Reading List on Healthcare Variations and Spending Costs

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NBER Bulletin on Aging and Health — 2014 No. 1

[By Staff Reporters]‏

The 2014 No. 1 Bulletin includes the articles below:

1) Regional Variation in Health Care: Physician Beliefs or Patient Preferences? by David Cutler, Jonathan Skinner, Ariel Dora Stern, and David Wennberg http://www.nber.org/aginghealth/2014no1/w19320.html

2) The Recent Slowdown in Health Care Spending: Explanations and Predictions by Amitabh Chandra, Jonathan Holmes, and Jonathan Skinner http://www.nber.org/aginghealth/2014no1/w19700.html

Assessment

Abstracts of Selected Other NBER Working Papers: http://www.nber.org/aginghealth/2014no1/WorkingPaperSummaries.html

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Retail Spending Therapy – Even for Doctors!

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More Than Just Shopping?

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

Rick Kahler CFP“It’s not just shopping, it’s retail therapy.”

As a bumper sticker or a joke between friends, this may be amusing. For those who shop to relieve stress, it’s not nearly so funny.

Medicating or soothing painful feelings with money is no healthier a behavior than medicating with alcohol or food. When stressed or in difficult circumstances, some people drink, some people eat, and some people shop.

My Experience

I have worked with several people with extreme forms of this behavior, who described their spending clearly as an addiction. It gave them a physical “high” similar to that experienced by an alcoholic or drug addict. Like other addictions, it had destructive consequences, such as creating overwhelming debt, draining life savings, destroying relationships, and even stealing from family members or employers.

Using spending as a medicator does not always show up in such dramatic ways, however. Even people who seem to live moderately and manage money responsibly can be “therapy shoppers” who spend in order to make themselves feel better.

Case Example:

When I first met Dr. Alexandra, for example, she was single, in her 40s, with a well-paying job as a local hospitalist and substantial net worth. She was investing part of her income, was current on all her financial obligations, and had only a modest amount of debt. She was certainly not spending beyond her means or jeopardizing her future security. She didn’t appear to be in any financial difficulty.

When we looked at her budget, however, the doctor was clearly uncomfortable with some of her spending habits. Instead of simply reassuring her that she was managing her money well and not overspending, I explored this issue with her. Eventually I brought up the possibility that she might be medicating her difficult job emotions with spending. It was an “aha” moment for her. She told me, “I’ve been doing that for years.”

Alexandra’s problem wasn’t the amount she spent. It was the reasons behind her spending. If she had a stressful day at work, she would go to the mall, in much the same way another person might stop at a bar for a couple of drinks on the way home. Shopping, finding bargains, and buying herself gifts were unthinking actions she used to soothe herself when she was upset.

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Frenzy

***

She never stopped to ask herself whether she needed, had a use for, or even wanted the things she bought. She didn’t spend more than she could afford, but she was spending time as well as money unproductively. She was also cluttering her house and her life with clothes she didn’t wear, knickknacks she didn’t care about, and gadgets she didn’t use.

Once she realized the emotional reason for her shopping, Alexandra was able to find more constructive ways to deal with stress. She learned that a conversation with a friend, writing in her journal, meditating, or taking a walk could serve the same purpose as a trip to the mall and were healthier responses to difficult days.

Modifying Behavior

For Alexandra, recognizing that she was using shopping to soothe her emotions was enough to help her change. Others, whose behavior is more deeply ingrained, might find change more difficult. In some cases, they might benefit greatly from working with a psychologist, financial therapist or other counselor with the expertise to help them look at the emotions underlying their spending patterns.

Assessment

If you think you may be using spending to deal with stress, it’s important to look beyond the numbers. The main issue isn’t whether your “retail therapy” is affordable or whether it is causing serious financial difficulties. If a pattern of spending is creating discomfort for you, it may be a good idea to explore what’s behind that spending. 

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Overcrowding in the ER

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State of Emergency

EmilyBy Emily Newhook

Whether you’re suffering from a broken bone or a life-threatening illness, a trip to the emergency room is always a scary prospect.

But, what happens when an ER is faced with more patients than it can accommodate? Between 1995 and 2010, annual ER visits in the U.S. grew by 34 percent, while the number of hospitals with ERs declined by 11 percent.

From long wait times to sky-high medical costs, overcrowding puts undue pressure on patients, providers and administrators when efficient, high-quality care matters most.

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State-of-Emergency

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The online MHA degree program MHA@GW created this infographic to show the impact of overcrowding on U.S. emergency rooms. The graphic looks at some of the major causes of congested ERs, examines the impact on care delivery and explores proposed solutions to the problem of overcrowding.

Assessment

Help us raise awareness of this important issue by sharing the infographic above.

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Enter the Financial Advisory Gurus?

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Understanding the Nexus Between Fame and Quality

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

  • “I see that firm’s ads everywhere.”
  • “His books are best-sellers.”
  • “That advisor does all kinds of free seminars for retirees.”
  • “She’s on TV all the time.”

The Case … For?

When a financial advisor, someone with a radio or television show, or an author of financial books becomes well-known, it’s easy to assume you can trust that person’s advice. This isn’t necessarily the case.

Recently I was selected by an Internet community site called moneytips.com as one of their top 50 “social influencers.” This is a list of professionals in the areas of wealth and personal finance who use social media and other Internet tools effectively.

Among the top three on this list are Dave Ramsey and Suze Orman, whose books and advice include a great deal of solid information to help people get out of debt, manage money well, and provide for the future. Many others in the top 50 are respected financial journalists and advisors.

The Case … Against?

However, the list also includes a few advocates for high-risk investment methods, proponents of dubious get-rich-quick schemes, and purveyors of poorly researched advice. Those who put together the list focused on how well people established a presence on the Internet and used technology to communicate. That’s an assessment completely unrelated to the question of whether the advice or information being communicated was worthwhile.

Financial Planning

Financial planning, just like any other field, has a solid core of practitioners who quietly and ethically serve their clients. It also has its gurus, its outstanding marketers, and its fringe practitioners with extreme ideas. The challenge for consumers is not to assume fame and quality always go together.

Linking Fame and Quality?

Here are a few suggestions for keeping a balanced perspective about famous or familiar financial faces:

1. Knowing about a professional isn’t the same as knowing a professional. Everyone you know may have heard of Noted Local Advisor. That’s not the same as being able to recommend him or her. Get recommendations first-hand, from people who actually are clients of a firm or have used someone’s plan or advice. Ask specific questions about what they’ve done and how it worked for them.

2. Yes, there are shortcuts to building wealth, but they come with very high risks. For most of us, the best ways to build wealth are gradual and even boring: saving part of every paycheck, living on less than we earn, and investing for the long term in a well-diversified portfolio of different asset classes. It’s natural to wish for an easier, faster way, but that desire can make you more vulnerable to high-risk schemes and even scams.

3. Even if a method of building wealth is perfectly legitimate and works for others, it still may not be a good fit for you. If you’re a reclusive introvert, for example, sales is probably not your best path to success.

4. Apply the same common sense and skepticism to financial products or wealth-building methods that you would use anywhere else. For example, you probably don’t assume that a car’s advertised gas mileage is what you’ll actually get under real-world conditions. In the same way, it’s a good idea to assume that your real-world results from a proposed investment or business will be lower than the advertised numbers.

5. Don’t assume every financial guru is a crook. Many reputable professionals can teach you a great deal about money. Your job is to learn the financial basics so you can evaluate them with some educated skepticism.

networking advisors

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Assessment

And always keep in mind that a product or idea is not the same thing as the selling of that product or idea. The true genius of some financial “experts,” after all, is marketing.

Conclusion

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Healthcare’s Start-Up Businesses and New Entrants

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Who Will be Healthcare’s Amazon.com?

[By PwC Health Research Institute]

New entrants are already having an impact

Abundant opportunity in the expanding health sector is attracting new players from far afield, from Fortune 50 retailers and telecom companies to fledgling startups backed by venture capital.

These new entrants, like health, wellness and fitness, are moving fast with fresh ideas about how to satisfy consumers’ appetites for better health and more convenient, affordable, high-quality care.

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fortune-50

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New Business Models

Consumers are ready to abandon traditional modes of care for new ones, suggesting billions in healthcare revenue are up for grabs now. Non-traditional players are creating these new modes of care – from home diagnostic kits that snap into smartphones to online services that can triage and prescribe treatments based on computer algorithms.

They are competing to be the Netflix, Amazon.com or Apple of the US health sector, all disruptors that transformed industries.

The Wellness and Fitness Sector

***

wellness market

***

More: https://medicalexecutivepost.com/2015/06/28/why-i-love-amazon-com-but-wont-buy-its-stock/

Conclusion

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There’s a New HIPAA Sheriff in Town

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On OCR Director Jocelyn Samuels

1-darrellpruitt

[By D. Kellus Pruitt DDS]

When the explosions of breaches of patients’ medical identities occur – as predicted by the FBI and others – will the new OCR Director Jocelyn Samuels continue to be as sympathetic and forgiving as Leon Rodriguez has been?

Or; will she take on the role of bad cop?

 

The Replacement

Samuels, who is tying up loose ends in her current position with the civil rights division at the Department of Justice, has replaced Rodriguez as the new head of the HHS’ Office for Civil Rights – which prosecutes HIPAA violations. Many are wondering about her level of enthusiasm for enforcement, especially since data breaches are only getting worse, not better.

Privacy and security attorney Adam Greene, who once served as a member of the OCR staff, tells GovInfo that the challenge for Samuels is “to strike the balance where HIPAA is seen as having ‘teeth’ but covered entities and business associates can still count on OCR as being reasonable when there are areas of ambiguity or privacy or security issues occur despite good efforts at compliance.”

(See: “Impact of New HIPAA Enforcement Leader – Are New Strategies, Directions on the Horizon?” by Marianne Kolbasuk McGee for GovInfoSecurity.com, July 11, 2014).

http://www.govinfosecurity.com/impact-new-hipaa-enforcement-leader-a-7049/op-1

Healthcare Harm

Principals in healthcare – providers and patients – continue to be harmed by EHRs designed to satisfy third-parties’ questionable Meaningful Use requirements rather than principals’ needs. For example, on April 8, the FBI warned that EHRs are becoming increasingly vulnerable to hackers. (See: “Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain”).

http://www.illuminweb.com/wp-content/uploads/ill-mo-uploads/103/2418/health-systems-cyber-intrusions.pdf

Under Rodriguez, OCR has arguably spared the rod (mostly), choosing instead to discuss and correct HIPAA violations in an informal, private, non-punitive manner. I think both Rodriguez and Secretary Sebelius backed off of more aggressive enforcement because they recognized that without cooperation from doctors and patients, EHRs are certain to fail – mandate or no mandate. Nevertheless, it has proven to be far too easy for stakeholders who cannot be held accountable to patients, to marginalize their needs.

Jocelyn Samuels

[New OCR Director Jocelyn Samuels]

Example

Rodriguez did his best to appease all sides. For example, it was under his watch that the name of the HHS website listing breaches of 500 or more patients’ identities was changed from “Wall of Shame” to the more benign “HHS Breach Reporting Tool.”

For hapless providers whose data breaches were unavoidable, the name change eliminates some of the shame associated with being nationally recognized as a careless doctor who cannot keep thieves from stealing patients’ identities.

Assessment 

As long as there is nothing holding down the cost and liability of HIPAA compliance, there will always be room for more regulation, and the cost of healthcare will never be cheaper.

Conclusion

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Retrospective Audio on the “Doctors’ Riot” of 1788

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History of Grave Robbers

By Overcast: [Stuff You Missed in History Class]

In the late 1700s, medical colleges needed cadavers for educational dissection, but there were no legal means for obtaining them.

This led to some unorthodox dealings in the acquiring of bodies, and brought New York to a fever pitch in 1788.

Poe

ME-P Editor at the Grave of EA Poe, in Baltimore, MD

[© iMBA Inc. All rights reserved. USA]

Audio Link: http://t.co/DbcgppVEYG

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Obama Nominates Robert McDonald as VA Chief [VOTE]

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But – Will He Succeed? [Opinion Poll]

RMRobert McDonald has been nominated as Secretary of Veterans Affairs, and will turn his mind to the aftermath of conflict and the 9 million former American service people enrolled for care.

If confirmed by the Senate, he’ll succeed Eric Shinseki, a retired general who resigned last month amid explosive charges of mismanagement, falsification of records and a toxic culture that left patients waiting indefinitely for treatment.

Earlier this month, the acting head of the agency confirmed that 35 veterans left off a list died before seeing a doctor, perhaps as result of the delay.

OPINON POLL

Assessment

Conclusion

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Prevalence Rates of Healthcare Access?

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Household Telephone Status

By http://www.MCOL.com

Tele Health

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How Much Social Security Is Actually Taxed?

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As much as 85 percent may be taxable

By Lon Jefferies  MBA CFP®

Lon Jefferies

If Social Security is your only source of income, it is unlikely that your monthly benefit is subject to taxation.

However, people like doctors and other medical professionals with substantial income outside of Social Security may have to pay federal income taxes on their benefits. In fact, it is possible that as much as 85 percent of your Social Security payout is taxable.

The Determination

To determine whether you are required to pay taxes on your benefit, the first step is to determine what the federal government deems your “combined income.” Your “combined income” is one-half of your Social Security benefit, plus all other income received during the year. Other income might include wages earned, capital gains recognized, dividends and interest collected, pension benefits received, and IRA funds distributed during the year.

Example:

For instance, consider a retired couple that receives an annual pension benefit of $20,000, takes an IRA distribution in the amount of $10,000, and receives $15,000 in Social Security benefits. This couple’s other income would total $30,000 (the pension and the IRA distribution). One-half of the Social Security benefit, or $7,500 would then be added to the other income to create a “combined income” of $37,500.

If a couple filing a joint tax return has a “combined income” of less than $32,000 ($25,000 for individuals), then all Social Security benefits are free of taxation. However, if the figure is between $32,000 and $44,000 ($25,000 and $34,000 for individuals), then as much as 50 percent of the Social Security benefit may be taxable. Further, if the “combined income” is greater than $44,000 ($34,000 for individuals), than as much as 85 percent of the Social Security payout may be taxable.

The “Combined Income” Threshold

So should couples do everything necessary to keep their “combined income” below $32,000 (the 50 percent threshold), or even $44,000 (the 85 percent threshold)? Fortunately, the tax system is progressive, meaning that just because a couple might fall in the bracket causing as much as 50 percent of their Social Security benefit to be taxable, not all of their benefit is necessarily taxed as such.

Example:

For instance, our sample couple with a “combined income” of $37,500 might be concerned that they are paying taxes on 50 percent of their Social Security benefit because that is the bracket they fall in. This would cause half of their $15,000 Social Security benefit, or $7,500, to be taxable. Fortunately, it is only the $5,500 of benefits received that pushes the couple’s “combined income” over and above the $32,000 threshold that is actually considered 50 percent taxable. As a result, only $2,750 (half of the $5,500 of “combined income” over the $32,000 threshold) of Social Security benefits is taxable. In this instance, the taxpayers are only paying taxes on 18 percent ($2,750/$15,000) of their Social Security benefits.

Getting Granular

Now suppose our imaginary couple received not $15,000 in total Social Security benefits, but $15,000 each, leading to a total benefit of $30,000. Assuming the same $20,000 pension benefit and $10,000 IRA distribution, the couple’s “combined income” would now be $45,000 (half of the $30,000 in Social Security benefits received plus the $30,000 of other income).

This provides another illustration of how the progressive tax system prevents higher-income taxpayers from feeling the need to do everything they can to get their “combined income” under the $44,000 threshold just to avoid the 85 percent bracket. First, a “combined income” of $45,000 clearly fills the entire 50 percent bracket of $32,000 – $44,000. Consequently, the entire $12,000 of Social Security benefits received within that range will be 50 percent taxable (or $6,000 of benefits received will be taxable). Additionally, another $1,000 of benefits over and above the $44,000 threshold will be 85 percent taxable, meaning another $850 of benefits are taxed. This means a total of $6,850 ($6,000 from the 50 percent taxable bracket, and $850 from the 85 percent taxable bracket) of Social Security benefits received will be taxable. Still, however, of the $30,000 of Social Security payments received by our couple, only 23 percent ($6,850/$30,000) ends up being taxable.

Taking this one step further, we can deduce that income outside of a Social Security benefit (the combination of pension benefits, IRA distributions, capital gains, etc) must be greater than $44,000 for there to even be a possibility that as much as 85% of a Social Security benefit would be taxable. If this other income portion of the “combined income” is less than $44,000, then at least some of our Social Security benefit will fall in the 50 percent threshold, if not the 0 percent threshold.

Benefits

The Calculations

Here is a useful calculator to determine the taxability of your Social Security benefit.

The point of this exercise is twofold. First, understanding the factors that may cause a Social Security benefit to be more or less taxable provides us with an advantage from a financial planning perspective. Second, it is important to realize that just because our “combined income” passes a threshold causing some of our Social Security benefit to be taxable doesn’t mean that the resulting tax liability is catastrophic.

Assessment

In fact, once realizing that the increase in tax liability from having some additional income is so inconsequential, some retirees may be more likely to spend and enjoy their retirement, which is the point of financial planning in the first place.

Conclusion

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Six groups that will shape mHealth apps of the future

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A Special ME-P Report

The Distinct Segment Publishers

By Ralf-Gordon Jahns and Markus Pohl

ralphmarkus

 

 

 

 

 

Introduction

Dr. Marcinko and ME-P Readers and Subscribers,

Did you know that mHealth app publishers can be grouped into 6 distinct segments?

Segments differ mainly by goals, business approaches and performance. Their desire to help others distinguishes them from the rest of the app community. Knowing these segments is a pre-requisite for all those who wish to successfully participate in the new mHealth app ecosystem.

The Publishers

So, who is behind the 100,000 mHealth apps published in today’s app stores? How do the publishers differ in terms of motivation, development tool usage and satisfaction about goals achieved? The mHealth app publisher segmentation distinguishes 6 groups of current mHealth app publishers. This segmentation is based on the results of themHealth App Developer Economics 2014study.

A deeper knowledge about the mHealth app publishers is essential to all health market participants who wish to successfully navigate inside the newly emerging mHealth app ecosystem.

mHealth app publishers are not like game or tool app developers. 46% publish apps, because they want to help others. They also have objectives like revenue generation or raising brand awareness, but this “altruistic” attitude clearly distinguishes them from the rest of the app economy.

Within the six mHealth app companies, publishers with a strong medical background and those who leverage existing app development tools & APIs seem to accomplish their goals better than those who do that to a lesser extent.

Traditional healthcare players like Pharma, Med-tech or insurance companies have not been able to define their role in the market yet. Established Healthcare Players are the only segment “mainly not” satisfied with their goal achievement.

These are the profiles of the 6 distinct mHealth app publisher segments:

1) Established healthcare players:

This group includes Pharma, hospitals, health insurance and Med-tech companies, representing 3.4% of the total number of app publishers. These players usually belong to the mHealth app publishers with > 5,000 employees. Their primary objective for being in the market is to raise brand awareness and they have published the largest number of mHealth apps. Nevertheless, average reach in terms of downloads is far below the market’s average. App publishers in this group are so far the least satisfied with the achievements in the mHealth app market. The usage of tools and APIs to improve the efficiency of the app development process and app monitoring as well as the value of the app is below its competitors.

2) App specialists:

App specialists are small companies, which typically hire 3-10 employees. They have entered the mHealth app market in order to benefit from its potential. They have an app developer background and are familiar with available development and support tools. The share of medical experts on board is relatively low. This group constitutes 14% of the mHealth app publisher community.

3) Helpers:

Helpers’ primary motivation for publishing apps is to help others and they are usually organized into small companies of 3-10 employees. Revenue generation is only a minor factor. Typically Helpers have already achieved or over-achieved their goals. In terms of downloads, they have the highest share of companies (61%) that achieved less than 5,000 downloads last year. Helpers represent 32% of the market.

4) Medical specialists:

Medical specialists leverage their medical know-how to develop mobile apps. Similar to the Helper group, Medical specialist have a large share of members who publish apps to help others. By far they have partly reached their goals. They have the highest share of companies, which in 2013 earned more than USD 1m with their mHealth app portfolio. They represent 20% of the market.

5) Fitness specialists:

This group of app developers represents around 10% of the total mHealth app developer community. They primarily develop fitness apps with a clear objective to generate revenue. They connect more often to medical databases and sensors and use app development tools above average. The usual company size is 11-100 employees.

6) Connecters:

This group of mHealth app publishers represents 18% of the total mHealth app developer community. Their strategy is to create value rich apps by enabling connection to other apps, sensors and databases. This group generates the highest average revenue and has the highest goal achievement level.

Apps

Assessment 

The mHealth app publisher segmentation is a snapshot of the current state of the market. It will change as segments become more important (medical specialists) or new groups appear.  One of the main questions will be if and how traditional healthcare players will be able to compete with these small and agile companies that are driving the market today.

More:

Conclusion

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

References:

Link to blog post:

http://mhealtheconomics.com/mhealth-segmentation-of-app-publishers-business-approaches/

Link to graph:

http://mhealtheconomics.com/wp-content/uploads/2014/05/research2guidance_mHealth_6_segments_business_approaches.jpg

Link to free report:

http://mhealtheconomics.com/mhealth-developer-economics-report/

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A 2014 Stock Market Mid-Year Review

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What Do We Know?

[A SPECIAL R&D REPORT FOR THE ME-P]

By Lon Jefferies MBA CFP®

Lon JefferiesIf you pay close enough attention to the news media you’ll eventually learn that much emphasis is placed on pundits’ forecasts, but very little consideration is given to how accurate the projections turn out.

When 2014 started, there were some pretty widely-accepted expectations regarding the investment environment. Let’s take a minute to review those anticipations and analyze how precise they turned out to be.

Interest Rates

One of the most universally accepted beliefs going into 2014 was that interest rates were on the cusp of rising, and that consequently, bond returns would drop. (Of course, this has been the expectation for around five years now, but that is a discussion for a later time.) Investors were questioning whether they should reduce or eliminate the bond portion of their portfolios until the rate increase occurred.

So, have we experienced the rise in interest rates we were expecting? On 1/2/14, the yield on the 10-year Treasury note was 3%. As of 6/30/14, the yield on the same note was 2.516%.

That’s right — interest rates have actually decreased over the last six months. Did those who stuck with their investment strategies and maintained their bond positions experience a decline in their portfolio’s value?

Here is how a variation of different bonds have performed year-to-date (as of 6/30/14):

  • US Government Bonds (IEF): 4.89%
  • US TIPS (TIP): 5.25%
  • Corporate Bonds (LQD): 5.37%
  • International Bonds (IGOV): 5.66%
  • Emerging Market Bonds (LEMB): 6.42%

Equities

How about the equities side of the portfolio?

In January, predictions for stocks were all over the map — some predicted a full out correction (a loss of more than -20%), some predicted that we would keep chugging along at 2013′s pace, and most predicted something somewhere in between. There were, however, many factors that were a common cause of concern.

So, was the reduction of the Fed’s Quantitative Easing a legitimate fear? In fact, this possibility has come to fruition. In December, the Fed was buying $85 billion per month of financial assets from commercial banks and other private institutions. The Fed has reduced this monthly amount during every meeting it has held this year, and that amount is now down to $35 billion per month. However, the key question is what impact has this had on the stock market.

Here is how a wide basket of equities have performed year-to-date (as of 6/30/14):

The most widely accept fear among equity investors was the phasing out of the Fed’s Quantitative Easing (QE) program. Investors worried that the Fed would begin lowering the amount of loans the government would buy from commercial banks each month, which would lower the availability of capital in the economy.

Historically, less money in the system leads to less investing in new businesses, less innovation, and fewer jobs created.

  • Large Cap Stocks (IVV): 7.08%
  • Mid Cap Stocks (IJH): 7.57%
  • Small Cap Stocks (IJR): 3.30%
  • Foreign Stocks (IEFA): 4.34%
  • Emerging Markets (IEMG): 4.70%
  • Real Estate (IYR): 16.09%
  • Commodities (DJP): 7.32%
  • Gold (GLD): 10.27%

Volatility

The last widely-held viewpoint at the beginning of the year was that 2014 was likely to be a year more volatile than anything we had experience in 2012 or 2013. There was a lot of clatter about valuations and PE ratios being too high, concern about the war in Ukraine, a consensus that China was about to experience a drastic decline in both imports and exports, and a general feeling that the market was due for a significant (if not healthy) pullback.

Additionally, how much have we heard about unfavorable weather patterns over the last six months?

Managing a Stock Portfolio

Lessons Learned

Of course, all of this is not to say that interest rates will never rise, that bond values will never decline, and that the market won’t return to the roller coaster it is.

In fact, all those things are certain to happen. Unfortunately, anyone who contends to know the uncertain part of this equation — when — likely doesn’t actually know anymore than you or me. For this reason, having and sticking to a diversified investment strategy that coincides with a detailed financial plan is the most likely path to financial success.

The most significant lesson inherent in these numbers is that market expectations are essentially useless. Near the beginning of the year, the vast majority of experts anticipated interest rates to rise, bond values to drop, and volatility to increase. Unfortunately, pundits making projections are rarely held to their inaccurate forecasts and are allowed to continue making a living showing they have no greater knowledge than the average investor.

Assessment

So, has 2014 been a wild ride?

The S&P 500 dropped by -5.51% from 1/22/14 – 2/03/14, and by -3.89% from 4/2/14 – 4/11/14. These are the only declines of more than 2% that the S&P 500 has experienced all year!

Additionally, as of 6/30/14, the S&P 500 has now gone 54 consecutive trading days without an up or down move of greater than 1%, the longest stretch since 1995! By historical standards, 2014 is considered to be a very smooth ride.

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Summer Tips for Physicians to Maintain their Vehicle

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Keeping your luxury vehicle running smoothly with these Hot-Weather “tips and pearls”

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Collision Center]

Dr. Marcinko

You and your car survived the harsh winter. Thanks to your preparation and careful driving, you stayed on the road and emerged from the thaw without incident. But, before breathing that sigh of relief and going on your way, make sure you know how to maintain your vehicle in the warmer temperatures with these tips and pearls.

Why? Warm weather can stress cars as much as the cold, so take steps now to prepare you and your car for the spring and summer by following these important tips.

Check the Climate Control System

Many doctors forget about their air conditioner while relying on the heater during the winter months. During that time, air conditioners can leak refrigerant and experience other mechanical failures without notice. Before getting caught without relief in the heat, take your car to your dealer for an AC checkup.

Inspect Windshield Wipers

During the winter, windshield wipers can stick to the windshield and tear before breaking free. Don’t let damaged wipers catch you off guard when the spring rains hit. Inspect your wipers and replace them if they look damaged or worn. If you need help with this, stop by your dealer for assessment, parts, and installation.

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Jag

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Inspect Tires

Your tires were fine before winter. Several months and possibly thousands of miles later, your tires may not be in such good shape now. Cold temperatures make the air inside tires shrink; that’s why you inflated your tires for winter driving. As the air warms, however, the air expands, often causing overinflated tires that can wear unevenly and prematurely. Check the tires on your car for proper air pressure and adjust them if necessary.

According to the National Highway Traffic Safety Administration, more than 3,000 deaths and 116,000 injuries between 2005 and 2009 resulted from tire-related problems. Don’t become part of those statistics.

Replace Air Filter

During the winter weather, salt and sand that are used to keep roads safe affect your car’s air filter. So, check it yourself or ask your dealer to check your air filter for signs of problems. By restoring free airflow into your engine, you can boost the fuel efficiency of your car by one-tenth or more. You will also improve acceleration, so take it easy on the gas.

Time for a Carwash

The melting snow, salt, and sand on winter roads covers your car and its undercarriage with a corrosive mixture, setting the stage for rust and marred paint. With winter weather past, take your car to the car wash for a thorough cleaning to prevent lasting damage from the winter. Better yet; wash it yourself. With some intentional care, you can keep your car looking great for a long time to come.

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Jag console

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General Inspection

The break between winter and summer is a great time to give your car a good once-over. Verify your registration and inspection stickers are up-to-date and that your insurance cards and all your paperwork are in order.

Also, check fluid levels for the oil, transmission, brakes, power steering, and windshield wash. If your car is due for scheduled maintenance, take it to your dealer now to have it done. Routine maintenance and prompt repairs will help your car beat the challenges of the heat.

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The Dating and Money Conversation for Medical Students

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Honey, We Need to Talk … About Finances!

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

Rick Kahler CFPWe are al aware of the student debt load crisis in this country.

But, one of the challenges at the beginning of a romantic relationship is having “the conversation” about an equally important issue for any couple: money.

Even more so for medical students, interns, residents, nurses, young doctors and medical professionals!

For example:

  1. What is okay to ask a potential partner about money, and when?
  2. How do you bring the subject up without seeming like a braggart, a coldhearted miser, or someone looking for a meal ticket?

There really ought to be some rules of etiquette for exploring this essential topic; something like, “by the sixth date, it’s appropriate to start undressing financially.” Unfortunately, we don’t have such guidelines.

The Money Minefield

Money is a topic fraught with emotional richness. In other words, it’s a minefield. Money is one of the top sources of conflict for couples, so if you’re dating, it’s crucial to learn a potential partner’s earnings, net worth, money habits, and financial beliefs. At the same time, talking specifically about money is so forbidden in our culture that we have no idea how to initiate a conversation about it.

Here are a few suggestions that might help:

1. Figure out your own money beliefs first. Before you even sign up with a dating site or accept your friend’s offer to set you up with her brother-in-law’s second cousin, think about what you want and need financially from a partner. Do you care if someone’s net worth is much higher or lower than yours? Is a certain level of debt a deal-breaker? What lifestyle are you comfortable with?

2. Tell before you ask. Begin with appropriate self-disclosure, in small steps, about your earnings, your long-term financial goals, or your beliefs about debt or spending. See how potential partners react. If they don’t disclose in turn, seem very uncomfortable with the conversation, or have beliefs or money habits much different from yours, you may be seeing red flags.

3. Observe. Watch how people handle money. Are there any patterns around spending or the use of credit cards that seem to indicate either overspending or excessive frugality? Do they throw cash around, or do they leave restaurant tips that Ebenezer Scrooge would be proud of?

Does someone’s home show signs of hoarding or stinginess? (A candlelight dinner of takeout Chinese at a card table is one thing for college students, but quite another for middle-aged professionals.) Do their cars or houses seem poorly maintained? Does their lifestyle seem more lavish than the typical earnings in their career field would support?

4. Listen. Despite the taboo on talking directly about money, we indirectly reveal a lot about our money beliefs by what we say. Notice how dates talk about saving or spending. Do they seem worried about money or reluctant to spend it even on basic needs? Do they seem angry about money or resentful of successful people? Do they boast about financial successes, things they own, or get-rich-quick schemes?

5. Ask. Even if everything else is all moonlight and roses. When you meet someone who seems like “the one,” don’t set aside everything that matters to you about money. Instead, remember how important this issue is to the long-term health of a relationship. Even if you can’t do it gracefully, ask the money questions. Talk frankly about debt, spending, saving for retirement, and each other’s expectations around lifestyles and careers.

Dating Currency

Assessment

Being the one to initiate that difficult money conversation doesn’t mean you’re coldhearted, unromantic, or greedy. It simply means you recognize that money is too important a topic to ignore. When we enter into a romantic relationship, it’s tempting to think that love means not having to talk about money. In truth, love means having the courage to talk about money.

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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™

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Invite Dr. Marcinko

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State Requirements for Individual Market Benefit Design and Cost-Sharing

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For Health Benefits

By http://www.MCOL.com

ACA State Requirements

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Understanding Healthcare Employment Benefits that are NOT Taxed at Full Economic Value

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On Entirely Legal AUTOMOBILE Employment Fringe Benefit Strategies 

[By Perry Dalessio CPA]

perry-dalessio-cpaWhen an employment fringe benefit does not qualify for exclusion under a specific statute or regulation, the benefit is considered taxable to the recipient.  It is included in wages for withholding and employment-tax purposes, at the excess of its fair market value over any amount paid by the employee for the benefit.

Examples:

For example, hospitals often provide automobiles for use by employees. Treasury regulations exclude from income the value of the following types of vehicles’ use by an employee:

  • Vehicles not available for the personal use of an employee by reason of a written policy statement of the employer
  • Vehicles not available to an employee for personal use other than commuting (although in this case commuting is includable)
  • Vehicles used in connection with the business of farming [in which case the exclusion is equal to the value of an arbitrary 75% of the total availability for use, and the value of the balance may be includable or excludable, depending upon the facts (Treas. Regs. § 1.132-5(g)) involved)]
  • Certain vehicles identified in the regulations as “qualified non-personal-use vehicles,” which by reason of their design do not lend themselves to more than a de minimus amount of personal use by an employee [examples are ambulances and hearses].
  • Vehicles provided for qualified automobile demonstration use
  • Vehicles provided for product testing and evaluation by an employee outside the employer’s work place

If the employer-provided vehicle does not fall into one of the excluded categories, then the employee is required to report his personal use as a taxable benefit. The value of the availability for personal use may be determined under one of several approaches.

jag346_SWHT

Assessment

Under any of the approaches, the after-tax cost to the employee is substantially less than if the employee used his or her own dollars to purchase the automobile and then deducted a portion of the cost as a business expense.

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The World Cup LifeStyle

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The Body of Injuries

[By Dr. David Edward Marcinko MBA]

[By Springer Publishers]

Did you know that this ME-P has a leisure and lifestyle vertical? Maybe; maybe not! So, with the publication of this info-graphic on the World Cup soccer matches; we invite all readers and subscribers to submit their own hobby activities.

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2

3

4

5

Assessment

Ankle-Leg Trauma

[Copyright Dr. David E. Marcinko, and iMBA Inc. All rights reserved]

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Understanding Some Common Portfolio Payout Methods

   Certified Medical Planner

By Dr. David Edward Marcinko MBA CMP™

Recognizing the risk that market volatility represents to long-term portfolio health, investment accounts and endowment funds utilize a variety of methods to calculate periodic payouts.

  • Investment Yield: An investment portfolio using this method spends only its dividends and interest and re-invests any unrealized and realized gains. There would appear to be two primary disadvantages of this method. First, the payout amount will be extremely volatile as yields on equity and fixed income investments fluctuate. Second, the endowment manager could be encouraged to adopt a short-term focus on yield to the detriment of purchasing power preservation.
  • Percentage of the Prior Year’s Ending Market Value: An endowment using this method would withdraw some fixed percentage of the prior year’s market value. As with the Investment Yield method, disbursements from the endowment can be somewhat volatile under this method.
  • Moving Average: This approach, which is most common among educational institutions, generally involves taking a percentage of a moving average of the endowment market value. The percentage commonly approximates 5% over a 3-year period.
  • Inflation Adjusted: This portfolio method simply adds some factor to the applicable rate of inflation for the institution or investor.
  • Banded Inflation or Corridor: This account method is similar to the Inflation Adjusted method except that it establishes a corridor or band of minimum and maximum increases in an attempt to limit the volatility of the disbursement amounts.

payout

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Happy Independence Weekend

Happy Independence Weekend Greetings to our Readers and Subscribers for 2014

From the Medical Executive-Post

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How Doctors Select a Cloud Services Provider?

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The Top Ten [10] Factors to Consider

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cloud

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Are You Addicted to Your Smartphone-Doctor?

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Changing the Way we Communicate

[By An Anonymous Physician]

Anonymous DoctorRemember the old on-call beeper system?

Well, smartphones have changed the way people communicate. In fact, I do not know a single doctor, nurse or healthcare professional that does not have one. They let you quickly stay in touch with patients, the hospital, ER or medical clinic through calling, texting, emailing, or social networking tools.

But, a smartphone is also much more than a communication device. There are apps that help you manage your life, learn about the world around you, or simply keep you entertained. It’s easy to see why users are so impressed with their new tech, but can it go too far?  So, how do you know if you’ve become addicted to your smartphone?

Here are a few indicators of concern:

It’s Always With You

One of the first steps to spotting an addiction is assessing how often you use your smartphone and how you feel when it’s not glued to your hand or resting in your pocket. Do you get nervous when your smartphone is out of sight or sitting more than an arm’s length away? Can you leave your phone in another room while you sleep, take a shower, or get dressed? You have voice mail for a reason, and it’s okay to occasionally be unreachable.

You Can’t Wait Without It

Without a doubt, a smartphone makes it easier to pass the time while waiting. You can play a game, read a book, check your email, or even catch up on some work. That’s great for sitting in your own doctor’s waiting room, but it shouldn’t become a need for the brief moments of downtime that crop up during your day. If you can’t wait two minutes for a cashier to ring up your groceries without pulling out your smartphone, you might have an addiction.

It Tracks Your Every Move

Smartphone apps often help you become more productive. You can monitor your diet and exercise, pay your bills and create virtual to-do lists. However, it’s easy to take this too far. You might have an addiction if you feel like you can’t eat, sleep, exercise, or go to the bathroom without logging it on your smartphone. (Yes, there are apps for all of that!)

You Call or Text People in the Same House

It’s easy to see how smartphones can help families stay in touch. But do you really need to text your kids when it’s time to come downstairs for dinner? Your family plan might make it free to call and text within your immediate family, but that doesn’t mean you need a fancy device to communicate when you are actually in the same house.

You Choose Your Phone Over Live Company

A smartphone can be great company when you’re bored and have some time on your own, but is it really better company than your actual friends? Twiddling with your smartphone while attempting to simultaneously carry on a face-to-face conversation is not multitasking! It’s just plain rude.

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Phone MD

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Assessment

I am not a psychiatrist by training, but if you find yourself frequently playing with your phone during social gatherings, there’s a pretty good chance that you may have a problem.

If you think you may be addicted to your smartphone, try taking a break from it. Put down the phone and give living, breathing people a chance. You will soon see that the world can be a fascinating place, even without augmented reality.

Conclusion

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Does the Summer Sun Damage your Luxury Vehicle’s Paint Job?

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Protecting your vehicle from the effects of sunlight

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Lexus Roswell, GA]

Dr. DEMSunlight is dynamic. It keeps us warm, allows plants to grow, and can even be converted into electricity.

Unfortunately, sunlight has an equally harmful side on human skin. As a result, the ultraviolet rays in sunlight, also known as UV rays, can burn unprotected skin and blister it. This is well known by doctors, especially plastic surgeons, dermatologists, you and me.

UV Damage

But, did you know that UV rays can seriously damage the paint on your luxury car or truck, too? Yes – it’s true.

During the warm weather seasons, exposure to UV rays actually breaks down the molecules that give your vehicle’s paint its color and shine. Though modern automobile paint includes additives to resist these effects, the paint’s effectiveness only lasts for a limited time period. So, when a car spends much of its life entrenched in sunlight, its paint will gradually fade and become dull.

Temperature too!

While sunlight is harmful, temperature can be a problem, as well. When a car sits out in the fierce midday sun, it gets hot and its body panels expand. Such expansion causes the paint to contract at a microscopic level, which may ultimately crack your car’s paint or dry out and crack leather seats. Over time, the gradual effects of the sun’s heat diminish your car’s gleaming showroom finish. As the sun is ubiquitous, it may seem as though sun damage is inescapable.

However, it is possible to extend the life of your car’s paint job by following these tips.

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My Jaguar

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Tips and Pearls

Seek shade

Whenever possible, keep your ride out of sunlight. Park in a covered garage or use a car cover for an immediate solution. You may also park your car under the shade of a tree for a short period of time, but it is important to remember that tree sap and bird droppings can also damage your paint finish.

Wax

Modern vehicles are finished with a layer of “clear coat” over the actual paint color. This gives the paint its deep gloss and helps protect the pigment from UV rays, however it doesn’t last forever. Regular waxing provides additional protection for your car, filling in cracks that form as a result of sunlight exposure.

A simple way to see if your car needs waxing is by performing the water beading test. To perform this test, drip water onto your paint. If the water forms beads on the paint surface, your car is perfectly waxed. However, if the water spreads on the paint surface, your car is in need of a new wax job.

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My Jaguar XJ-V8

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Assessment

As a classic British Jaguar XJ-V8-L sedan aficionado; can you think of any more ways to protect my car, and your car, from the sun?

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