December | 2013 | The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Are FAs a Wise Investment?

Posted on December 30, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Ask-the-Advisor

Dear Dr. David Edward Marcinko,

Are financial advisors a wise investment? Mine charges me 1% each year for all my assets under their management. Is it worth it?

—Allen

It is hard to know for sure. But the fact that many financial advisers have different hidden fees suggests to me that they themselves don’t think that people would pay if they charged for their services in a clear and upfront way.

Re-Frame

To help you think about this question in your own life, let’s contrast two cases: In case one, you are charged 1% of your assets under management, and this amount is taken directly from your brokerage account once a month. In case two, you pay the same overall amount, but you send a monthly check to your financial adviser.

Consider

The second case more directly and clearly depicts the cost of your financial adviser, providing a better frame for your question. So, put yourself in the mindset of the second case, and ask yourself if you would pay directly for these services.

I think the best answer, according to colleague and economist Dan Ariely PhD, can be expressed in this manner.

If the answer is yes, keep your financial adviser; if the answer is no, you have your first action plan for the New Year.

More:

Why Physician-Investors Must Understand TAMPs

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.

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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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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Ask-an-Advisor", Investing | Tagged: david marcinko, Financial advisor fees | Leave a comment »

My Experience with ObamaCare

Posted on December 27, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Not a Unique Story – to Date

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

Like millions of Americans, I jumped on Healthcare.gov on October 1 to view the long-anticipated plans on the insurance exchanges mandated by the Affordable Healthcare Act, known as Obamacare. I needed a new healthcare plan and purposely held off buying one in September to compare the coverage and prices of an Exchange plan.

My disappointment paralleled that of thousands of other Americans wanting to do the same. After six tries that day, I gave up. I tried the site multiple times for each of the next six days. No luck.

The Short Form

Finally, on the seventh day, the site actually let me start an application. I chose to go with the “short” form since I was certain I would not qualify for a subsidy.

The short form application took 30 minutes to fill out. There were very few questions about health, just whether anyone in the household smoked. A number of questions had me wondering if I was applying for a passport. These included my Social Security number, race, citizenship, relationships to everyone in the family, and whether I was ever incarcerated.

When I reached the end of the form, I hit “submit,” anticipating that plan options and costs would appear. Instead, I was sent back to the starting page of the form. After 60 minutes of trying to get out of this endless loop, I gave up.

Three More Weeks of Trying

For the next three weeks, I went to the site at least once a day. I was never able to get past the endless loop to view plans or prices. I took a two-week break.

On November 14, I tried again. Success! Well, sort of. No endless loop. Instead, the site said it lost my original application and I needed to complete a new one. After another 60 minutes filling out the application, I ended up stuck in a loop again, unable to view plans or prices, much less choose one.

Giving Up

Frustrated, I decided to give it a rest until the site re-launched on December 1. I figured I would still have plenty of time to meet the December 15 deadline for enrollment.

On December 1, I eagerly popped onto the site. Not only was the site not functional, it had lost my application for the third time.

I gave up.

Enter the Insurance Broker

I phoned my insurance broker. She was able to give me all the information I had tried to get out of healthcare.gov for the past 60 days. She also said my insurance company was canceling my current plan. Obamacare deemed the coverage substandard because it did not cover pregnancy, mental health costs, and pediatric dental and vision costs. Although I don’t want or need any of that coverage, Obamacare gives me no choice.

Prices

My old policy cost $1,192 a month. The new one costs $1,506, which includes $59 a month in mandated surcharges on non-exchange policies to help fund Obamacare. My maximum family out-of-pocket expenses must also increase $208 a month. The total potential increase is a staggering $524 a month.

###

A Skeptic

As someone who listened with great skepticism as politician after politician promised that Obamacare would lower health care costs, lower our deficit, and guarantee we could keep any existing plan, I feel sadly vindicated. In March 2010, when Congress passed Obamacare, I paid $660 a month for health care that had better coverage than I have now. For that same coverage today, my premium would be $2,450 a month.

Assessment

Unfortunately, my story is not unique. It is ubiquitous to the average American who has health insurance. Our elected officials and government agencies failed us miserably. So far, there appears to be no relief in sight.

More

Conclusion

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Filed under: Health Insurance | Tagged: ACA, Health Insurance, ObamaCare, Patient Protection and Affordable Care Act, PPACA, Rick Kahler CFP® | 21 Comments »

On Bull Markets under Democrats

Posted on December 26, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Political Discourse by Kevin Outterson

[By Staff Reporters]

The Dow hit an inflation adjusted record high this week (WSJ). Here is the (unadjusted) S&P since 1975 with Republican administrations in red and Democrats in blue.

Before you jump to partisan conclusions, last month, Tyler Cowan reviewed the Blinder and Watson paper on why Democrats preside over superior economic performance (their conclusion: mostly good luck).

Source: Bull markets under Democrats

More:

Conclusion

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Filed under: Health Law & Policy, Investing, Portfolio Management | 6 Comments »

The Business of Christmas 2013

Posted on December 25, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

X-Mass Illustrated

With Christmas today, we thought it would be fun to post an infographic on the business of Christmas.

From the explosive growth of online shopping to the top selling Christmas gifts of different decades, we’ve got it covered.

Conclusion

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Filed under: Breaking News, iMBA, Inc. | Tagged: The Business of Christmas, X-mass | 4 Comments »

Seeking Securities Analysts, Stock-Brokers and Investment Bankers for New “Financial Planning Textbook for Doctors”

Posted on December 24, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Planning our newest major textbook

By Ann Miller RN MHA [ph-770-448-0769]

[Executive-Director]

Dear Stock Brokers, IBs and Securities Analysts,

Greetings from the Institute of Medical Business Advisors, in Atlanta, Georgia.

Historical Review

As you may know, we released: Financial Planning Handbook for Physicians and Advisors, some time ago. It has enjoyed much success and acclaim in the medical and financial service sectors.

Recently, we have been asked to produce the next edition of this book for our target market of physicians, nurses, medical professionals, healthcare administrators – and those in the financial services sector who target this large and fertile, but rapidly changing niche market.

Why Now?

Urgency for the update has been prompted by ARRA, HI-TECH, the flash-crash of 2008 and the day-crash of 2011; by social, macro-economic and demographic changes; by political fiat and especially the PP-ACA.

Our medical colleagues are frustrated, afraid and fearful for their financial futures. They WANT informed advice.

Thus, true integrated financial planning information that targets this market – very expertly and specifically – is greatly needed.

The Invitation

And so, we ask if you are interested in contributing an updated vision of an existing book chapter.

INVESTMENT BANKING-SECURITIES-MARKETS-MARGIN
HOSPITAL EMPLOYEE BENEFITS AND STOCK OPTIONS
INVESTMENT POLICY STATEMENT CONSTRUCTION

Not to worry – The original MS-WORD® chapter files are archived and available for use. We will forward it to you, upon assignment acceptance.

And, we are again fortunate that our Editor-in-Chief will be Dr. David Edward Marcinko FACFAS MBA CMP™ along with Professor Hope Rachel Hetico RN MHA CMP™ serving as Managing Editor.

They opined at a recent interview for the ME-P.

” … We have entered into an emerging era in the financial planning ecosystem. It is a new era where one size does not fit all; and off-the-shelf financial products and mass sales customization is no long adequate for physicians and medical professionals; or their related generic financial planners or wire-house advisors.

It is a period of rapid change, shifting reimbursement paradigms and salary reductions that focus the healthcare industrial complex on pay-for-performance [P4], compensation for value and quality care; rather than procedures performed and quantity of care.

All must learn to do more with less professionally; and plan their personal financial lives more efficiently than ever before. Mistakes will be more difficult to overcome and the wiggle room that high income earning physicians, nurses and medical professionals used to enjoy is being narrowed by demographic, economic, social, technological and political fiat.

This emerging financial planning analog follows the health industry’s fiscal metamorphosis …”

Style Instructions

The look and feel, format and style, and font and size of the book will remain the same. We use endnotes, not foot notes; and include mini-case reports or illustrative case models. It will be a major text; not a handbook.

Timeline for submission is about 3 months. Additional time is available, if needed, for a comprehensive update. But, we are trying to avoid running too far along into 2014 in order to avoid income tax season and the related time constraints on all concerned.

A Pleasure – Not Burden

This should be a pleasurable project for you; and not anxiety provoking.

So, if you are a medically focused and experienced financial advisor with an: MBA, CFP®, PhD, MD, DDS, MSA/MS, CPA, RN, CMP®, DO, JD and/or CFA degree or designation, etc; please let me know if you are interested in updating and revising our chapters. OR, authoring a new to the world chapter.

Your Payback

In return for your conscientious industry, you will receive a complimentary edition of the entire textbook; be listed on this ME-P as thought-leader with related book advertising content attributed to you; and given e-exposure to our almost 600,000 readers and ME-P subscribers …. Such the deal!

And, you will be added to our roster of experts for potential referrals, interviews, pod-casts and other marketing efforts

Assessment

Regardless of your decision, we remain apostles promoting your core vision of physician focused financial planning whenever possible.

Or, you may suggest another possible author- writer-expert contributor; if you wish.

Just let me know; ASAP [MarcinkoAdvisors@msn.com]

Thank you.
ANN
ANN MILLER RN MHA
[Executive-Director]
INSTITUTE OF MEDICAL BUSINESS ADVISORS, INC.
Suite #5901 Wilbanks Drive
Norcross, Georgia, 30092-1141 USA
[Ph] 770.448.0769

NOTICE: This invitation is not for all readers of the ME-P. It is a privilege invitation intended for those who possess the needed credentials, as decided by us, with an inclination to serve. We reserve the right to accept or reject contributors, and content, at our own non-disclosed discretion.

Filed under: "Advisors Only", Career Development, CMP Program, Financial Planning, iMBA, Inc., Investing, Portfolio Management, Recommended Books, Retirement and Benefits, Taxation | Tagged: About iMBA Inc., authors needed, certified medical planner, CMP, Dr. David Marcinko, financial planning for doctors, hope hetico, invitation | 18 Comments »

On Health Websites and “Apps”

Posted on December 24, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Not Just a Fad – Anymore

By Jennifer Tomasik, Carey Huntington and Fabian Poliak

http://www.CFAR.com

Health Information Technology [HIT] may have arrived slowly into clinics and insurance companies, but the pace of innovation and adoption in consumer electronics today is astounding (and accelerating).

Devices are quickly penetrating every facet of our lives in the form of laptops, smartphones, tablets, and beyond. Thousands of health and wellness websites and software applications (“apps”) already exist, and we believe their role in healthcare will be increasingly a central one. Some are crucial elements of health organizations’ programming, such as the online platform that ShapeUp is built on: www.ShapeUp.com

Are they Effective?

Many are stand-alone tools without an organization or programming per se—i.e. apps for counting calories, monitoring glucose levels, or tracking sleep. But are websites and applications effective means of engaging individuals in their own health? And if so, what separates the good ones from the bad ones?

The Data

A 2009 meta-analysis of web-based smoking cessation programs found the pooled quit rate for participants to be 14.8% after follow-up conducted three months out, and 11.7% after six months out. [i] These figures are an improvement over the rate of people attempting to quit without any help or resources, as previously cited.

Internal Studies

From our own study of health websites and applications, we are beginning to see that high-quality digital resources share many of the same characteristics as great products and services do in the physical world. They create pull by engaging users via explicit reward structures. They enable teamwork and foster social accountability. Their content is interactive, informative, and often individualized. Their use is intuitive, convenient (e.g. accessible by web on a laptop or tablet and by smartphone “mobile apps”), and even effortless to the user (e.g. automatically collecting, synchronizing, and analyzing information).

Fragmentation

The fragmented world of websites and applications is not without its problems.

In today’s “app market,” the void that many websites and applications fill is not necessarily in the best interest of “health consumers,” and the quality of their products or services is often questionable. We see such issues as a reality of any market in its early stages.

Assessment

However, we are optimistic that greater consultation with medical professionals, greater investment and competition among health organizations, and improved regulation can help this new market mature into an indispensable virtual ecosystem of resources for health-seeking individuals.

More:

Conclusion

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[i] Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. “Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials.” Arch Intern Med 2009;169(10):929-37.

Filed under: Information Technology | Tagged: health information technology, HIT, Jennifer Tomasik, On Health “Apps”, On Health Websites, www.CFAR.com | 6 Comments »

On Investment Insurance?

Posted on December 23, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Guaranteed living Benefits

By Rick Kahler CFP® www.KahlerFinancial.com

Many investors, panicked by the market crash of 2008-2009, started a search for some type of investment vehicle to protect them from the next market downturn. Some decided the answer was a variable annuity with a “guaranteed living benefit” rider.

Insurance

At first blush, this seems to be a good use of insurance. For a nominal cost, insurance helps us spread the risk of a catastrophe. Consider auto insurance. There is a very small chance I will total my car in the next year. It’s hard to predict whether that will happen, but one thing is sure, it is all or nothing. Either I will or I won’t.

However, predicting the number out of a large group of people who will total their cars becomes much easier. While we don’t know who will total their cars, we do know about what percentage of people will. This predictability allows an insurance company to determine the average number of claims and set an annual premium that covers the anticipated claims and generates the company a profit.

Market Crashes

Insuring market crashes works much differently. Michael Kitces, in his Nerd’s Eye View blog post of November 20, explains, “The problem with trying to insure against a market catastrophe is that the risks don’t ‘average out’ over time, instead, they clump together.” In other words, the insurance company has either no claims or 100% of their policy holders having claims.

Why? When insuring against a stock market decline, there are absolutely no claims when markets trend upward. However, when markets head down, every policyholder potentially has a claim. Kitces notes that usually “companies are very cautious not to back risks that could result in a mass number of claims all at once. This is why most insurance policies have exclusions for terrorist attacks and war.”

Policies

To help insure against this concentrated risk, the companies use several methods to design these policies. One is to collect a fee for the guarantee that funds a reserve to offset potential losses. Kitces says this fee is so “tiny” that it “just doesn’t cut it.” He gives an example of a company with $300 billion of guaranteed annuities where the market declines 25%, exposing the company to a $75 billion loss. A guarantee fee of 0.5% is only $1.5 billion, not enough to even begin to cover the losses.

Loss Mitigation

Another way the companies mitigate their loss is that, unlike auto insurance, these policies do not pay immediate benefits. If the market drops by 50%, you don’t get a check for your original investment plus a fair return for the time they had your money. What you get is a promise to pay you a lifetime stream of income, usually at some date in the future. If you had a portfolio of mutual funds holding thousands of companies and purchased a “guaranteed living benefit,” you actually transfer the diversified risk to one insurance company that has actually concentrated, rather than spread, the risk.

Variable Annuities?

Does this mean you should avoid variable annuities? No, as not all of them concentrate their risk. Most allow you to invest in a broad range of securities and spread your risk. Consider avoiding annuities that have a “guaranteed living benefit” and fees of over 1%.

Other Options

Kitces cites two other options for investors. One is to keep your portfolio invested in mutual funds that hold a broad selection of securities and simply lower your risk by owning less equity and equity-like investments and more bonds.

A second is to spend less, keeping your withdrawal rate under 3%.

Assessment

Practicing both of these strategies is a way of providing your own insurance against market crashes.

More:

Conclusion

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Filed under: Insurance Matters, Investing | Tagged: "guaranteed living benefit", Michael Kitces, Rick Kahler CFP®, variable annuity | 1 Comment »

Pity the Poor Hospitals?

Posted on December 20, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Historical Look-Back to the Future?

By Wayne Firebaugh CPA, CFP® CMP™

www.CertifiedMedicalPlanner.org

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future. … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been effected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect. [1]

In Agreement

Many health administration and endowment managers would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. Although they might be startled to learn that Dr. MacEachern made these observations in 1932, there is the old truism that there is nothing new under the sun.

Today

More current healthcare statistics after the November 7th 2012 presidential election and Patient Protection-Affordable Care Act confirmation, suggest that the financial crises are much the same for today’s hospitals as they were for hospitals during the Great Depression. The American Hospital Association (AHA) recently reported a number of gloomy statistics for hospitals: [2]

Hospitals provided $39 billion in uncompensated care to patients in 2010 representing 5.8% of their expenses.
Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million, that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.

More Metrics

A further review added more daunting numbers: [3]

In 2010, 22.4% of hospitals reported a negative total margin.
From 1997 through 2009, hospitals saw a small net surplus from government payments from sources such as Medicare and Medicaid deteriorate into a deficit approaching $35 billion.
Emergency departments in 47% of all hospitals report operating at, or over, capacity partially reflecting an approximate 10% decline in the number of emergency departments since 1991.
The average age of hospital plants has increased 22.5% from 8.0 years to 9.8 years in just fifteen years.
From 2003 through September 2007, hospital bond downgrades have outpaced hospital bond upgrades by 19%.

In a time when so much seems different yet so much seems the same, hospitals are increasingly viewing their endowments as a source of help. But what is an endowment?

Latin Roots

The same Latin words that give rise to the word “dowry” also give rise to the word endowment.[4] Interestingly, the concepts of a dowry and an endowment are in many ways similar. Both are typically viewed as gifts for continuing support or maintenance.

With respect to the healthcare entity, an endowment is generally used to smooth variations in operating results and to fund extra programs or plant purchases. Any entity that enjoys the support of an endowment also encounters the conflicting objectives between current income and future growth.

Assessment

Dean William Inge, a 19th century cleric and author, aptly noted that: “Worry is interest paid on trouble before it is due.”

When managing an endowment, it is important that the institution focus its attention on those items that it can control rather than worrying about those it cannot control. Successful endowment managers seem to agree that there are at least two major areas subject to the endowment’s control: asset allocation (also known as investment policy) and payout policy.

More:

The Danger of Groupthink with Endowment Fund Portfolio Managers

Conclusion

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[1] MacEachern, M.T., MD. “Some Economic Problems Affecting Hospitals Today and Suggestions for Their Solution.” The Bulletin of the American Hospital Association. July 1932.

[2] Steinberg, C. Overview of the U.S. Healthcare System. American Hospital Association (2003). Carline Steinburg is Vice President, Health Trends Analysis, for AHA.

[3] “Trends Affecting Hospitals and Health Systems.” TrendWatch Chartbook 2010. American Hospital Association (2010).

[4] Merriam-Webster Online.

Filed under: "Doctors Only", Health Economics, Practice Management | Tagged: A Hospital Industry Outlook, ACA, AHA, American College of Surgeons, American Hospital Association, Dean William Inge, Patient Protection-Affordable Care Act, Wayne Firebaugh | 7 Comments »

The AHRMM Stance on Comparative Effectiveness Research [CER]

Posted on December 19, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Association for Healthcare Resource & Materials Management

By Adam Higman

By Brian Mullahey

By Kristin Spenik

By Jerzy Kaczor

http://www.SoyringConsulting.com

In today’s hospital setting, data and healthcare information is the most accessible it has ever been making it necessary for healthcare professionals to assess and evaluate its accuracy. Additionally, the healthcare supply chain is filled with “me-too” products with often dubious improvements in clinical efficacy over competitive and legacy products.

The AHRMM Issues & Legislative Committee

AHRMM’s Issues & Legislative Committee has advocated the usage of Comparative Effectiveness Research (CER) to offer substantial, evidence-based data to aid healthcare organizations in their purchasing decisions. CER data includes unbiased conclusions regarding healthcare products and supplies, after having compared the advantages, usefulness, and possible harm of numerous pharmaceuticals, medical devices, equipment, surgical procedures, and tests for specific disease states and treatments of care.

Goals

By utilizing the CER-provided data, materials management professionals can :

Warrant top-performing Value Analysis Committees
Verify the cost-effectiveness and ability of salvaging “single use items”
Regulate Medical/Surgical products
Capitalize information technology efforts to decrease expenditures and inaccuracies
Change supplies, services, and technologies to lower budget-friendly, clinically-acceptable options that endure needed specifications
Convert to supplies, services, and technologies that produce better patient outcomes at a lower total cost that meets needed specifications
Prioritize capital expenditures
Use third-party benchmarking tools to get the most out of resources ²

More:

Take the DME Inventory Switching Challenge!

Conclusion

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Filed under: iMBA, Inc. | Tagged: Association for Healthcare Resource & Materials Management, CER, comparative effectiveness research, DME, DMEPOS, durable medical equipment | Leave a comment »

Unusual Forms of Property and Liability Insurance for Doctors

Posted on December 16, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Coverage Types

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Obviously, not all forms of insurance coverage can be described in detail on this ME-P. That’s where our books are useful.

However, as a licensed P&C insurance agent for more than a decade, the healthcare professional or medical practitioner should consider other forms of commercial property and liability coverage not considered the “norm.”

Directors and Officers Liability Insurance

The officers and directors of large practices, or healthcare facilities can be held personally accountable, and thus liable, for breaches of their duties by a number of parties.

Commercial Automobile / Vehicle Insurance

As the name suggests, this coverage provides protection for any commercial vehicles owned and operated by the healthcare corporation. If the practice or facility owns automobiles or other vehicles that are used in the “usual and customary” business activities, this coverage is required. The policyowner should be aware of the nine classifications of automobiles insured to ensure that coverage is appropriate.

Commercial Umbrella Liability Insurance

This coverage is very similar to the umbrella coverage discussed under the personal coverage area. Again, risks above the limits established by the underlying commercial liability coverage trigger the umbrella policy. The word of caution for this coverage is “Read the Provisions Carefully” as there is little standardization among insurance companies. Make sure the umbrella policy covers what you want it to cover, with the right limits of benefits and “trigger” points, with proper exclusions, and proper endorsements (if being used specifically for a medical practice).

Employee Benefits Liability Insurance

Virtually each medical practice or healthcare facility has employee non-cash benefits in addition to their payroll. These benefits usually include group insurance and some form of retirement plan (a 401(k), for example).

However, each of these benefit packages exposes the employer to liabilities under state and federal statutes. Employee Benefits Liability Insurance covers an employer, or if so stipulated by some policies, the employees who act on behalf of the employer, against liability claims involving alleged errors or omissions, or improper advice or administration of the employee fringe benefit plans.

For example, an employer may be liable for not enrolling an employee on a timely manner resulting in no medical coverage. Frequent litigation also arises out of violations of the Employee Retirement Income Security Act (ERISA) of 1974. Since 1974, the provisions and reach of this Act has become massive and errors can occur.

Assessment

Can you think of any other forms?

Conclusion

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Filed under: Insurance Matters | Tagged: Commercial Automobile / Vehicle Insurance, Commercial Umbrella Liability Insurance, directors and officers liability insurance, employee benefits liability insurance | Leave a comment »

Percentage of Americans Putting Off Medical Treatment Because of Costs

Posted on December 14, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Do we really know?

www.MCOL.com

Assessment

Conclusion

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Filed under: Health Economics, Health Insurance | Tagged: health costs, medical costs, Percentage of Americans Putting Off Medical Treatment Because of Costs | 10 Comments »

What is Form 834?

Posted on December 12, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

President Obama’s Most Important Number

[By Staff Reporters]

This is an “834 EDI transmission.”

Health Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see on the Federal Website. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And, it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

Washington Post Article:

This is an “834 EDI transmission.” Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And it might be the new health-care law’s biggest problem.

What is the ANSI 834 Enrollment Implementation Format?

The 834 Transaction is the HIPAA-compliant Benefit Enrollment and Maintenance Transaction. Its purpose is to electronically transmit enrollment and dis-enrollment information.

In 2004, DHCS implemented a 4010 834 solution, however, this was implemented along with a supplemental transaction that held eligibility history.

The HIPAA 5010 version of all transactions is scheduled to be implemented on January 1st, 2012. DHCS will implement a compliant 5010 834 on this date. The current FAME file will continue to be made available for a short period of time after this date to allow plans time to transition. Once this transition period has been completed the FAME file will no longer be made available to managed care plans.

Impacted Covered Entities

Internal DHCS program areas and DHCS Health Plan trading partners.

5010 834 Documents

5010 834 Generic Test Data Overview (pdf)

General FAME Documents

FAME Data Element Dictionary (pdf)

MEDICARE PART D INFORMATION

Project Information

DHCS Medicare Part D information web page

MMA Part D Carrier Cross Reference Table (pdf)

File Layouts

MMEF 2100 Medicare Part D layout (pdf)

MMEF REC Medicare Part D layout (pdf)

Assessment

Conclusion

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Filed under: Drugs and Pharma, Health Insurance, Information Technology, Risk Management | Tagged: ACA, Accountable Care Act, Form 834, Medicare Part D, PP-ACA | Leave a comment »

Medical Practice as a Portfolio Asset Class?

Posted on December 11, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Valuing the Quintessential Alternative Investment

By Dr. David Edward Marcinko MBA CMP™

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

As all FAs, and informed physician investors know, the investment industry and Modern Portfolio Theory [MPT] strives to make optimal ‘allocations’ into different ‘asset classes’; according to some defined risk tolerance level or efficient frontier.

Equities, fixed income, property, private equity, emerging markets and so, are all ‘asset classes’, into which physician investors and mutual fund or portfolio managers will make an allocation of their total funds under management. It is quite proper for them to do this as they seek to balance the risk and potential returns for their own; ME, Inc., or other clients’ money.

But, by creating a “new” asset class, this concept opens the door to significant capital flows; advisory and management fees. Hence; the unrelenting innovation of Wall Street, and its’ commission driven and fee-seeking mavens, is unending.

Making an Impact

This secular and non-secular concept is broadly known as “impact investing”; and may be illustrated using Social Security as an example.

So, Wall Street opines, if you’re not counting on Social Security benefits as a part of an overall asset allocation strategy, you may be missing out on bigger gains in a retirement portfolio. Those of this ilk say that retirement investors should consider the value of their Social Security as a portion of their fixed-income investments. Others believe it may be too risky for some.

The Strategy

Generally, adopting such strategy would mean shifting a big portion of investible assets out of bonds and into stocks. And, into the hands of money managers, stock brokers, wealth and endowment fund for a fee; of course. This is akin to those financial advisors who rightly or wrongly goaded clients a decade ago, to not pay off a home mortgage and instead reposition the free cash flow into a rising; and then falling; market.

Of course, there are detractors, as well as proponents, of this emerging financial planning philosophy.

Vanguard Group

Jack Bogle, founder of the Vanguard Group, often cites his penchant for basing one’s asset allocation on age. (If you’re 40 years old, you have 40% of your investments in fixed income and 60% in equities. By the time you’re 60, you’ve got 60% in fixed income, 40% in equities).

Example:

So, let’s consider Social Security, citing a physician with $300,000 in an investment portfolio, and capitalizing the stream of future payments.

If the $300,000 is all in equity funds, even equity-index funds, and $300,000 in Social Security, you are already at 50/50″ fixed income versus equities. The next step is a conversation as a DIYer or ME Inc physician investor or advisory client. This is the nexus of where Social Security meets risk management.

Now, how will the doctor feel when market goes up and down? Some may believe the concept, but not enjoy the inevitable more fluctuating self-directed 401-k, or 403-b plan. So, one must be comfortable with taking on a larger stock position.

Source: Andrea Coombes; MarketWatch, September, 2013.

http://money.msn.com/mutual-fund/social-security-as-part-of-your-portfolio

The Negative

Others experts, like Paul Merriman, opine that Social Security is not an asset class and the idea is fundamentally flawed and should not be a part of anyone’s portfolio.

Why? As classically defined, a portfolio is composed of financial assets. A financial asset is something that can be sold. Social Security cannot be bought and sold. Because of that, it has a market value of zero.

Source: Paul Merriman, MarketWatch, November 2013

Assessment

Therefore, the definitional decision is left up to the informed reader, modern physician or enlightened advisor. Is a medical practice an asset class?

MORE: About iMBA Inc Expertise in Healthcare Valuation

MORE: Social Security as an Asset Class?

Conclusion

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Filed under: Alternative Investments, Investing | 3 Comments »

Take the Accountable Care Organization 2013 e-Poll

Posted on December 10, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

TAKE THE POLL

www.MCOL.com and Accountable Care News are conducting the 2013 Accountable Care e-Poll. Please respond by 5 PM Pacific, Friday December 13th, 2013. Results will be emailed to participating respondents upon request.

e-Poll

You can take the e-poll by going to: http://aco2013.questionpro.com/
The e-poll asks the following questions:

Please indicate your perspective:
Is your organization involved with ACOs- including development, operation, or contracting arrangements?
When would you estimate ACOs would have a material impact in your marketplace:
If ACO Medicare pilots are not ultimately successful, will that cause commercial and Medicaid ACO arrangements to generally fail as well?
What will be the impact of the newly enrolled individuals coming into the system as a result of Medicaid expansion and the health insurance exchanges?
How confident are you that ACOs will actually generate the necessary savings?
Will bundled payments prove to be a more effective delivery and payment reform model than ACOs?

Assessment

Again, to take the e-poll now, go to: http://aco2013.questionpro.com/

Conclusion

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Filed under: Health Insurance, Managed Care, Voting Polls | Tagged: ACA, Accountable Care Organizations, PP-ACA | 3 Comments »

ME-P Picks [Public Viewpoints on Health Reform and Policy]

Posted on December 9, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and related sources

By http://www.MCOL.com

Delolitte Employer Poll Gives Grades From 500 employers Regearding Healthcare Reform

33% would give a grade of an A or B
38% say a C is an appropriate letter grade
29% believe a D or F would be more appropriate
22% of employers say the ACA will reduce costs by the year 2019
19% said it will improve quality of care by the year 2019
50% of respondents said it will widen access to health insurance.

Source: Deloitte

Some more new Lists:

Assessment

Visit: www.CertifiedMedicalPlanner.org

Conclusion

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Filed under: Health Insurance, Health Law & Policy, iMBA, Inc. | Tagged: Dr. Marcinko, Health Insurance, healthcare reform, HealthCare.Gov | 2 Comments »

On Healthcare.Gov System Availability

Posted on December 8, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Review of Website “Uptime”

By www.MCOL.com

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: Health Law & Policy, Information Technology | Tagged: ACA, Affordable Care Act., PP-ACA | 7 Comments »

Seeking a Physician Leader of Population Health Management‏

Posted on December 7, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Centene Corporation Seeking Medical Director

By Paul Esselman

Dear Dr. Marcinko,

Centene Corporation is seeking a Medical Director to manage its newly formed health plan, Arkansas Health & Wellness Solutions.

Based in Little Rock, Arkansas with its core operational functions handled by NovaSys Health, this plan has been approved to participate as a Qualified Health Plan issuer in the Arkansas Health Insurance Marketplace.

The Medical Director will work with a well-established provider to help build a new business line from inception; partnering with NovaSys senior leadership, s/he will assist in development of a medical management infrastructure to position the organization to expand its membership with the Medicaid patients in the state.

Assessment

I would welcome your thoughts as to whom I may contact regarding this highly visible role.

Kind regards,

Paul Esselman
Cejka Executive Search
4 CityPlace Dr., Ste. 300
St. Louis, MO 63141
314.236.4588 Office
pesselman@cejkasearch.com
http://www.cejkaexecutivesearch.com

Conclusion

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Filed under: "Doctors Only", Career Development | Tagged: Arkansas Health Insurance Marketplace, Cejka Executive Search, Centene Corporation, medical director, Paul Esselman | 2 Comments »

How You Can Financially Profit from the PP-ACA?

Posted on December 6, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

An Obamacare Sales Opportunity

By Dr. David Edward Marcinko MBA CMP™

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

Presumably, as a result of my financial advisory activities, I received this email solicitation the other day,

So, I thought I’d pass it along [unchanged] to our ME-P readers, FAs, insurance agents and subscribers for comment.

USA BENEFITS GROUP EAGLE DIVISION ………. PROVIDING CAREER SOLUTIONS FOR 36 YEARS

[Better Contracts + Better Schedule + Better Career Opportunities]

Dear Prospect [that would be ME],

I received your resume on Monster. You already know that the real money in any organization is in sales. The salespeople of the world make things happen and are highly rewarded for that work. But it’s hard work.

The Product

What if you could find a product that everybody needs, that they have money budgeted to purchase, and are looking for someone to help them buy it? Do you think you could help that person? That’s exactly the situation in the health insurance industry today!

Our government is telling people they HAVE to have it. Folks are either buying it now from somewhere or will soon be eligible for subsidies so they CAN buy it. And EVERYONE is confused and looking for someone with answers on how to get this product!

You can be that Person

Over the next sixty months, billions of dollars are going to change hands as people readjust to a dynamic health care environment. How can you get into the river and get your hands on some of that money? By preparing to serve people!

USA Benefits Group

The USA Benefits Group is a highly successful team of insurance brokers who are “reform ready” – staying up to date on this perhaps once-in-a-lifetime shift in this industry. We are independent, non-captive agents who are setting up qualified, turn-key “private exchanges” to help people obtain health insurance in a webinar-based setting from our home offices.

I’m encouraging you to click here: www.usabg.net/dcollins to learn more. If you’re serious and ready to make a move, you can call me toll-free now at 866-328-6182. If you’re qualified, I also have Regional Management positions available.

Advantages of working with my Eagle Division

1. 36 year old system for success
2. 100% control of your future
3. Equal opportunity
4. Recession proof
5. Top Companies to represent
6. Excellent co-op lead program
7. Weekly advance commissions ($2,000 To $4,000 Net Weekly)
8. Vested Lifetime Renewals ($10,000 To $20,000 Monthly In Under 3 Years)
9. Annual Incentive Trips
10. Annual Production Bonuses to $50,000+

I’m looking forward to talking to you.
David Collins
DIVISION MANAGER
866.328.6182
DC@usabg.net

Assessment

Is this a good product to sell? If so, why does it need an intermediary to push it?
Don’t subsidies, carve-outs, exemptions and sales commissions serve to jack-up price and lower quality? [think eMRs]? What about the overall cost of healthcare delivery; up or down?
What about the USA Benefits Group; credible or not? Are cold calls the way to go?
What is your impression of Division Manager Mr. David Collins and his Eagle Division? Feel free to contact him … and tell him what you think.

Conclusion

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Filed under: Ethics, Health Law & Policy, Insurance Matters | Tagged: ACA, CMP™ Course, David Collins, insurance sales, ObamaCare, PP-ACA, USA Benefits Group | 6 Comments »

A Mobile Health “apps” Opinion Survey

Posted on December 5, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Original Research Opportunity

By Thomas Martin [Doctoral Candidate]

[School of Public Policy and Administration]

University of Delaware – trm@udel.edu

[412-992-1285]

Dear Dr. Marcinko and ME-P Readers and Subscribers,

The University of Delaware is conducting research to assess medical provider attitudes towards applications “Apps” in healthcare settings. Mobile devices hold great promise for reshaping the “time and place” where an individual receives care. This study is almost complete.

The Research

Please consider forwarding this to a colleague if you thought the questions were intriguing. The research tool evaluates a number of key topics emerging in the healthcare space:

Opinions on the integration of apps into the Meaningful Use program
Characteristics important to users when downloading an app
Assessing desirable pricing structures

Invitation

I’d like to invite you and your ME-P readers to provide feedback on how you leverage Apps in the healthcare setting. The research instrument should take no more than 10 minutes to complete and all responses are confidential. The results may be published in a scholarly journal or industry research publication.

Respondents should be:

U.S. Providers, Physicians, or Nurses
IT Staff involved in Health IT and mobile decisions

If you have any questions, please do not hesitate to contact Thomas Martin (PI) at trm@Udel.edu,tmartin@himss.org or 412 992 1285.

Assessment

The survey is now open. Click here to start.

the research

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Information Technology, Voting Polls | Tagged: healthcare apps, m-Health, Mobile Health, Mobile Health Market | 10 Comments »

On Childhood Life Insurance Policies

Posted on December 4, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A “Gift’ from Loving Parents?

By Rick Kahler CFP® www.KahlerFinancial.com

When Susan came into the world in 1974, of course her physician parents wanted the best for her. At that time, one of the loving things many parents did for their children was to purchase life insurance policies on them.

The Reasons

Parents had two reasons for these policies. The first was to pay for the funeral if a child were to die prematurely. The second was to build a little nest egg that the child might use later in life for college or a down payment on a home.

Growing Up

When Susan was six months old, her parents bought a $2,500 whole life policy on her. That amount would actually have purchased two funerals in 1974. The premium was $38 a year. If we adjust these numbers for inflation, they are comparable to a current policy with a death benefit of $12,000 and an annual premium of about $180.

Agent Explanation

The insurance agent explained they could purchase term insurance on Susan for $12 a year, but this would not accumulate anything to help Susan with a down payment on a home or college tuition.

For an additional investment of $26 a year, Susan’s policy would grow and accumulate dividends, giving her the cash she would need for that down payment.

Letting it “Grow”

Susan never did tap her policy for college or her first home. Instead she let it grow and accumulate, doing nothing but toss her annual statements into a file folder. Even so, Susan’s parents dutifully paid the premiums every year.

Today

This year, Susan became curious about her policy and dug out her most recent annual statement. She learned that if she died today her death benefit would be $2,945.90. This was the original $2,500 face value of the policy, plus dividends of $445.90 that had accumulated over 39 years. If she wanted to cancel the policy, the company would send her a check for the “surrender value” of $1,120.45.

Crunching Numbers

Susan grabbed a calculator and figured that the total premiums paid were $1,482. At first glance it would appear the policy may not have been a great investment, since the cash value in the policy was less than the sum of the payments.

But, to make a fair comparison, she needed to subtract the cost of providing the insurance ($12 a year, or a total of $468) from the total premiums. Only $26 a year, or a total of $1014, had gone toward accumulating the cash value. It was actually the $1,014 that grew to $1,120.45, which represented an annual return of about 0.25%.

Alternatives

Susan was curious what the $26 a year might have grown to if her parents had purchased only the term insurance and invested the difference in a stock mutual fund. She did some research and found there was a reasonable chance stocks might have returned 8% annually, meaning she would have $6,212 today. That would make a down payment on a small house and might pay for one semester of tuition at a state school. The death benefit of almost $3,000 from the term life policy would pay about half the cost of a proper funeral.

Assessment

Susan realized cancelling the policy and adding the money to her savings or investment portfolio would be the best financial decision. She was surprised at how difficult it was to carry out that decision. The policy had “always been there.” Cancelling it felt like rejecting a loving gift from her parents, especially since her father had died a few years earlier. The policy was part of her security. Giving it up was an emotional as well as a financial decision.

Susan said, “It was like saying goodbye to an old friend.”

Conclusion

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Filed under: Insurance Matters | Tagged: Childhood Life Insurance, life insurance for kids, Rick Kahler CFP®, www.KahlerFinancial.com | 2 Comments »

The State of Retail Clinics

Posted on December 3, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

In 2010

By www.MCOL.com

Assessment

Conclusion

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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
ADVISORS: www.CertifiedMedicalPlanner.org
PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Alerts Sign-Up, iMBA, Inc., Practice Management | Tagged: healthcare clinic, minute clinic, outpatient centers, retail clinics, urgent care | 5 Comments »

An Open Call for ME-P Support

Posted on December 1, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Letter with Advanced Appreciation

By Ann Miller RN MHA [Executive-Director]

MarcinkoAdvisors@msn.com

Dear ME-P Readers,

As the holidays approach and the year winds down, we’re reminded of how much each of you brings to the ME-P and our work.

We couldn’t do what we do so effectively without the subscribers to our daily news and book purchasers, the comments on our stories, the participants in our groups – the people who not only read our ME-P posts, but think about them, talk about it with friends and colleagues, support and push for change based on what they read.

Donate

We hope you agree that we’ve worked hard this year to deliver on our mission. It’s been a year in which we didn’t hesitate to take on the biggest subjects from the NSA ObamaCare encryption mess to Medicare Part D, from the HIEs to the latest abuses by the CFP-BOD on fiduciary terms, advisor payment definitions and conflicts of CEU interest.

If you value this work, I hope we can count on you to show your support at this season by becoming a ME-P subscriber, reader and donor.

Assessment

With many thanks and best wishes for the holidays.

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Filed under: Breaking News, Ethics, iMBA, Inc. | Tagged: An Open Call for ME-P Support, ME-P, Medical Executve-Post, support us | Leave a comment »

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