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  • David E. Marcinko [Editor-in-Chief]

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

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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

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

    Later, Dr. Marcinko was a vital and recruited BOD  member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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

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The State SHOP Market-Places 2014

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Total Number of Plans for Small Employers 2014

SHOP

Conclusion

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Physicians and Retirement Planning

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More than Brokerage Accounts and Insurance Policies

Shikha-MittraBy Shikha Mittra; AIF®, CFP®, CRPS®, CMFC®, MBA

Many physicians think that by having a few brokerage accounts or a few insurance products, they are doing  retirement planning. Just as when a patient visits the physician with a heart condition, or a severe ailment, s/he would not rush into surgery or prescribe the most popular heart medication on the market without a detailed medical analysis.

Similarly, retirement planning is not cherry picking the best stocks or mutual funds  It’s similar to the process of diagnosing a major medical condition, finding alternatives and then charting the best course of action; through medications, surgery if required, and regular checkups. 

Integrated with Financial Planning

Retirement Planning involves an in depth analysis of your needs, wants and resources; and looking at alternative scenarios and then developing a long term strategy to achieve those goals. It takes into account all other areas of your financial planning situation such as cash flow, insurance needs, investments, taxes and estate planning. It’s based on your risk tolerance, time frame, annual savings and your prioritized goals.

And, you increase the probability of success by following this process and monitoring it on a regular basis to make sure you are on track. All assumptions made are strictly unique and there is no one size fits all retirement strategy!

###

financial-plan

Assessment

The more time you have to plan for your retirement, the less risks you have to take near retirement, and the easier it gets to make your retirement vision a reality!

More: http://www.medicalnewsinc.com/retirement-and-succession-planning-cms-351

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

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Attempting to Time the Stock Market?

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A Fruitful or Futile Endeavor?

[By Dr. David Edward Marcinko MBA CMP]

BC Dr. MarcinkoSome medical professionals, or their financial advisors, believe they are “smarter than the market” and can time when to jump in and buy stocks or sell everything and go to cash.

A Tale of Two Physician Investors

Wouldn’t it be nice to have the clairvoyance to be out of stocks on the market’s worst days and in on the best days? Consider these two doctors.

The Good Stats

Using the S&P 500 Index, our agile imaginary MD investor managed to steer clear of the worst 12.42% annualized return (including reinvestment of dividends and capital gains) during a recent 20+ years time frame, sufficient to compound a $10,000 investment into $107,100.

The Bad Stats

But, what about another unfortunate DO investor that had the wonderful mistiming to be out of the market on the best day of each year. This ill-fated investor’s portfolio returned only 4.31% annualized from Jan. 1992-March 2012, increasing the $10,000 portfolio value to just $23,500 during the 20 years.

Assessment

The design of timing markets may sound easy, but for most all investors it is a losing strategy: http://www.CertifiedMedicalPlanner.org

caution

Conclusion

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SPECIAL ISSUE VOTING

***

Poll: Do you support a one-year delay to ICD-10?

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About the AIF® Designation

Certified Medical Planner

A Fiduciary Moniker?

[By Dr. David Edward Marcinko MBA CMP®]

DEM blue tieInvestment fiduciaries and professionals are constantly exposed to legal and practical scrutiny — it comes from multiple directions and for various reasons.

And, it is likely that complaints and/or lawsuits alleging investment mismanagement will continue to increase.

Although some of these allegations may be justified, many can be avoided by having clear knowledge of who constitutes a fiduciary and what is required of one.

AIF® Designation Training 

The AIF Designation Training and designation help mitigate this liability by instructing in practices that cover pertinent legislation and best practices. The Accredited Investment Fiduciary® (AIF®) designation represents a thorough knowledge of and ability to apply the fiduciary practices.

And, did you know that all Certified Medical Planners® are fiduciaries for their clients? http://www.CertifiedMedicalPlanner.org

Assessment

So all FAs, feel free to check em’ out at: http://www.fi360.com/

More:

Conclusion

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Tips on Purchasing a Vehicle

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An Economic and Ethical Decision?

[By Dr. David Edward Marcinko MBA CMP™]

Dr. DEMWith the possible exception of the handgun, the automobile represents the greatest single item of ownership that is capable of inflicting death, injury and damage. America’s fascination with the automobile has resulted in a marked increase in the power and potential speed of our vehicles.

The latest trend in Sports Utility Vehicles (SUVs) has also witnessed a substantial increase in damage due to their higher ground clearance and heavier frames. The owners and operators of any vehicle must be financially able to respond to any resulting claims, or they need to transfer the risk through insurance. All states require some minimal coverage for personal vehicles.

Purchasing the Vehicle

Typically, car buyers who wait until the end of the year can score a deal. Buying at the end of the month can also increase negotiating power as dealerships look to move volume, and shoppers in the late summer and early fall may be able to get a deal when the new-model-year vehicles enter inventories.

JAG 2 (1)

Also, cold or rainy weather can work to a doctor’s advantage, since bad weather can discourage people from walking around a lot to look at vehicles, potentially giving those who do show up a bit more negotiating power. Even a serious buyer who goes to a dealership near the end of the day may receive a better price as the dealer makes concessions to speed things up so everyone can go home.

JAG 2 (2)

Assessment

So, if you time your car purchase right, and you aren’t buying one of the more popular models or colors, you might save $500 to $2,000 just by waiting until the end of the month or day to make your purchase.

Beware my [premium] gas guzzler above; not an EPA favorite, but she passes annual emissions inspection like a champ!

Conclusion

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Understanding Medical Practice Anti-Trust Risks

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Medical Risk Management

By Dr. Charles F. Fenton III JD

fenton* Monopolistic risks are reduced when more than a few networks or contracts are available in the local area for excluded medical providers to join.

  • * Fee schedule MCO contracts, per se, are not generally considered price fixing, provided the doctor providers have not conspired with one another to set those prices. Moreover, network pricing schedule should not spill over into the non-network patients.

Some Issues:

  • Individual providers may be excluded from a network if there is a rational reason to do so. It is much more difficult to exclude a class of providers, than it is to exclude an individual provider.
  • A safety zone can be created if networks or other contractual plans require a substantial amount of financial risk-sharing among plan participants, since Stark II laws have been relaxed. Such zones have been created by the Department of Justice (DOJ) and Federal Trade Commission (FTC), in recent policy statements.
  • The FTC and DOJ are not likely to challenge an exclusive provider IPA that includes no more than 20-25% of the doctors within the panel, who share financial risk. Such panels are likely to fall within a Safe Harbor.
  • Tying arrangements (e.g.: the requirement to buy one item/service in order to buy another item/service) are suspect if not reasonably justified. For example, a patient should not be required to obtain a brace prescription from a specific provider, in order to purchase the device from a laboratory that the doctor owns.
  • Non-exclusive provider panels will not usually be challenged if no more than 30% of the providers are included (another Safe Harbor provision). Physician networks are often analyzed according to four criteria: (1) anti-competitive effects, (2) relevant local markets, (3) pro-competitive effects, and (4) collateral agreements.Further anti-trust considerations consist of analyzing
  • Market Power. This consists of two factors: (1) Geographic Power and (2) Product Power.

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Flag MOney

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  • Geographic Power is difficult to define in today’s environment. In the past, the geography that was analyzed when medical practices merged was the immediate neighborhood. Currently, the geographical area could consist of an entire metropolitan area. In the past, individual patients would often seek a physician whose office was close to work or home. Now they seek a physician based on inclusion in a health plan. Now, health plans choose physicians based on needs within an entire metropolitan area.
  • Product Power relates to the specific service being performed. There are two products in today’s environment: (1) Primary Care and (2) Specialty Care. Since there are so many primary care physicians in practice, it would be difficult for all but the largest group to acquire product power.

Assessment

It is easier for medical specialists to develop product power. However, certain specialists may never be able to obtain product power.

For example, foot care is provider by many types of physicians. Primary care physicians, emergency physicians, chiropractors, physical therapists, orthopedic surgeons, nurse practitioners, and podiatrists all provide foot care. Therefore, it would be difficult, even for a large group of podiatrists to obtain significant product power.

Conclusion

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The [Financial] Case Against Marriage?

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Popular with Older Couples

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

Rick Kahler CFP“Two can live as cheaply as one.”

This old saying is mostly true. However, when it comes to death, divorce, and taxes; two people are probably better off financially if they don’t marry. Intentionally or not, many federal and state laws reward couples who choose to live together without marriage.

Insurance and Tax Examples

Laws relating to Worker’s Compensation insurance are one example of this. Someone whose spouse has died in a work-related accident may be eligible to receive a monthly benefit, paid for the rest of his or her life. However, most state laws provide that the benefits end if the recipient remarries. This puts a real cost to remarrying.

Example:

Consider as an example a woman who at age 50 loses her husband to a work-related accident and receives a settlement of $2,000 a month for life. Assuming she will live another 35 years and could invest the proceeds in a 3% bond, the present value of that income stream is $520,000. That means a person would need $520,000, invested at 3%, to give a monthly income of $2,000 for 35 years.

Therefore, if this woman fell in love and wanted to remarry two years into receiving the payments, the remaining 33 years of monthly payments she would forfeit has a value of $502,000. This puts a rather quantifiable cost on one’s social, emotional, and religious values.

Tax Code

The tax code also encourages couples to remain unmarried.

Example:

Take a couple who both earn high incomes. Suppose each has taxable income of around $400,000, which is the breakpoint where the 39.6% tax bracket begins. As two singles, as long as their taxable income is $400,000 or less, they both remain in the 35% tax bracket. However, if they marry, their joint income goes to $800,000 while the 35% tax bracket only expands to $450,000 for couples. That means they now pay an additional 4.6% in federal income taxes on the excess of $350,000, or $12,600. Some may be quick to dismiss that amount as trivial, given their income level, but the point is still that marriage for them brings a tangible cost in higher taxes.

###

Heart

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Prior Marriages

Those with previous marriages may find another disincentive to marriage in the challenge of passing on assets to children upon your death or if the new marriage should end in divorce. If leaving assets to children is a priority, you will probably need to negotiate a prenuptial agreement with your finance. This is especially important for couples with unequal assets.

A prenuptial agreement is a real romance killer. It highlights the reality that every marriage is a business deal, with the added emotional weight of negotiating the divorce settlement before there is a wedding. Some couples find it easier to live together without marriage and keep their assets largely separate.

The Un-Marrieds

For couples that decide not to marry, the potential tax planning is ripe with opportunity.  Such couples can do anything that the tax code or state statutes prohibit married or related parties from doing. This provides some great tax savings and asset protection opportunities.

For example, spouses cannot be the trustees of each other’s irrevocable or asset protection trusts, but unmarried partners absolutely can.

Choosing not to marry is becoming especially popular with older couples. This is because many older people with previous marriages have accumulated two things: assets and children. They find marriage less compelling when they and their new partner won’t have children together.

Assessment

Younger couples who do plan to have children still recognize that marriage is important. For many reasons, marriage isn’t going out of style any time soon. Few of those reasons, however, are financial ones.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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New “Physician-Focused” Financial Planning Book Reviewers Needed

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Discerning the “Best Emerging Practices” in Financial Planning for Doctors and Health Professionals

http://www.CertifiedMedicalPlanner.org

By Ann Miller RN MHA AdviceforDoctors@Outlook.com

[ME-P Executive Director]

The Medical Executive-Post occasionally fact-checks and codifies the posts and comments of our readers, subscribers and other experts in order to present them in book form. This is a form of academic, or cognitive, crowd-sourcing. It might also be called a form of private Wikipedia styled information gathering. We may use it to create new books, up-date prior books, or fill in the gaps of books-in-progress.

Book Reviewers  

And so, we are requesting informed [MD-DO-DDSs] doctors and [FA, CFP, CPA, CMP, PhD, CFA or MBA] related folks, or other knowledgeable readers and subscribers to review the Table of Contents of our current project, now under review. We wish to ensure no important topics of interest are omitted for modernity. Editorial writing and assistance will be provided.

www.CertifiedMedicalPlanner.org

Our ME-P Book Review Format:

An easy to follow, and typical book review format, usually starts with the preliminaries such as stating the title of the book, its author, place of publication, publisher, date of publication, and the number of pages. This is completed by us.

What follows next is the making of an introduction to at least give the readers a preview of the review. It is sometimes followed by background information of the book in order to set out criteria in judging a book.

This includes the author’s basic information such as the era in which he wrote the book, or how it relates to his life experience.

Then it is followed by writing a short summary of the content or text of a novel, history book, or any other type of book.

Testimonials, Too!

Crafting a brief, 2-3 sentence, informal testimonial is also needed.

Books

Assessment

This is highly confidential peer-reviewed styled publishing; do not disclose material. MarcinkoAdvisors@msn.com

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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Communithy Health Center Funding Under Current Law

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FY 2010-16 in $-Billions

http://www.MCOL.com

Funding

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
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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The “Rich Doctor” Myth

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Considerations for the Next-Generation of Potential Providers

By Brian J. Knabe MD CMP™ CFP™

By Hope R. Hetico RN MHA CMP™

By www.MCOL.com and www.CertifiedMedicalPlanner.org

Brian J. Knabe MDA decade ago, Fortune magazine carried the headline “When Six Figured Incomes Aren’t Enough. Now Doctors Want a Union.” To the man in the street, it was just a matter of the rich getting richer.

The sentiment was more precisely quantified, according to health economist and financial advisor Dr. David E. Marcinko MBA CMP™, in the March 31, 2005 issue of Physician’s Money Digest, who with Editor Gregory Kelly reported that a 47-year-old doctor with $184,000 in annual income would need about $5.5 million dollars for retirement at age 65.

Of course, physicians were not complaining back then under the traditional fee-for-service system; the imbroglio only began when managed care adversely impacted income, or when the stock market crashed in 2008; or with passage of the Patient Protection and Affordable Care Act [PP-ACA] in 2010 or its’ full implementation in 2014.

And now, in the Trump era.

***

Rich Doctors

More:

  1. More on the Doctor Salary Conundrum
  2. Doctor Salary v. Others [Present Value of Career Wealth]
  3. Are Doctors Members of the Middle Class?
  4. Taxing the [not so] Rich [doctors]
  5. Doctor – Are You on Your Way to $5.5 Million?

Conclusion

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

Update on Healthcare Business Trends in 2014

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Future Care 2014 e-Poll Findings

By www.MCOL.com

MCOL recently conducted its twelfth annual Future Care e-Poll, asking stakeholders their perspective of trends, winners and losers for the coming year and beyond. The corresponding white paper with complete findings from the e-poll is now available for MCOL members, including comparisons to previous year’s results.

Business

Participants were asked to respond to four items:

1. Please categorize your organization: (a) Payor (Health Plan, Employer, TPA, Agent, PBM); (b) Provider (Hospital, Physician, Pharmaceutical, Other Providers); (c) Vendor or Other

2. Which of the following health care business trends do you think will have the greatest overall impact in 2014?  (a)  Advances in Health Care Technology; (b) Consumerism Initiatives (c) Compliance Issues; (d) Effects of the Economy (e) Affordable Care Act Implementation (f) Increased Consumer Cost Sharing (g) Population Health and Wellness Initiatives (h) Government Spending Cuts (i) Other

3. Rate the ultimate anticipated impact in the marketplace of these selected health reform provisions including those already implemented:  (a) Accountable Care Organization Development; (b) Health Plan Medical Loss Ratio Regulation; (c) State Health Insurance Exchanges (d) Extension of Dependent Care Coverage; (e) EHR Development – Meaningful Use; (f) Health Insurance Guaranteed Issue/ Elimination of Pre-Existing Conditions; (g) Expansion of Medicaid Coverage; (h) Mandated Coverage Provisions for Business and Individuals

4. Please project who you think the economic winners and losers for 2014 will be: Who do you think will be economically better off, the same or worse off by this time next year:  (a) Consumers; (b) Employers; (c.) Health Plans; (d) Hospitals; (e) Physicians; (f) Pharmaceutical

Assessment

Link: http://www.mcol.com/futurecareepoll.pdf

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Understanding the Homestead Exemption

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A Traditional Asset Protection Shelter

J. Christopher Miller, EsqBy J. Christopher Miller JD

www.RobinsonMiller.com

The State of Florida also offers a generous homestead exemption.

A homestead exemption is an asset protection shelter created by statute that prevents one parcel of real estate and its improvements from being attached and levied upon by creditors. By investing money in luxurious homes on large tracts of land in rural areas of Florida, some doctors and many wealthy individuals are prudently protecting their estates from the reach of creditors.

EXAMPLE:

Dr. David Mackenzie, a Florida resident and domiciliary, invests $4 million of his earned cash into a home with acreage in Florida. The home fully qualifies for the homestead exemption. If Dr. Mackenzie later declares bankruptcy, his home will be exempt from the liquidation of his assets. After the liquidation, all of his debts will be discharged by the bankruptcy court.

Although Dr. Mackenzie may have lost his nonexempt assets, he will still own a $4 million asset free and clear of outstanding creditors, with which he may rebuild his accustomed lifestyle.

Home for Sale

Assessment

Another effective use of the homestead exemption is to backstop an incorrect form of jointly owned property. Although tenancies by the entirety and joint tenancies with rights of survivorship automatically leave the surviving spouse with the full ownership of property, the surviving spouse often may use the homestead exemption to preserve a primary residence against creditors’ claims.

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Conclusion

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Can Politically-Correct Names Save Obamacare?

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Saving Electronic Health Record Interoperability?

1-darrellpruittBy D. Kellus Pruitt DDS

If HHS successfully persuades Americans to use happy names for its bad ideas, will the cheap trick save electronic health record interoperability which is critical to the success of Obamacare?

Healthcare Lexicon 

According to the government’s modernized healthcare lexicon, doctors have been demoted to “providers,” insurance companies, including Medicare/Medicaid, have been promoted to “payers,” and patients’ position in the hierarchy has diminished from “principals” to “stakeholders” – a rank on par with 3rd parties such as insurers, HHS and other unaccountable parasites.

Wall of Shame

Ominously, HHS recently changed the contentious name “Wall of Shame” to a more innocuous“ breach reporting tool,” to describe the public list of data breaches involving the medical records of more than 500 patients. It turns out that the growing list of major data breaches is unexpectedly shaming  far too many providers and payers – including Medicare/Medicaid. Imagine that!

In fact, since Americans’ growing disgust with privacy breaches threatens the very success of Obamacare, there is evidence that HHS has turned to betraying its lawful obligation to the nation by hiding breaches from those who are most vulnerable – Americans.

HIPAA Failure

The half-baked plan to shame providers who experience data breaches – perhaps through no fault of their own – is not working out like HHS had hoped. Due to HIPAA’s abysmal failure to halt data breaches, the Wall of Shame has become a national embarrassment and an obstacle to EHR adoption. I expect the public listing of major breaches to be quietly scrapped soon in favor of keeping patients in the dark concerning their risks of identity theft.

Dentistry 

In dentistry, on the other hand, common sense as well as market resistance evidently caused HHS and other stakeholders to give up trying to prohibit use of the 8 syllable “electronic dental records” in favor of the 14 syllable “electronic health records for dental practices.”

Nevertheless, holdouts (including Dissent Doe) still occasionally feel it is important to correct this dentists when I use “EDR” instead of “EHR.” You got to love ‘em.

Obama Care 

Assessment 

Transparent silliness suggests that HHS is failing in its duties. Due to lack of accountability, we can expect EHRs and EDRs to become even more expensive and more dangerous, possibly bringing an end to Obamacare.

Conclusion

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Ten Irish Inventions that Changed the World

Celebrating St. Patrick’s Day – Seriously

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With St. Patrick’s Day here, we thought we’d share this infographic that explores ten of the greatest Irish inventions ever.

Source: GoIreland.com

Conclusion

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Emerging Patient Collaborative Marketing Trends

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On Patient Acquisition and Patient Retention [PRM]

By Dr. David Edward Marcinko MBA CMP™

By Hope Rachel Hetico RN MHA CMP™

David and HopeGiven today’s economic and political environment, with its’ increasing competitive pressures, medical practices are focused more-than-ever on patient acquisition and patient retention. Modern medical practices are teaming together to offer comprehensive end-to-end solutions [patient relations management].

If you are partnering with other healthcare organizations to pool in your expertise, offer joint solutions and take up joint medical marketing and patient communications programs, be careful how you execute and about what you agree with your partners on sharing patient databases.

It is advisable to formulate a simple and clear privacy policy and adhere to that in the partnership agreements. Comply with the policy at all patient touch points. Communicate this very clearly with your partners and patients prominently in all your channels of communication. Inventory your data collection processes and gateways. Select appropriate projects to add security to your data across extended networks and partners.

Note there is no silver bullet to protect the privacy. Privacy compliance is as much a business issue as it is a technical issue, sometimes more so.

Implications for Patient Strategies

While you are formulating and implementing privacy policies; you need to address the following questions:

  • Do your patients respond to your practice’s privacy strategy?

It is not enough to have a privacy policy that is so confidential no one is aware of that. It is imperative for practices, once they implement their privacy strategies, to understand how patients are responding and loop the feedback to fine-tune policies accordingly.

  • How do you consider the impact on the patient from every privacy decision you make?

Every privacy decision made will impact the patient and your practice; but to what extent? How do you determine this impact? Some of them will be patient-facing and some will be in the back–end.

This step is essential so that you can make appropriate decisions and make optimum usage of resources:

  • Will your medical practice operations support the privacy initiative?

Privacy enablement requires resources and training with perhaps no immediate, apparent short-term value-add to the top-line or bottom-line.

Medical practices that take a proactive view of privacy enablement as cost of doing business in the 21st century will benefit. Practices still need to adopt critical processes and technology that agree with their resources and gradually privacy enable in an incremental way.

Role of Technology

There is no technology silver bullet. Privacy enabling a practice is composed of elements of company loyalty towards patients, commitment to build long lasting and profitable patient management by building trust, and engaging cross-functional teams that can pick and deploy suitable data security across the network.

Here are some salient steps for secure data management that affect technology choices of any medical practice:

  • Privacy and compliant database development – healthcare organizations have to “listen” and record what patients are saying, and if and how they prefer to be contacted, or not at all. All  these details will have to be stored in a secure database, which is regularly refreshed with the outcome of practice communications with patient. This will be the central repository that the office draws upon to design and execute consistent and privacy enabled patient communications.
  • Protect the data across the practice, from group to group, area to area, or from network to network. It is not enough for a medical practice to protect data from external intruders, but also from internal data abusers. It is not enough that patient data is secure during transmission at the patient touch point. It also needs to be safe where it is stored. It is not unusual to have patient data stored or lying around where it is accessible by internal intruders. Therefore it is imperative for medical practices to go beyond traditional firewalls to have multi-layered security at the data level.

Patient CRM

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Conclusion

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Sale of a Personal Residence

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Tax Implications

By Perry D’Alessio CPA [D’ALESSIO TOCCI & PELL CPA] http://www.DaleCPA.com

perry-dalessio-cpa

For many medical professionals, a home is their largest asset.  In addition, it is their largest tax shelter as well.

Historical Review

Certain costs of the purchase and ownership of the home are deductible expenses if the taxpayer itemizes (i.e. interest with total loan balance not to exceed one million dollars, interest on home equity loan interest up to $100,000, and property taxes). The law regarding the sale of a personal residence changed in mid-1997.

This change in the tax law has been one of the most overlooked by all taxpayers.  The new law states that the first $250,000 ($500,000 for married taxpayers filing jointly) of gain from the sale of a residence will be free of federal income tax.

How to Qualify?

To qualify for this exclusion the medical professional taxpayer must have owned the residence and occupied it for at least two of the last five years prior to the sale.  In addition, if the taxpayer does not meet the above requirement due to change in employment, health or various other reasons, s/he may receive an “exclusion” for a portion of the above amount.  An added bonus is that the taxpayer may take advantage of this same exclusion again after a two-year waiting period.

Assessment

Compared to the old law where a taxpayer had to “buy up” into a higher priced home in order to defer the gain on sale of the old residence, this is a huge benefit.  For healthcare professionals this is an especially fortuitous change in the law.  Depending on the state you reside in a residence is, for the most part, creditor proof, this tends to be one of the investments that is maximized. The potential to reap rather large tax-free treatment is something to keep in mind.

Drs. Home

Conclusion

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Eligibility for Health Insurance Coverage as of 2014

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Among the Currently Un-insured for Selected United States

By www.MCOL.com

Eligibility

Conclusion

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Join the ME-P [Membership Drive]

A Call to Increase Membership Rolls and Activity Levels

By Ann Miller RN MHA

[Executive-Director]

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Dear Readers and Members,

We have some important updates for you!

Subscriber Map

We are making it easier to connect with physicians, management consultants and FAs from all 50 states, and beyond, in real-time fashion.

Channels

We currently have over 50 topic channels for your interest. You may post de-novo or comment on an existing post.

Dynamic Content

We are working on ensuring there is dynamic content on the site. This includes but is not limited to:

  • Latest activity constantly being updated
  • New blog posts added by members and non-members
  • New people of all stripes online at any given time
  • New member spotlight interviews
  • New videos added to breaking news
  • New polls and events added daily
  • New discussions by group moderators

Video News

We want to save our members time. We are going to the major websites to find the latest medical, management, financial planning, investing and HIT news.

We also seek to find related analog videos and upload them to the site.

ME-P Membership Drive

We are looking to add to our ME-P subscriber rolls in this membership drive. We need physician, medical management and FA subscribers and contributors to take us to new heights.

If you are interested, or know of someone who might be interested, please refer them to us, ask them to subscribe and/or reply to this post – or me – directly at: MarcinkoAdvisors@msn.com

Conclusion

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Education versus Retirement

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Not An “all-OR-nothing” Proposition

Rick Kahler CFPBy Rick Kahler MS CFP® http://www.KahlerFinancial.com

I recently had the opportunity to share an evening out with some friends, new parents with six-month-old twins.

The conversation centered on birthing, breastfeeding, and burping!

Thinking Education

One topic we didn’t discuss was baccalaureate degrees. Most people might think it’s premature to consider college education while your kids aren’t even crawling.

Actually, that’s the perfect time to think about it, especially if you intend to fund all or a significant part of your children’s education. Don’t wait till kids are 17, 14, or even 11 to settle on a philosophy of “who pays what” toward their education. If you do, you risk becoming a financial burden to your children in retirement.

Most parents perceive paying their children’s college expenses as a loving act. They believe it will help give their children a good start on a career and chance to get ahead. The facts suggest it actually may accomplish just the opposite. The reason? Most American parents who fund their children’s college education underfund their own retirement.

Parents who fail to fully fund their own retirement may dearly cost their children later. Such parents often rely on their children to take care of them in their final years. Research indicates that looking after parents in their old age comes at a great financial price.

The Research

According to Alan Blaustein, the founder of CarePlanners, elderly parents who underfunded their retirement cost their children an average of 18 hours a week, $30,000 a year in hard costs, and a total of $300,000 in forfeited wages and benefits. Most studies put the total cost from $250,000 to $750,000, depending on the length of time the parents needed care.

Considering that the tuition at many four-year colleges averages around $100,000, most children would be much further ahead to pay for their own education while parents fully funded their own retirement.

Not only does paying for kids’ college education potentially hurt them financially, it also can hurt them academically. I reported last year on research  that found children whose parents pay the tab for college have lower GPA’s than those who earn scholarships, borrow, or work their way through college.

humpty-dumpty

[Retirement-OR- Educational Funding?]

The Psychology

Clearly, the logical and loving approach for parents is to focus on retirement first, even if that means letting children pay for their own education. Yet the average American parent recoils from the thought, finding it unloving, selfish, or irresponsible even in the face of clear evidence that the opposite is true.

Such “illogical” emotional responses to factual data actually make perfect sense. The Nobel Prize-winning psychologist, Daniel Kahneman, discovered that we make 90% of all financial decisions emotionally, not logically. Moreover, the more complex the financial decision, the higher the probability is that we rely on our emotions to make it. Sadly, evolution wired our brains to make poor financial decisions.

So, Start Early

Do yourself and your children a favor and assess your ability to save for retirement when your children are very young. Fully fund your retirement first with maximum contributions to 401(k) plans or IRAs. If there is anything left over, start 529 college savings plans when kids are babies. This will allow the tax-free earnings to grow and multiply by the time they set off to college.

Assessment

Remember, too, that college funding isn’t an “all or nothing” proposition. Many parents choose to pay some college expenses and help the kids find ways to fund the rest through scholarships, jobs, and loans.

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Conclusion

In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.

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Fiduciary Financial Advisor versus Non-Fiduciary FAs

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Understanding the Difference

Dr. DEMBy Dr. David Edward Marcinko MBA CMP™

GOAL: To understand the difference between fiduciaries and non-fiduciaries, examine the SEC conduct rules.

Stock-Brokers (non-fiduciaries) are subject to FINRA Conduct Rule 2310(a) which reads:

In recommending to a customer the purchase, sale or exchange of any security, a member shall have reasonable grounds for believing that the recommendation is suitable for such customer upon the basis of the facts, if any, disclosed by such customer as to his security holdings and as to his financial situation and needs.

A fiduciary follows a higher standard of conduct: 

A fiduciary duty is an obligation to act in the best interest of another party. A fiduciary obligation exists whenever the relationship with the client involves a special trust, confidence and reliance on the fiduciary to exercise his discretion or expertise in acting for a client. A person acting in a fiduciary capacity is held to a high standard of honesty and full disclosure in regard to the client and must not obtain a personal benefit at the expense of the client.

Five primary responsibilities as a fiduciary to clients are:

  • To always put clients’ interest first
  • To act with utmost good faith
  • To provide full and fair disclosure of all material facts
  • Not to mislead clients, and
  • To expose all conflicts of interest and all compensation to clients.

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Assessment

Conclusion

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Common Daily Clinician Health Technologies

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Most Commonly Provided to Support Daily Activities

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Health Technology

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American’s Personal Experience with the PP-ACA

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The Law of the Land

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ACA

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Assessment

So, tell us your personal experi9ence with the ACA

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On Recent Stock Market Losses

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Should Physician Investors Be Concerned?

Lon JefferiesBy Lon Jefferies MBA CFP®

Many doctors and some investors viewed the end of January and early February as a pretty scary time. Over a period of just 12 trading days (1/15-2/3), the S&P 500 lost -5.76%. This spurred conversations online and in the media about the end of a long bull market run and even the possibility of a bubble. However, since the end of that tough stretch, the market has responded strongly and is again reaching new all time highs.

What’s Up!

So what happened during that short time span to cause such a response? Was it a concern about the health of emerging markets that caused such a scare, or perhaps the threat of rising interest rates? Did the uncertainty of having a new Fed chairman cause a pullback in the market, or maybe the concern of a terrorist attack in Sochi during the Olympics? These are all clearly issues that obtained a good amount of short-term attention, but I’d contend that none of them were the root cause of the market decline.

Historical Review

History illustrates time and again that market volatility leads to memory problems for many investors.  Check out this chart itemizing all market corrections of 5% or more since the bull market began.

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original_19861592

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As you can see, although the S&P 500 index has increased in value from 676.53 on March 9, 2009 to 1,819.75 on February 11, 2014, the S&P 500 has endured nine pullbacks of over 5% during that time frame.

As illustrated by the lengths of the red lines associated with each correction, many of these market declines happened over a similarly short time span.

Consequently, despite the S&P increasing in value by 169% over the last five years, the market has experienced a decline of at least 5% every six and a half months on average.

In fact, nearly a third of the months since the bull market began have seen the market decline, and by an average of 3% per month.  Considering this information, late January and early February wasn’t particularly unusual.

Periodic Pull-Backs

These periodic market pullbacks aren’t specific to the recent strong run. Historically, we typically see three stock market dips of 5% or more every year and one correction of more than 10% every 20 months. Yet, for some reason, the same conversations and concerns are repeated during every market correction. Investors wonder if this is the beginning of an extended market decline or even a crash?

People consider selling their assets and taking their money out of the market. It is so easy to forget that we have seen similar circumstances in the past and that very rarely has anyone benefitted from selling.

Refer back to the chart itemizing all market corrections over the last five years. There wasn’t a single market decline that didn’t recoup all value in a short period of time. Even the 20% decline that occurred in 2011 only took nine months to go from peak to trough to new all time high.

Assessment

As a result, I’d suggest that the January decline in the markets is not only nothing to be concerned about, but it is expected and healthy. In fact, if you have done your homework as an investor and have a well diversified portfolio with a stocks/bonds ratio that matches your risk tolerance, you’ll be hard-pressed to find a market movement that justifies dramatic action.

Of course, there will always be market corrections (even the occasional crash), but as long as your portfolio is built to accurately match your investment time horizon, market values are likely to recover before the pullback is catastrophic to your retirement goals. Next time the market experiences a short-term correction, remember it isn’t anything we haven’t seen before.

Conclusion

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On “Ethical Wills”

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AKA Heritage or Legacy Wills [An Ash Wednesday Tribute]

By Dr. David Edward Marcinko MBA CMP™

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Dr. DEM

An ethical will is a document designed to pass ethical values from one generation to the next.

It was first postulated in 1998 by Barry K. Baines MD in his Ethical Will Resource Kit.

He then founded the www.EthicalWill.com website, now known as www.CelebrationsofLife.net His hospice care experience provided the impetus for developing resources to help people write and preserve their legacy of values at any stage of life [personal communication].

By 2005, Andrew Weil MD promoted ethic wills as a “‘gift of spiritual health”’ to leave family members. The goal is to link a person to both their family and cultural history, clarify ethical and spiritual values, and communicate a legacy to future generations.

Today, ethical wills are written by both men and women of every age, ethnicity, faith tradition, economic circumstance, and educational level. For FAs, an ethical will can open the door to start a bigger conversation about estate planning. Susan Turnbull, a principal with Personal Legacy Advisors in New Hampshire is author of The Wealth of Your Life: A Step By Step Guide for Creating Your Ethical Will, a document that some financial advisors offer their clients as a template for creating them.

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ethical-exercises

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Assessment

In recent years, the practice has been increasingly used by the general lay public and medical professionals. In fact, the American Bar Association [ABA] described it as an aid to estate planning in health care and hospice and as a spiritual healing tool.

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The Baby-Boomer Retirement Crisis

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Panic or Warning?

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

Rick Kahler CFP“The world braces for retirement crisis.”

This headline caught my attention because of its tone of near-panic. It implied that the pending retirement crisis was like a hurricane or other natural disaster, striking with little warning and beyond our control. Not so. Financial columnists like me have warned for the past two decades that Baby Boomers are woefully unprepared for retirement.

The AP Piece

The article itself, an AP piece published at the end of 2013, was actually quite a good summary of the problems looming as Boomers retire worldwide. It quotes a survey done by the Center for Strategic and International Studies as concluding, “Most countries are not ready to meet what is sure to be one of the defining challenges of the 21st century.”

Governmental Outsourcing 

Instead of limiting their lifestyles and saving for retirement like their parents did, Boomers around the world outsourced their retirement to government. Not only did the Boomers not save, they fostered an entire culture of spending more money than they’ve earned; a trend evident not only in their personal finances, but also in all levels of government.

The Blame Game

The financial press often blames the Great Recession of 2008 for the coming retirement crisis. Few reporters ever suggest that the personal and public overindulgences of the Boomers in the decade prior to 2008 were largely the cause of the crash. Neither the Boomers nor most of their governments have the cash to support them in retirement. Retirees need a nest egg of 25 times their desired annual income.  Most Boomers don’t have more than three or four times that income saved in retirement plans.

The Poll

According to a 2010 Gallup poll, Americans are concerned about the Social Security system but unwilling to make sacrifices in order to fix it. A majority of respondents favored raising taxes on high earners and limiting benefits to the wealthy. Otherwise, they didn’t want to limit benefits, raise retirement ages, or increase taxes for all workers. Given a choice between raising taxes OR reducing benefits, however, more respondents (49% to 40%) would opt for higher taxes.

The Dilemma

The problem with this is two-fold.

First, in many developed countries facing this problem, including the US, tax rates already exceed 50% on upper income earners, leaving little room for extra revenues.

Secondly, the AP articles notes that birth rates in most developed countries are declining “just as the bulge of people born in developed countries after World War II retires.” This means the younger taxpayers just will not be able to foot the bill.

The Solution

One possible solution has three components:

1. Lower taxes to spur economic activity, thus creating more jobs and ultimately increasing revenues to government.

2. Increase the Social Security retirement age. When Social Security was created, average Americans lived only a few years beyond age 65. Now we live into our 80’s. Increasing the retirement age to 75 or 80 would be keeping with the original intent of the program.

3. Create incentives for young Americans to save. Australia is already doing this. Allow taxpayers to save up to $75,000 a year, tax-free, and allow distributions to be tax-free.

For now, if you are a physician, medical professional or lay Boomer who has woefully underfunded your retirement plan, putting more money away now won’t make much difference unless you can save 30% to 50% of your income. Declining birth rates, however, mean fewer available skilled workers, so many Boomers will be able to work longer.

Assessment

The best retirement plan, then, might be to invest in improving your workplace skills, shedding weight, starting an exercise program, and eating healthier. The biggest assets Boomers may have for retirement are the skills and health to stay in the workforce.

But, what about doctors and other medical professionals?

MD Boomers

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Our ME-P Recommended Books Review

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