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

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

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

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

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

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

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Establishing a Healthcare Compliance Program

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Basic Program Components

trites

[By Pati Trites MPA CHBC]

All healthcare organizations should evaluate compliance policies and procedures for practicality and appropriateness on a regular basis.

The List

The following are suggested items for inclusion in a compliance program:

  • code of ethics;
  • code of conduct;
  • mission and vision statements;
  • employee handbook or manual;
  • rights and responsibilities of patients;
  • protocol for addressing compliance issues;
  • job descriptions;
  • performance evaluations; and
  • competency assessments.

***

Compliance

***

Conclusion

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“Claying” Your Own Luxury Vehicle

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How to Remove Bonded Surface Contaminants

[By Dr. David Edward Marcinko MBA]

Dr. DEMClaying is the process of removing bonded surface contaminants from your car that cannot be removed by washing alone and that need to be eliminated before the polishing process, using synthetic poly clay.

It works by gently pulling and lifting the bonded contaminants off the surface which then become encapsulated in the clay.

A detailing spray, or designated clay lube is used to lubricate the surface to prevent the clay bar from inflicting damage as it is drawn across the surface.

The Process

One panel at a time is worked and once the clay has picked up contaminants it can be folded and remolded to reveal a fresh, clean surface and prevent any contaminants being drawn over the surface.

Claying is primarily used to remove bonded contaminants from the paintwork of your car but can also be used on glass, metal and other parts of your car depending on the grade of the clay being used.

***

clay-bars

***

You should clay your car if you are looking to achieve the best possible results. The depth of shine and reflection of a polished and waxed vehicle may be compromised if bonded surface contaminants have not been removed. It is important to clay your car before polishing because if the contaminants are picked up during the polishing process they may be drawn over the surface inflicting light scratches and swirl marks.

It is also important to ensure bonded contaminants are removed because they will act to attract and accumulate other dirt and debris and if left bonded to the surface for a long enough period of time may even weaken the paintwork underneath.

***

DEM Jag

***

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Conclusion

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Critical Illness Insurance Coverage

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Financially Coping with Illness

[By Staff Reporters]

From 2015 to 2020, medical expenses are expected to outpace inflation at an annual rate of 5.3 percent versus 2.1 percent for general inflation, according to the Department of Labor [DOC]. As a result, most Americans will be unprepared financially to cope with an illness without significant savings.

So now, Prudential Group Insurance is offering critical illness insurance through employers.

***

doctors

***

For about $200 to $250 per year or $8 to $10 a month, employees who fall ill with cancer, kidney failure, stroke, heart attack, coronary artery disease and other serious illnesses, can receive a lump-sum payment upon documented diagnoses.

Assessment

Although Prudential does not offer the product to individuals, insurers, such as Mutual of Omaha, do.

Link: http://www.criticalinsurance.com/

Conclusion

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On Hospital 30 Day Re-Admission Rates

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And … Problems Paying Medical Bills for 2011

By http://www.MOCL.com

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Conclusion

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The New “Patient Centered Health Plan” Video

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An Alternative to Obamacare?

[By Staff Reporters]

Did you know that Tennessee’s US senatorial candidate, Dr. George Flinn, just announced his Patient Centered Health Plan as a sustainable alternative to Obamacare?

“This country needs a strong, positive alternative,” said Flinn. “We need to unite behind a solid proposal now because the longer Obamacare is in place, the harder it will be to repeal.”

The PCHP [Patient Centered Health Plan]

The Patient Centered Health Plan advocates a quality, affordable system promoting principles such as portability, competition across state lines, and the expansion of health savings accounts (HSA).

Flinn stated that his plan aims to end the assault Obamacare has created on our liberty and free enterprise in this country.

From massive job loss, decreased quality of care, doctor shortages, layoffs in health services, and millions still uninsured, Obamacare is doing the opposite of what it was made to do.

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GF

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The Plan Link

The plan is available in detail at www.patientcenteredhealthplan.com

Selected Lists On Health Savings Accounts:

Assessment

Both parties criticize one another for different aspects of Obamacare. The only consensus is its inability to effectively function. For the betterment of the United States, party lines need to be overlooked in order to find a solution.

Patient Centered Health may be the answer.

Conclusion

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On Children’s Health Insurance Coverage

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By Source and Year

http://www.MCOL.com

child

Conclusion

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Re-Thinking the Medical Career Choice?

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Would You Do it All Over Again?

Redeux

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Some Thoughts on Money Happiness

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Can Money Buy Happiness?

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

Rick Kahler CFP

It turns out money can buy happiness, after all—sometimes. Having a good income and the security of money invested for the future don’t insure happiness, of course. They do, however, give us a foundation that can make it easier to find happiness.

Spending

Part of the secret to using money to foster happiness is knowing what to spend it on!

For example, spending money to lift your mood—the whole “retail therapy” idea—does not lead to happiness. It provides only a momentary sense of pleasure, which often in the long run fosters unhappiness. There are ways to spend money that do create happiness.

Here, based in part on several posts about money and happiness by Dr. Jeremy Dean on his site Psyblog, are a few of them:

1. Experiences. Research says you will find greater happiness spending your money on experiences rather than on stuff. Experiences live in our memories much longer and give us more emotional enjoyment than things, which can quickly lose their importance. In fact, just the anticipation of planning an experience often creates happiness. And if you want to take the happiness level up a notch, take a friend along with you.

2. Exercise: The number-one strategy people can use to feel better, increase energy levels, and reduce tension is exercise. Exercising can mean spending money on a gym membership, a personal trainer, and equipment. However, exercising can also be inexpensive. Walking, for example, requires little more than a pair of good walking shoes and—at least here in South Dakota—a warm winter coat.

3. Stuff that will provide you experiences: Buying things that create or are necessary for experiences count as happiness spending. Music is an experience that research says is a mood enhancer; even sad music can bring pleasure. Spending money on music might mean buying concert tickets, but it could also mean buying recordings, an iPod, smart-phone, speakers, and similar equipment.

4. Stuff that supports doing what you’re good at; like medicine: What are you good at and really enjoy? PsyBlog says spending money for things you excel at typically creates happiness. A set of golf clubs and a budget for green fees could be a great purchase if you’re good at golf—or even if you aren’t so good at the game but you enjoy it for the exercise and time with friends. The same goes for buying things to support hobbies, such as art supplies, garden plants, or quilting fabrics. Maybe you enjoy helping others, so charitable giving or spending money on volunteer opportunities would increase your happiness. I love researching almost anything, so spending money on research data can be a mood lifter for me.

5. Coaching/Therapy: Few things are more valuable for long-term happiness than hiring a good coach or therapist. Research shows talk therapy to be as effective as or better than antidepressants. In my co-authored book, Conscious Finance, I describe how spending $80,000 on therapy was the best investment I ever made in my own happiness and well-being.

6. Meditation: The biggest happiness bang for your buck might come from meditation. It isn’t free, but it’s very inexpensive. You will need to attend a class or buy an instructional video or book. I recommend “Open Heart, Open Mind” by Thomas Keating, but there are many others.

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Happy

****

Assessment

While we know that money by itself isn’t a source of happiness, we also know that having enough money to comfortably meet our basic needs does make us happier. In addition, we can consciously choose to spend in ways that buy happiness. Such investments may not provide financial returns, but they can provide significant happiness returns.

Conclusion

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Preparing Your Car’s AC for Hot Weather

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Summer is Near

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Lexus Roswell, GA]

Dr. DEMAir conditioning systems are specifically designed to be largely maintenance free, but small issues can grow into big problems without regular checks. In short, it pays to be prepared for the unexpected in hot weather conditions. If you want to keep your cool during your daily commute or on an upcoming road trip, here is a handy checklist to help you prepare your car’s air conditioning system for spring and summertime driving.

Timing is everything

Don’t wait until the hot weather has arrived to start using and testing your air conditioning. Use the system regularly throughout the year, and particularly in the spring, when you have a few weeks before the hot weather kicks in to get any remedial work carried out. Test the air flow in the system. Turn the air conditioning on high and manually inspect each of the vents. Is air coming out of every vent? Is the air pressure the same around the car, or are some vents weaker than others? Change the temperature of the system. Is the air cooling down as you would expect?

Listen for strange noises

This isn’t about things that go bump in the night, but more about ticks, rattles, or knocking sounds that might indicate there’s a problem with the system. Listen at each vent and also at the dashboard when the car is idle, and when you put your foot on the gas. It’s quite possible that there is a small obstruction (such as a leaf or twig) somewhere in the system, or there could be a more serious problem.

***

Jaguar 2000 V8-L

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Check out unusual smells

Excessive oily, mechanical smells could indicate that the system is damaged or underperforming in some way and may need mechanical attention. Stale or unpleasant odors may indicate that the air filter needs replacing or that something is caught somewhere in the system. Your owner’s manual will be able to tell you how to change the filter, or get your mechanic on the case if you’d rather not do it yourself.

Check the coolant level

If the air is powerful but doesn’t appear to cool properly, you may have a problem with the coolant level in your air conditioning system. This will naturally deplete over time, but low levels may also indicate a leak in or damage to the system. The owner’s manual for your car can probably give you instructions on how to check, but if you’re unsure, consult a trusted mechanic for a second opinion.

***

JAG Bay

***

Assessment

Though your vehicle’s air conditioning system may not require frequent attention, scheduled maintenance checks are the key to keeping the cabin comfortable and your bank account safe from costly repair bills

Boys and their Toys

Doctors and their Cars

Conclusion

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2013 Physician Compensation Report

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Salary Update

By MedScape

Doc Comp

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Full Report:

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Financial Strain for European Hospitals‏

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Percentage with High-Risk Default Potential by Country 

[By www.MCOL.com]

E

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Conclusion

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How Much is a Financial Advisor Really Worth?

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And … Can it be Quantified?

Doctors and FAs

[By Staff Reporters]

How much of a boost in net returns can financial advisors add to client portfolios? According to Vanguard Brokerage Services®; maybe as much as 3%?

The Study

In a recent paper from the Valley Forge, PA based mutual fund and ETF giant, Vanguard said financial advisors can generate returns through a framework focused on five wealth management principles:

Being an effective behavioral coach: Helping clients maintain a long-term perspective and a disciplined approach is arguably one of the most important elements of financial advice. (Potential value added: up to 1.50%).

Applying an asset location strategy: The allocation of assets between taxable and tax-advantaged accounts is one tool an advisor can employ that can add value each year. (Potential value added: from 0% to 0.75%).

Employing cost-effective investments: This component of every advisor’s tool kit is based on simple math: Gross return less costs equals net return. (Potential value added: up to 0.45%).

Maintaining the proper allocation through rebalancing: Over time, as investments produce various returns, a portfolio will likely drift from its target allocation. An advisor can add value by ensuring the portfolio’s risk/return characteristics stay consistent with a client’s preferences. (Potential value added: up to 0.35%).

Implementing a spending strategy: As the retiree population grows, an advisor can help clients make important decisions about how to spend from their portfolios. (Potential value added: up to 0.70%).

Source: Financial Advisor Magazine, page 20, April 2014.

networking advisors

The Fine-Print

But, Vanguard notes that while it’s possible all of these principles could add up to 3% in net returns for clients, it’s more likely to be an intermittent number than an annual one because some of the best opportunities to add value happen during extreme market lows and highs when angst or giddiness [fear and greed] can cause investors to bail on their well-thought-out investment plans.

More: http://www.CertifiedMedicalPlanner.org

Assessment

Most retail financial services products are designed to enhance the well-being of the Financial Advisor and/or vendor at the expense of clients. The clients get only the leftovers. Of course, no one tells them that secret. They have to figure it out for themselves. As the old line goes, “Where are the customers’ boats?”

Source: Rowland, M: Planning Periscope [Where Advisors are the Clients]. Financial Advisors Magazine; page 36, April 2014

Conclusion

Are doctors different than the average investors noted in this essay?

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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™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

Understanding Average [Physician] Investor Results

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On the failure of the average investors to keep up with investment markets

[By Lon Jefferies MBA CFP® http://www.NetWorthAdvice.com]

The following chart was recently published by Bob Doll at Nuveen Investments:

investor-results

Epic Failure

Doll attributes the failure of the average investor to keep up with investment markets (or even inflation, for that matter) to market timing and emotionally driven decisions to move into and out of the market.

The Data

How long has it been supposedly common knowledge that investors are better off choosing an investment strategy that represents their risk tolerance and sticking to it both in the good times and bad? Still, this data illustrates that investors are terrible at sticking to their strategy when markets stall, and still have an overwhelming urge to buy after the market has already done well and sell shortly after a market drop (i.e. buy high and sell low).

A Financial Plan

Again, having a defined, documented investment strategy can help you avoid the types of behavior that cause other investors to significantly under-perform the market. This is where having a written financial plan can be invaluable.

Assessment

Of course, working with a financial advisor with a history of executing a steady, buy-and-hold approach can provide important support in avoiding detrimental behaviors during the rough times.

Conclusion

Are doctors different than the average investor noted in this essay?

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Does the Method of Tax Filing Change IRS Audit Potential?

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Will that be a Paper or Electronic Tax Return?

[By Dr. David Edward Marcinko MBA CMP™]

dr-david-marcinko5I’ve prepared and filed personal, medical practice as well as PC, S and C corporate tax returns for many years now. I bought my first computer in 1988, participated on dial-up bulletin boards with modem soon thereafter, and have been on the internet since 1995.

But, I do to have a definitive answer to this question.

Two Competing Theories

Some CPAs suggest filing the old-school way if you’re worried about an audit. Why? Paper filing means more work for the IRS to access all the information in your return. Others disagree:

Philosophy in Favor of Paper Returns

Some suggest that a paper tax return might reduce your chance of an audit because the IRS must transcribe your information into a computer by hand. The IRS does not transfer all of the information in your return as a result of the prohibitive cost of transcribing returns. When you file a return electronically, a computer instantly analyzes your return for errors and discrepancies.

Source: http://www.ehow.com/info_8488086_filing-increase-chances-irs-audit.html#ixzz2yh9m8pEy

Philosophy in Favor of Electronic Returns

Filing an electron tax return reduces the number of math mistakes on your return and the chance that the IRS makes a mistake when it transfers data by hand. Overall, electronic returns contain fewer errors than paper returns which increase the chance of audits. Also, the IRS may perform an automatic audit when its electronic scanning system cannot read your handwriting.

Source: http://www.taxdebthelp.com/tax-problems/tax-audit/irs-audit-statistics#ixzz2yLVTp0l1

Tax

Assessment

Remember, your duty as a taxpayer is to be truthful and accurate, but you don’t have to make it easy for the IRS.

Conclusion

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On Next-Generation Medical Practice Management Strategies

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Establishing the Way-Forward

[By Dr. David Edward Marcinko MBA CMP™]

dr-david-marcinkoMedical practices today are operating in a new or next-generation practice management environment. There are significant pressures on physicians to increase, or at least maintain revenues and bottom line profits. These pressures are coming from many sources.

First, there is the increase in managed care penetration. As managed care grows, and the ACA implements via ACOs, doctors are forced to sign up with these health plans in order to maintain their patient base. They perform the same services but get paid less for them. Reimbursement is undergoing a paradigm shift, progressing from retail, to a wholesale, mentality. Capitation is changing reimbursement patterns. When capitation becomes the payment system, most doctors lose revenue simply because they do not know how to practice in this type of payment environment.

Second, payers’ have a continuous desire to reduce costs, including federal government programs such as Medicare and Medicaid. Many are bundling services together into single payments. More importantly, many payers are simply reducing what they pay doctors. Government intervention, such as HIPAA and eHRs, is also putting pressures on practice revenues. Increased scrutiny by the Government with regard to fraud and abuse issues, along with the Stark rules and regulations, have both impacted practice revenues. Some practices have found they cannot create the revenues they used to since Stark became law. As a result of government scrutiny, physicians coding practices have become much more conservative, thus impairing revenue.

Finally, these pressures have created a significant increase in competition within the healthcare marketplace. To increase revenues, physicians are becoming more aggressive in the marketplace. Many are spending more money on marketing activities in order to increase patient volume. Others are forming affiliations or alliances to go out and obtain exclusive contracting relationships, which is another way to increase patient volume.

In aggregate, physicians are now forced to take initiatives to increase practice revenues. Practices that do not place emphasis on this strategic strategy find themselves with declining revenues as well as declining profits. This means less money available for physician compensation. However, some practices have been successful in growing their revenues with the following practical strategies, which vary for each practice and each practice locale.

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ImageProxy

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Competing for Managed Care Related Contracts

The objective here is to go out and obtain exclusive contracting arrangements that will add profitability, not necessarily volume, to the practice. This usually means entering into an arrangement with a third party payer. To do this, the practice must do two things. First, it must make sure it is positioned so that a payer will want to award a contract to the practice. In other words, it must have something to sell to the payer. For example, primary care practices are attractive to those payers who want to award global risk contracting arrangements. Second, the practice must market itself to these payers. This means going out and meeting with payer representatives about potential contracting arrangements. The meeting should solicit from the payer what kind of exclusive contracting relationships it is looking for and more importantly, what it thinks about the practice itself. In other words, find out if the payer would even consider awarding a contract to the practice.

Ancillary services

A practice should analyze the services that it is now referring out, so that it can bring them in house to generate revenue. This conflicts with hospital-owned practices since the employed physicians refer most ancillaries to the hospital. In other words, because of government rules, the physicians cannot look to these revenues for additional compensation. However, still look for these opportunities – there might be ancillary services the hospital does not render or does not want to render that could be provided by the practice itself.

Examples of ancillary services that most medical practices could implement include lab, radiology (ie, X-Ray, mammography, echo testing, bone density testing, etc.).

Physician Extenders

As a result of declining reimbursement, physicians are spending less time on patient treatments that do not pay well. In other words, they are not spending time on care that could be rendered by someone else (i.e. by a lower cost provider). Adding a physician extender to a practice can increase revenues simply by freeing up physician time to do other, better paying clinical activities.

For example, an extender could conduct certain post-operative visits, which usually are not paid if treatment is within a designated global surgical period. Extenders could also be used to add patient volume, especially in primary care practices. Many busy practices hire extenders in order to allow patients quick, convenient access to a healthcare provider for simple medical conditions. This way, patients do not have to wait for an appointment. As a result, this leverages the volume of patients a practice can treat on a daily basis.

Added Venue Value

In some service areas, a medical practice can branch out to increase revenue. Practices may be successful adding satellite locations in areas that are either underserved or need a more qualified physician. For example, some practices in urban areas have set up satellite offices in other parts of their county, which are usually geographically outside the urban area itself. Since a significant amount of capital will normally be required to start up the office from scratch, it may be more practical to acquire or merge with an existing practice. The emphasis would then be on increasing the efficiency and profitability of that practice site.

Improving Operations and Productivity

In most cases, revenues can be increased for a medical practice simply by improving operations and physician productivity. For example, many practices have problems with their billing and collection activities, including receivables management. Charges do not get billed on a timely basis, collections at the time of service are inadequate, there is a failure to detect incorrect payer reimbursement, and receivable follow up is unstructured or non-existent. All of this can lead to high receivables and low collections – in other words, lower revenues. The entire billing and collection process should be analyzed and evaluated to see if there are any improvements that can be made that could increase practice revenues.

Next, physicians should look closely at CPT® coding patterns. This is critical for those practices operating in a fixed fee environment because fee schedules cannot be increased to generate additional revenues. First, look at your coding for evaluation and management services. Many doctors under code these services and many do not know how to bill for consultative visits. Look at all other coding issues related to your specific medical specialty. Are modifiers being applied correctly? Are surgical complications identified and billed correctly? Are all available CPT® codes being billed? These are just a few examples.

Make sure the practice fee schedule is maximized. There should not be any billing of a service where the billed charge is approved 100% for payment by the payer. This is especially true for managed care payers. To identify these situations, you must have a system in place to review the Explanation of Benefits (EOBs) that are received from the payers with each reimbursement. Look for those charges that were approved 100% for payment. When identified, the related service fee on the practice charge master should be increased immediately.

Finally, for hospital-owned medical practices, increasing physician productivity can result in an immediate increase in revenues. History has shown that physician productivity often declines after a physician practice is acquired. This is usually because the incentives in the employment contract are misplaced. In these situations, the incentive should be placed on the doctor’s base salary and not any bonus possibilities. A doctor will often maintain productivity if he or she knows that his or her base salary could decline if productivity targets are not met.

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Business Med Practice

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The Template Textbook for Success

For comprehensive practice management information on how to increase office efficiency, operations, revenue and profit, an excellent textbook is: The Business of Medical Practice, 3rd edition.

Assessment

Regardless, the keystone of integrated financial planning for all physicians is consistent income. The following practice benchmarking methodology will assist in proactively monitoring this all-important parameter of your financial life, before it is too late.

Conclusion

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How Much Did Your Doctor Receive From Medicare?

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From Medicare Part B in 2012

By http://www.nytimes.com

Use the form below to find a doctor or other medical professional among the more than 800,000 health care providers that received payments in 2012 from Medicare Part B, which covers doctor visits, tests and other treatments.

You will need to know the medical providers’ name, specialty and/or zip code.

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David MD MBA

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LINK:

http://www.nytimes.com/interactive/2014/04/09/health/medicare-doctor-database.html?_r=0

Source: The information presented here is from a database released by the Centers for Medicare and Medicaid Services. The database excluded, for privacy reasons, any procedures that a doctor performed on 11 or fewer patients. The total reimbursements for each doctor does not include those procedures either. Results shown above include only the individuals like doctors, nurses or technicians but not organizations like Walgreens. While some providers could have multiple offices, the address shown is the main address indicated in the database. Descriptions of the procedures are from the American Medical Association.

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Beware the WET heartBLEED Bug!

Hacking – Web Encryption Technology [WET]

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[By Staff Reporters]

A newly discovered bug in widely used Web Encryption Technology [WET] has made data on many of the world’s major websites vulnerable to theft by hackers.

 

heartbleed-640x775

BEWARE!

[An OpenSSL Hack]

LINK: http://money.msn.com/business-news/article.aspx?feed=OBR&date=20140408&id=17508701&ocid=ansmony11

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Medical Records as Malpractice Defense

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A “Complete and Accurate” Record  

By J. Christopher Miller JD

J. Christopher Miller, Esq

The best defense against any medical malpractice liability claim is a complete and accurate written or electronic record of the facts.

To Observe and Treat

In particular, medical malpractice claims will frequently be stalled or thwarted by a consistent written description of the symptoms you observe and the treatments you prescribe.

Extensive record keeping will not only help formulate a defense against a claim, but it will also (and perhaps more importantly) create the appearance that you are careful and highly competent in all of your affairs. Members of a jury may not be able to discern whether the medical judgments you made in a particular case were good or bad, as they do not have the years of education and training that you do.

Trial Jurors

Jurors can, however, sense whether your practice is organized and professional. If your records are thorough and consistent, jurors will assume that you dedicate as much attention to the substantive aspects of your work as you do to the tedium of recordkeeping. If you are active in the management of your office, you should keep track of its operations and establish logs for your employees to complete as they perform their daily tasks.

Assessment

Not all information, however, ought to be written down. Keep your written records to the facts you have observed and leave your speculations for department meetings.

Conclusion

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What You Should Know About 401(k) Loans

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Take Care this Option

Lon JeffriesBy Lon Jefferies MBA CFP®

According to 401k.org, about 20% of Americans eligible for a 401k loan have one, and the average outstanding loan balance is $7,600. As 401k loans are an option for many, it is a good idea to familiarize yourself with the pros and cons of this financial tool.

Additionally, be aware that not all 401(k) plans allow employees to borrow from their accounts. Check with your H.R. department before you even begin to consider a loan.

The Rules

The maximum loan amount allowed is restricted to the lesser of half the vested account balance or $50,000. While interest rates vary by plan, the most common rate is the prime rate plus one percent (prime is currently 3.25%). Unless lent funds are used to purchase a home, most 401k loans must be fully repaid within five years.

The Advantages:

  • Loans are not subject to income tax or early withdrawal penalties (unless the loan defaults).
  • Loans are convenient. There is no credit check or long application process.
  • Loans have low interest rates. Most 401k loans are cheaper than rates charged by credit cards and second mortgages.
  • Interest paid on the loan is paid to yourself, not a bank or other lender.

The Disadvantages:

  • Borrowed money will not be invested in the market so potential investment gains will be forfeited. Click here for a calculator illustrating what a loan will eventually cost in interest and lost investment return.
  • Borrowed funds will be taxed twice! Borrowers earn wages, pay taxes on those wages, and use those after-tax funds to repay the loan. During retirement, the retiree will again pay taxes on withdrawn funds. Consider an investor who is in the 25% federal tax bracket – being tax twice would be extremely expensive.
  • Investors with a 401k loan ultimately contribute less to their retirement plan because a portion of new contributions will go towards paying off the loan.
  • If you cease working with your current employer, your entire loan is usually due within 60 days. If you can’t repay the loan, it is considered defaulted and you will be taxed on the outstanding amount and subject to a 10% early withdrawal penalty if you are under age 59½.Generally, I feel that a 401(k) loan should be considered only if it’s essential and all other financial resources have been exhausted.

    Loans

    Assessment

    However, there are instances when a 401(k) loan can be a fantastic solution. For instance, I have a client who expects to receive an inheritance within the next few months. This client would like to purchase a new home immediately and needs funds for a down payment. It makes sense for this client to borrow from his 401(k) plan in order to cover the initial cost of the home loan and repay the loan in full once the inheritance is received. This enables this individual to borrow funds inexpensively but then not forfeit the great benefits provided by his retirement plan.

Conclusion

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Treating Children “Equally” in Estate Planning

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“Equal” isn’t necessarily “Fair”

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

Rick Kahler CFPIn estate planning, “equal” isn’t necessarily the same as “fair”. I rarely see an estate plan that does not treat children equally. When I do see inequality, it’s usually because a parent is estranged from one child and leaves him or her nothing. So, “equal” isn’t necessarily “fair”.

Some call this the “placebo of estate planning equality”.

Psychologists

Many experts on the psychology of estate planning recommend that parents divide their estates equally among children. The main reason is to help enhance sibling relationships after the parents’ deaths. The goal is to eliminate the potential for hurt feelings and perceived injustice if parents favor one sibling over another financially.

Estate Division

Dividing an estate into equal shares for each child might seem to be the obvious way to treat children fairly. However, that usually only works if you’ve treated them equally during your lifetime. If you have given more to one child during life, it’s usually smart to level the playing field at death.

The Financial Samurai

I was reminded of this principle late last year in a post by a blogger who goes by the name Financial Samurai, who tells this story:

He perceived that his parents couldn’t afford to send him to a private college. To help them financially, he chose to go to a public university. His younger sister chose a private university costing eight times as much. After graduating, he worked hard to save enough to repay his parents. When he offered them the money, ten years after graduation, he was shocked when they declined it. Only then did he learn they had saved equal amounts for his and his sister’s educations. When he chose the less expensive school, they transferred what they saved on his tuition to help pay for his sister’s more expensive private education.

While he tries his best in the balance of the article to take the high road, assuring readers this injustice really doesn’t bother him, it’s clear that it does, a lot.

“No-Talk” Rules

The amazing thing about this story is that this family never discussed the financial aspects of college. The parents never told their son they were saving for his college education or communicated their intent to pay for it. He never asked, assuming that paying for college was his responsibility. The unspoken “no-talk” rule around money that so many families follow was rigidly in place.

College funding is far from the only way parents treat children differently. Another common one is bailing out one child who has financial struggles, either self-inflicted or caused by outside circumstances. Parents may also lend or give one child some money to start a business. Or they may feel they owe more to a child who has been the one to take care of them in old age.

Many of these inequalities can be compensated for in estate planning. One strategy is to subtract any excess paid to one child from his or her portion of the inheritance. It’s important here to provide for inflation, such as adjusting the amount paid to the child upward by the cumulative increase in the Consumer Price Index (CPI) from the date of the payment to the date of death.

placebo-pill

[The “Placebo” of Equality]

Assessment

If parents feel it’s fair to leave more to a child who has cared for them, it’s best to establish that amount carefully, based both on tangible factors like the market value of the care and on intangibles like the relationships among the siblings.

So, no matter what adjustments you make in your estate plan to equalize what children may have received during your lifetime, it’s crucial to talk about those adjustments. Clear communication about what is “fair” goes a long way to maintain strong sibling relationships long beyond the parents’ lives.

Conclusion

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How Obama’s 2015 Proposed Budget Impacts Retirement Accounts

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Fore Warned is Fore Armed!

By Lon Jefferies MBA CFP®

Lon Jeffries

President Obama recently unveiled his proposed budget for 2015. Included in the proposal were the following potential changes to investor retirement accounts:

Apply Required Minimum Distribution Rule To Roth IRAs

There are currently two main reasons to invest in a Roth IRA – to pay taxes at your current rate in anticipation of being in a higher tax bracket in the future, and to invest in an account that does not require minimum distributions when the investor reaches age 70½. However, President Obama’s 2015 budget calls for Roth accounts to be subject to the same RMD requirements as other retirement accounts.

This change would make Roth IRA accounts much less appealing for a good portion of the investment community. Additionally, if enacted, the rule would dramatically reduce the benefit for many individuals to convert their traditional retirement accounts to Roth accounts. Lastly, this rule would essentially betray all investors who already converted their accounts to Roths by taking away a benefit they were counting on.

Eliminate Stretch IRA

Non-spouse beneficiaries of retirement accounts currently have the option of either withdrawing the funds from the inherited retirement account within five years of the original IRA owner’s death or stretching IRA distributions over their expected lifetime. Stretching distributions is considered favorable because it allows the investor to spread the tax liability from the income over their lifetime and continue taking advantage of the tax-deferral provided by the retirement account. However, Obama’s proposal would eliminate non-spouse beneficiaries’ ability to stretch distributions over a period of more than five years.

If implemented, this change would have severe tax implications on people inheriting a retirement account and drastically reduce the value of tax-deferred accounts as estate planning tools.

Cap on Tax Benefit for Retirement Account Contributions

Currently, investors obtain a full tax-deferral benefit on all contributions to retirement accounts. Under Obama’s proposal, the maximum tax benefit that would be allowed on retirement contributions would be 28%. Consequently, an investor in the 39.6% tax bracket would only be able to deduct 28% and would still need to pay taxes at 11.6% (39.6% – 28%) on all contributions made.

Eliminate RMDs For Retirement Accounts Less Than $100k

Currently, investors over the age of 70½ must begin taking taxable distributions from their retirement accounts in the form of required minimum distributions (RMDs). Under Obama’s proposal, individuals whose retirement accounts have a total value of less than $100k would no longer be subject to required minimum distribution rules. This would enable retirees with less in their retirement accounts to take greater advantage of the tax-deferral benefit an IRA provides.

Retirement

Retirement Account Value Capping New Contributions

Under the new proposal, once an individuals’ retirement account value grew to a certain cap, no further contributions would be allowed. This cap would be determined by calculating the lump-sum payment that would be required to produce a joint and 100% survivor annuity of $210,000 starting when the investor turns 62. Currently, this formula would indicate a cap of $3.2 million. This cap would be adjusted for inflation.

Proposal, Not Law…

Keep in mind that these potential changes are currently just proposals and are not certain to be implemented into law. In fact, with the exception of RMDs for Roth accounts, all of these suggested adjustments were proposed by Obama last year and none were approved by congress. Consequently, history suggests that Obama may have a hard time getting these changes implemented. Still, examining the proposals provides some insight into the direction President Obama would like to proceed.

Conclusion

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Cyclical Stocks versus Defensive Stocks

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Industry and Economic Cycles

By Tim McIntosh MBA CFP® MPH http://www.SIPLLC.com

TMThe distinction between cyclical stocks and defensive stocks lies in how closely related the stock’s performance is to industry and economic cycles.

Cyclical Stocks

Stocks that operate in industries that are highly correlated to the strength of the domestic economy are considered to be cyclical stocks.

For example, the construction and automobile industries are generally considered cyclical industries given that demand for their products is highly related to the current economic environment. In periods of weak or declining economic growth, demand for automobiles and new construction products decline, thus resulting in a decline in earnings for companies operating within those industries.

Defensive Sticks

Defensive stocks are viewed as being less susceptible to fluctuations in the overall economy.

For example, since demand for food products is generally considered to be less dependent on the strength or weakness of the overall economy, food stocks are generally considered defensive stocks.

Managing a Stock Portfolio

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Appreciating the Highest Rates of Uninsured or Underinsured‏ Americans

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For the Five States with the Highest Percent of People Under Age 65

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Uninsured

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Health Plan Rankings and Satisfaction‏

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 Top 20 Private Health Insurance Plans [HIPs]

By www. MCOL.com

ImageProxy 1

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On Money Anxiety?

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Even … While the Housing and Market Indicators are Recovering!

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

Rick Kahler CFPTwo economic indicators suggest that the US economy is recovering from the recession.

The housing market is almost back to 2006 levels in most areas of the country. We’ve also seen record highs for the Dow Jones stock index.

The Money Magazine Survey

Yet, according to a recent survey by Money magazine, many people still feel anxious about their finances. They may be more optimistic about their own current circumstances, but still worry about their future or about the economy in general.

This continued anxiety despite a rosier economic outlook may not seem logical. When you take a closer look, however, it makes perfect sense.

Why the Anxiety?

For one thing, people who suffered job losses, foreclosures, or other financial setbacks during the recession haven’t necessarily recovered emotionally even if they have recovered economically. Like other traumatic life experiences, painful financial experiences can leave lasting emotional damage.

In addition, even those not directly affected financially by the recession were affected emotionally by the alarming economic headlines. Our brains have evolved to react to threats with immediate action, so these news reports triggered a fearful urge to “Do something now!” Unfortunately, some investors panicked and “did something” by selling out of the stock market at the bottom. This may have reduced their anxiety in the short term, but it increased anxiety in the long term as they wrestled with when to get back into the market. Even some who did nothing still experience a lingering sense of anxiety and stress.

Still Filled with Angst

Now that the news is better, though, why aren’t we over all that angst?

For one thing, our brains don’t respond to good economic news in the same immediate way they do to fear-inducing news. A headline like “Dow hits record high” doesn’t give our brains a jolt of happy hormones equal to the shot of fear we get from “Dow hits new low.”

What we do relate to personally are changes that affect us directly, like cash in our pockets, a pay raise, or an observable increase in our purchasing power. Many people aren’t necessarily seeing those affects right now.

Example:

To illustrate this, two of the most significant economic indicators—the housing market and the stock market—don’t affect the vast majority of us on a daily basis. Unless you are buying or selling a home, you don’t really notice or care about real estate values. Gas, food, and consumer goods prices affect the average household the most.

The same is true for the stock market. Some 53% of Americans don’t have any money invested in stocks at all. Even if you do, an increase in the overall value of your retirement account isn’t likely to change your immediate cash flow. And if you haven’t received a raise in several years or can’t find a good job, your reaction to news of a record stock market high is likely to be, “So what? Things still aren’t that good for me.”

To reduce anxiety, then, what we really need is an improvement in our personal circumstances. That change may be a tangible financial one like finding a better job or getting a raise.

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Money Anxiety

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Assessment

It also can be a change in focus. You might choose to pay less attention to things you can’t control, like news reports about the economy. This gives your brain less exposure to information that feeds its fear. Another option might be to focus on what you can do: building up an emergency fund, paying down debt, or cutting spending in order to contribute more to a retirement account. In that way, you can turn anxiety in your favor, using it as a motivator to improve your financial situation.

Related:

Conclusion

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

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Certified Medical Planner™ Program “In-the-News”

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Post-CFP® Subject Matter Expertise

By Ann Miller RN MHA [iMBA Inc., Executive Director]

Mike Kitces MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC an uber-financial services blogger over at www.Kitces.com had this to say about us in a recent essay: Finding Your Niche Or Specialization With Post-CFP Designations

The News Essay

CMP (Certified Medical Planner) – The CMP™ designation was created by Dr. David Edward Marcinko MBA CMP™ [reformed CFP®] and the team at the Institute of Medical Business Advisors, Inc., (who also produced the “Financial Planning Handbook for Physicians and Advisors“). It is intended for advisors who aim specifically to serve physicians and the medical community. Content focuses not only on the insurance and investment issues relevant to physicians, but also provides an understanding of the business of medical practices themselves so advisors can help work with their physician clients to have more successful businesses as well.

CMP™ Practitioner Testimonials

I am happy to give my unbiased, unpaid opinion on the CMP™ program to anyone considering the course.

David K. Luke MS-PFP, MIM, CMP™ [Net Worth Advisory Group]

9980 South 300 West, Suite 110 Sandy, Utah 84070

david.luke@networthadvice.com

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cmp-program1

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CMP™ Practitioner Testimonials

I am in favor and support the CMP™ program and curriculum … but just like any other academic curriculum, it is an “accretive academic” program rather than an instant “change of life” program.  I use the material that I learned on a regular basis, but I cannot say that I use it every day.  You will be more able to “talk-the- talk” of the physicians if you have completed the CMP™ curriculum. I would do it again!

Savant recently hired a physician, Dr. Brian Knabe MD as an advisor. He is leaving the medical field, transitioning out, and entering the field of financial services. He has enrolled in this curriculum. Let me know if you wish to discuss.

Thomas A. Muldowney MSFS CFP® ChFC CLU CRC CMP® AIF®

[Savant Capital Management, Inc®]

190 Buckley Drive – Rockford, IL 61107 Tel 815-227-0300 – Fax 815-226-2195

Tmuldowney@savantcapital.com

caution

Assessment:

Link: What Comes After CFP Certification? Finding Your Niche Or Specialization With Post-CFP Designations

Visit: www.CertifiedMedicalPlanner.org

Visit: Enter the CMPs

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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Does Health Care Contribute to Health?

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And … How much does it cost?

By staff reporters

As Ezra Klein noted, The Bipartisan Policy Center included this infographic in their report on obesity and its economic consequences (PDF).

health-infographic

Assessment

Is this graphic even accurate?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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