either buyers or sellers.

Financial planners can also be fiduciaries. Yet those who offer financial advice and services in conjunction with the sale of a financial product are not fiduciaries.

Fiuduciary

Follow the Money

How can you generally tell whether a financial professional is required by law to act in your best interests? Simple. You follow the money. Wherever the professional’s compensation comes from is most likely where the fiduciary responsibility goes.

If you hire a fee-only financial planner, you are directly paying that person for professional advice and services. The planner receives his or her income from you and others like you. You are clients, not customers, and the planner is legally obligated to act on your behalf.

This is not the case if you buy financial investment products or receive financial advice from someone who is compensated by commissions. It doesn’t matter whether this person’s business card says “financial consultant,” “financial planner,” “investment advisor,” or “broker.” Anyone can use those terms.

Commission Sales

But, if someone is paid by commissions from financial companies, he or she is a sales representative whose fiduciary responsibility is to those companies. They may call you their “client,” but in the legal sense, you are not. You are a customer who buys products from a salesperson. Just like those who sell cars, groceries, or shoes, these salespeople owe their primary loyalty to their employers. They are obliged to operate in the best interests of themselves and their companies.

This relationship has a built-in conflict of interest. Because financial salespeople make most of their money from commissions, their recommendations to customers are usually biased toward investments that will be the most profitable for themselves. Their legal responsibilities are to act fairly and honestly. Most either don’t or won’t disclose the amounts and sources of their commissions

More:

Assessment

A financial salesperson who is not a fiduciary certainly can act with integrity. I know many who do. That means they are honest people who want to thrive in business by selling legitimate products in a responsible and ethical way. It does not, however, make them fiduciaries.

Conclusion

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Understanding the Spoils of Healthcare Fraud and Abuse

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Self Explanatory – Need we say more?

By ME-P Staff Writers

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Picture1

[Click on image to enlarge]

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Assessment

Conclusion

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How Volatile Is the Stock Market Today?

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And … Is it Dangerous?

By Lon Jefferies CFP® MBA www.NetWorthAdvice.com

Lon JefferiesBased on conversations with physician and clients, I’d suggest that most investors view the market of the new millennium as more volatile and fragile than it’s been in the past.

JUNE 4, 2013

DOW 15,253.7 +138.1
NASDAQ 3,465.49 +9.58
S&P 1,640.61 +9.87

New concerns that could affect a portfolio are seemingly always coming to light – think of the near-financial collapse of the U.S. economy during the last recession, the U.S. debt downgrade, the potential bailout crises in Europe and the possible devaluation of the euro, domestic unemployment concerns, and the perennial concern about the inflation/deflation of the dollar.

Add to this the idea that the world has become a more unstable place and the reality that supercomputers make thousands of trades every second.

How Valid Are the Concerns?

To determine the validity of these perceptions, Allan Roth analyzed the performance of the Wilshire 5000 (an index of the market value of all stocks actively traded in the United States) since 1980 in the May edition of Financial Planning Magazine. Surprisingly, Mr. Roth found that market swings of more than 30% weren’t much more common during the past 10 years than they were from 1980-2002. In fact, on a monthly basis, market swings of more than 10% actually occur less these days than in the past.

On a daily basis, the mean standard deviation of returns (a measure of volatility) over the entire 32-year period was 1.01%. In other words, during 68% of trading days, the index increased or decreased by less than 1.01%. Further, on 95% of trading days the index went up or down by no more than 2.02% (or two standard deviations). While daily standard deviation hit a record in 2008 of more than 2.5%, last year actually had lower volatility than the overall average. Consequently, while volatility hit a high in 2008, it has been at a very normal level since.

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Stock_Market

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Why the Perceptions?

So why do investors perceive more uncertainty in today’s environment? Mr. Roth mentions a few hypotheses:

  • Magnitude Effect – To suffer a 2.5% decrease in 1972, the S&P 500 would have needed to decrease by 2.54 points. To endure a 2.5% decrease today, the index would need to decrease by 41.25 points. Although both represent the same investment loss, we perceive the double digit point swing as larger and more dramatic.
  • Availability Bias – Humans overestimate the probability of events associated with memorable or vivid occurrences. Memorable events are further magnified by excessive coverage in the media.  Because the market crash of 2008 was so remarkable, investors tend to overestimate the probability of a similar crash and underestimate the probability of market appreciation, which historical data says is significantly more likely.
  • Access to Information – Jason Zweig, a columnist for the Wall Street Journal, says “today between websites, Facebook, Twitter, the TV and smart phones, an investor couldn’t escape knowing about a big move in the stock market if he or she tried. Whatever you pay attention to, while you are attending to it, will always seem more significant than it really is.”
  • Simple Fear and Pessimism – Meir Statman, a finance professor at Santa Clara University, suggests “people who think the U.S. is in decline view investing as riskier now than in the past, when they believe the country was better off, and no amount of data showing actual volatility would change their minds.” Similarly, Daniel Kahneman, a Nobel laureate and Princeton professor suggests “people always think the present is more volatile than the past. Because we know that historic crises have resolved themselves, we may simply remember the past as being less volatile than we viewed it at the time.”

More:

Assessment

It’s likely beneficial for physicians and all investors to evaluate their behavior and determine if they exhibit any of these biases. History tells us that the most dominate factor leading to investment success is to keep your asset allocation steady. Being aware of tendencies that might encourage us to make rash investment decisions could save us a lot of stress during critical market movements.

Conclusion

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The Chiropractic Fad?

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Now those hieroglyphics make sense!

By Anthony Narushka DC945457_573594136020162_1396079168_nAssessment

Chiropractic, it’s no fad!

Polish Chiropractic Association

New PCA BOD Members

[2009 Polish Chiropractic Association  BOD Members]

Conclusion

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