Handling Protected [Cyber] Health Information [PHI]

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[By The Doctors Company]

***EHR risks

***

NOTE

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

 

On Children’s Inheritance

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In Estate Planning

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

Rick Kahler MS CFPEstate planning can be one of the most emotionally difficult aspects of financial planning. One often-overlooked aspect of estate planning is talking with your heirs about your legacy plans.

While most of us probably accept in theory that these conversations are important, actually carrying them out can be terribly difficult.

Suggestions

Here are a few suggestions that may help.

  1. Communicate your values about money in a larger context with both words and behavior. Our estate plans often reflect lifelong values such as a commitment to charitable giving or a wish to provide first for our families. If children are familiar with your values, chances are they will have a good idea of what to expect from your estate.
  2. Evaluate your children’s money skills. Just because kids grow up in the same family doesn’t mean they will have the same knowledge and attitudes about money. Especially if children will inherit significant amounts, conversations about estate planning can become part of larger conversations designed to help teach them how to manage and become comfortable with their legacies.
  3. If your estate plan does not treat children “equally,” for whatever reasons, it’s best to share that information well in advance and to communicate it privately to each child. There are many reasons why treating children differently in an estate plan can be the fairest thing to do, but that doesn’t mean it’s wise to let them learn the specifics when a will is read. If parents and individual children can discuss these provisions and the reasons for them ahead of time, there is less likelihood of conflict between siblings after the parents are gone.
  4. Don’t allow children to assume they are inheriting more than is the case. If most of your estate will go to charity, don’t keep it a secret. Not telling the kids may avoid conflict now, but it will sow seeds for deeper conflict and resentment after your death.
  5. Prepare children for large or unexpected inheritances. I’ve worked with heirs who were stunned to receive legacies much larger than their parents’ lifestyles had led them to expect. If you have a substantial net worth that’s “below the radar,” perhaps in the form of land or business ownership, your children may be totally unprepared for what they will inherit. Find ways to help them learn more about both the financial and the emotional aspects of managing inherited wealth. You might also consider options, such as giving more to the children during their lifetime, to help reduce the impact of a sudden inheritance.
  6. Acknowledge your own fears. Although it is seldom expressed, perhaps the strongest reason for not discussing estate plans with family members is fear. It’s natural for parents to be afraid that children will be angry or disappointed, will build too much on their expectations for an inheritance, or will be resentful of other heirs.

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Currency

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Communications

Talking to family members about estate planning and legacies can be difficult and even painful. Those discussions, however, will almost certainly be less painful in the long run than the stories children may make up about your decisions after you are gone.

Role of Planners and Coaches

Financial planners and financial coaches can play an important role that goes beyond providing financial advice. They may also be helpful in facilitating the family conversations. In especially difficult circumstances, the help of a financial therapist can also be invaluable.

Assessment

Using the available resources to help you discuss your wishes with family members can be an important aspect of estate planning. Having those difficult conversations is one way to enhance the legacy you want to pass on to your family.

Conclusion

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How Using a ‘Scorecard’ Can Smooth Your Hospital’s Transition to a Population Health-Based Reimbursement Model

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Transforming Business and Operating Models

[By Russ Richmond MD]

Russ Richmond MDDr. Marcinko and ME-P,

The US healthcare system’s myriad of problems again seized the headlines recently with the release of an Institute of Medicine report, which found that 30 percent of healthcare spending in 2009 – around $750 billion – was wasted. Citing the “urgent need for a system-wide transformation,” the report blamed the lack of coordination at every point in the system for the massive amount of money wasted in healthcare each year.

One critical area in particular need of transformation is the business and operating model that drives healthcare in the US. There is broad-based agreement across the healthcare industry that the current fee-for-service model does not work, and needs to be changed. The sweeping health reform law enacted in 2010 included a range of more holistic, value-based payment structures that are now being referred to as “populatiobn health.”

Population health is an integrated care model that incentivizes the healthcare system to keep patients healthy, thus lowering costs and increasing quality. In this value-based healthcare approach, patient care is better coordinated and shared between different providers. Key population health models include:

  • Bundled/Episodic Payments – This is where provider groups are reimbursed based on an expected cost for a clinically defined episode of care.
  • Accountable Care Organizations (ACOs) – This new model ties provider reimbursement to quality and reduction in the total cost of care for a population of patients.

Both of these care approaches aim to reduce care utilization through prevention programs, case/disease management and integrated care coordination, including better information transfer across different providers. Equally important, they are focused on reducing the cost of treatment by managing physician misuse and overuse and driving volumes to lower cost settings of care.

The shift to coordinated care is rapidly picking up steam across the country. According to a recent American Hospital Association survey of hospital chief executives, some 98 percent of respondents agree that hospitals should investigate and implement population health management strategies. Anecdotally, the hospital leaders participating in the survey indicated that it is not “if” they will have to pursue these risk sharing strategies, but “when.”

Even with healthcare providers now realizing that migrating to a population health approach is inevitable, there is still significant confusion about the crucial details of implementing these models. Hospital managements are worried about being left behind in the headlong rush toward adoption of ACOs and other value-based reimbursement models. Against this backdrop, healthcare providers now confront a growing list of urgent questions:

  • Which of the emerging population health-based care models is right for our hospital?
  • How much risk is prudent for our hospital with these new reimbursement models?
  • Should we move to an ACO, or is that too big of a jump for our hospital?
  • How does our management team even start to plan effectively to make the shift to a prevention-focused care and reimbursement model? Where do we begin?
  • What is the optimal time-frame for making these changes?

Using a “Scorecard” to Assess Your Population Health Readiness

So, how do hospital leaders break through the confusion and uncertainty to put their institutions on a clear path toward a successful population health-based future?

An effective way for hospitals to manage this process is by using a “scorecard” based on industry benchmarks to assess their relative readiness for – or current performance in – adopting a value-based reimbursement model.

The scorecard contains metrics that quantify the financial and volume impact on a hospital when it transitions to a population health-based reimbursement model. These metrics can be grouped into a range of key categories – i.e., top 5% high-cost patients, non- urgent emergency department visits, avoidable admissions, readmissions, physician overuse, outpatient procedures performed in lower cost settings, and proportion of one-day inpatient procedures done as outpatient. Hospital managements can address each of these categories in order to reduce per-member, per-month costs of care.

For example, new risk-sharing models have created more impetus for physicians and health systems to work together to prevent avoidable admissions. In 2011 alone, potentially avoidable admissions accounted for 10-14 percent of total inpatient admissions for most hospitals. With the growing push to reduce avoidable admissions, an average 300-bed hospital could potentially lose $9.5 million in annual contribution, as they would no longer obtain volume/revenue from these avoidable hospitalizations. On the flip side, if a hospital doesn’t prevent avoidable hospitalizations, they would be penalized for these unnecessary visits.

The emerging population health landscape has also resulted in hospitals experiencing growing competition from lower cost settings such as Ambulatory Surgery Centers (ASCs). Over the past decade, the number of ASC operating rooms has doubled. Historically, ASCs and hospitals shared in the growth of common procedures such as shoulder arthroscopy. But, with 60 percent of hospitals now within a 5 minutes drive from an ASC, and given the industry’s accelerating shift to population health models, ASC’s price advantage puts hospitals at a competitive disadvantage.

The scorecard gives hospital executives the ability to accurately assess the financial and volume impacts of population health-based reimbursement models to their institution. This is critical in identifying opportunities for improvement, setting priorities, and making key strategic and operational decisions that will help guide a hospital through periods of great change and uncertainty.

Population-Health

Key Principles for Implementing Population Health

Through our work helping hospitals to prepare for a coordinated care future through strategic assessment tools like scorecards, we have identified three key principles that help to drive a successful transition:

1. First, the entire organization needs to embrace change – To engineer a successful shift to one of the new risk sharing business models, your hospital’s management team – indeed the entire organization – will need to embrace change. The fact is, much of that change is already happening right now, so it makes sense to manage it in a way that works best for your hospital’s specific needs and culture. The scorecard process will help your senior management team to clarify goals, assumptions and priorities around where the hospital needs to go, and how best to get there, in the population health future.

2. Plan for “evolutionary” change – Moving to a new value-based health system need not involve a wrenching “revolution” for your hospital. Indeed, jumping headfirst into the unknown is a recipe for disaster for most providers. Taking well planned, incremental steps is usually the best and least disruptive way to evolve to a fundamentally different reimbursement and care model like population health. For example, some hospitals are starting with their own employee populations to experiment with ACO-like care models.

3. Learn to love data – It’s an article of faith in management that you can’t improve it if you can’t measure it. At the core of the population health scorecard assessment approach is the imperative to collect the right data, analyze them, and then continually measure your actions and results as your hospital travels along the population health journey. Data are essential for effective decision making, and also for implementing a new risk sharing reimbursement model at your institution.

Implementing the fundamental changes necessary to meet the historic challenges now confronting healthcare providers has been compared to swapping out the engines in a jet plane – while it is still airborne! As daunting as that metaphor sounds, hospitals can successfully evolve to the population health-based future if they take the right steps to plan for the changes and implement them in a methodical, data-driven fashion.

Careful planning and practical assessment tools like the scorecard help hospital leaders make smarter strategic decisions around value-based healthcare.

About the Author

Dr. Russ Richmond is the CEO of Objective Health, part of the global McKinsey healthcare practice, which serves hundreds of public- and private-sector organizations worldwide. He is passionate about the use of data to manage health and to improve healthcare performance. Dr. Richmond holds an MD from the University of Cincinnati and a BS in Biology from the University of Michigan.

Conclusion

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About Theranos

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What is Is – How it Works

[By Staff Reporters]

The next time your doctor recommends a blood test, you may be able to swing by your local Walgreens. You can have your finger pricked and receive results within four hours. The process of blood testing has remained the same since the 1960s. Doctors and nurses drawing vials of blood, from you, that are sent to labs leaving patients waiting for results for days or weeks.

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theranos

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Enter Theranos

Theranos is a privately held health technology and medical laboratory services company based in Palo Alto, California that provides blood tests. The company’s blood testing platform uses a few drops of blood obtained via a fingerstick rather than vials of blood obtained via traditional venipuncture, using microfluidics technology.

Link: http://en.wikipedia.org/wiki/Theranos

Founder Elizabeth Holmes

At 30, Elizabeth Holmes makes her debut on the Forbes 400 as the youngest self-made woman billionaire. She dropped out her sophomore year of Stanford University to found Palo Alto, Calif.-based blood testing company Theranos in 2003 with money she saved for college. With a painless prick, her labs can quickly test a drop of blood at a fraction of the price of commercial labs which need more than one vial. Theranos has raised $400 million from venture capitalists, valuing the company at $9 billion, and Holmes’ 50% stake at $4.5 billion. She has assembled a stellar board that includes elder statesmen George Shultz and Henry Kissinger. Last year, Walgreens, the largest U.S. retail pharmacy chain, with more than 8,100 stores, announced plans to roll out Theranos Wellness Centers inside its pharmacies.

Link: http://news.therawfoodworld.com/walgreens-implements-new-technology-uses-just-one-drop-blood-run-dozens-tests/

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blood test

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Conclusion

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More on 401(k) Choices

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Studies, Research, Experiments and Experience

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

Rick Kahler MS CFPHere is a conversation I’ve had too many times: An acquaintance says proudly that he invests the maximum into his 401(k). I ask what allocation he’s made between equities and bonds.

He says he just divides his contributions equally among the four investment choices the plan offers. I cringe.

The Book

While it’s wise to put the maximum into your 401(k), it’s also important to choose the right investment options. This is difficult for most people, as shown in the 2004 book, Pension Design and Structure, by Olivia Mitchell and Stephen Utkus.

The Study

In one study, participants were asked to allocate their 401(k) contributions between two investment funds. The first group was given a choice of a bond fund and a stock fund. A second group was given the choice of a bond fund and a balanced fund (50% in stocks and 50% in bonds). A third group was given the choice of a stock fund and a balanced fund.

In all three cases, a common strategy was for participants to split their contributions equally between the two funds offered. Yet because of the difference in the funds, the asset allocations of each group differed radically. The average allocation to stocks was 54% for the first group, 35% for the second, and 73% for the third.

The Experiment

In another experiment, participants were asked to select investments from three different menus offering options with varying degrees of risk. Most made their choices simply by avoiding both the high-risk and the low-risk extremes. They didn’t select a portfolio from the available options based on the appropriateness of the risk each presented.

Investing your retirement funds in such a haphazard manner is almost the same as playing the roulette wheel. A portfolio with 35% in stocks will perform very differently than one with 73%. Especially if you’re young, holding the portfolio with the 35% stock allocation or the 73% may mean a significant difference in your retirement lifestyle.

Another Study

In another study, when employees were given a choice between holding their own portfolio or that of the average participant in the plan, about 80% chose the average portfolio. That’s like going into a clothing store and telling the sales clerk, “Just give me a suit in whatever size you sell the most.

Implications

These studies suggest ways employers can help employees make better investment decisions. One strategy is to reduce their investment choices to a small number of funds that offer portfolios with an asset allocation based on various target retirement dates. Another is to offer employees a variety of investment choices, along with guidance and education so they could make intelligent choices.

My Experiences

In my 30 years of investment experience, the strategy I’ve seen work the best is having a wide variety of asset classes (global stocks, global bonds, treasury inflation protected securities, real estate investment trusts, and commodities) that do well in a variety of economic scenarios. A study reported on by Peng Chen in Financial Planning in 2010 found that from 1970 to 2009, a portfolio with a minimum of 10% to a maximum of 30% in each of these asset classes out-performed portfolios that did not have commodity exposure. Splitting 401(k) contributions equally among these asset classes would provide a greater chance of having an appropriately well-balanced portfolio.

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Spreadsheet

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Assessment

Once you’ve chosen a variety of asset classes, then keep your hands off except for periodic rebalancing. True, this strategy means that in any given year your portfolio will always have winners and losers. Yet with a broad range of assets, the losers and winners tend to balance out. Over the long run the odds are good that you will do fine.

Note: Ditto for 403(b) plans.

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Hospital Admission Costs

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In Four Nations

By http://www.MCOL.com

ImageProxy

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.

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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Reviewing Physician Disability Insurance Policies

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Including Policy Checklist

By Dr. David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org

Dr. DEM

The Basic Premise 101

Could you continue to support your family and pay your bills if you were unable to work for any length of time because of illness or injury? If you were to become disabled, do you know how much money would be coming in each month and from what sources?

The Checklist

As a doctor I covered the ER, and was an insurance agent, for almost a decade. But, I reformed and am now a Certified Medical Planner™ and B-school professor. And, I know that every disability insurance policy has different features.

The following checklist will help you compare policies you may be considering:

  1. How is disability defined? Is it defined as the inability to perform your own job, or inability to do any job? We recommend all our clients, as physicians, to obtain a policy that protects them in their own specialty. This kind of policy is defined as an own-occupation policy, which protects the income you earn in your own specialty and continues to pay benefits if your disability requires that you choose a new specialty or occupation.
  2. Are benefits available for partial or residual disability, as well as for full disability? The most comprehensive policies will pay you a benefit even if you are not completely disabled. If you can only earn up to 20% of your income you are deemed totally disabled; if you can earn 80% or more you are deemed totally well. Partial or residual policies pay benefits when you fall in the category between 20-80%.
  3. Are full benefits paid, whether or not you are able to work, for loss of sight, loss of hearing, or loss of limbs? This is called presumptive disability. Some policies do not cover presumptive disability, some cover you for a specified amount of time, and some protect you for life.
  4. What is the maximum benefit I am eligible for? The amount is based on your income to a maximum of $15,000 per month for one company, and $20,000 total.
  5. Is the policy non-cancelable, guaranteed renewable, or conditionally renewable? The most comprehensive policies are non-cancelable and guaranteed renewable; these put you in total control, not the insurance company, practice or association. The insurance company cannot raise rates, cannot reduce benefits, add exclusions, or cancel your policy at anytime. You are in control, and the policy is portable and goes wherever you go.
  6. How long must you be disabled before premiums are waived? Premiums are waived at the end of the waiting period and refunded for the amount paid during the waiting period.
  7. Is there an option to buy additional coverage, without undergoing additional medical tests or examinations, at a later date? This kind of coverage is called guaranteed issue disability insurance and is available to those who qualify.
  8. Does the policy offer an inflation adjustment feature? If so, what is the rate of inflation? Is there a maximum? This feature is available by an added rider. Ask a licensed DI4MDs.com agent if inflation protection fits your needs at this time.

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Ankle-Leg Trauma

[Back When I Covered the ER]

[Copyright David Edward Marcinko and iMBA Inc., All rights reserved. USA]

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Other Items

  • What is an adequate level of benefits in relation to your present and future obligations?
  • How long a waiting period (until benefits begin) should you select to fit your situation?
  • How long do you want to receive disability income should it become necessary? How much coverage can you get at your current salary?

More: More on Disability Insurance for Physicians

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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Enter “Population Health” Management

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Understanding the Costs and Risks

Dr. DEM

[By Dr. David Edward Marcinko MBA]

By http://www.MOL.com

Gratefully, our book, Financial Management Strategies of Hospitals and Healthcare Organizations [Tools, Techniques, Case Studies and Checklists] has become an academic best seller.

It contains a chapter on Wellness and Population Health 2.0; included here for your review [By Jennifer Tomasik, Carey Huntington, and Fabian Poliak].                 .

Population Health

I am especially proud of this work for 2016.  This managerial book mimics the popular style of colleague Atul Gawande MD in his acclaimed work The Checklist Manifesto.

Why? All hospitals are still subject to the imperative: No Margin – No Mission.

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Pop Health

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Assessment

In an example of population health management and policy leadership, another colleague, David B. Nash MD MBA of the Wharton School, and Endowed Dean of Jefferson University Medical School [father of population health], even wrote the “Foreword”.

Click on this link to read it entirely.

Link: Foreword.Nash

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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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***

Invite Dr. Marcinko

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Medical Assistants Recognition Week

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Week of October 20-24, 2014

[By Staff Reporters]

Medical Assistants Recognition Day [October 22nd], and Week, is celebrated on Wednesday of the third full week in October.

What is a Medical Assistant?

Medical assistants work alongside physicians, mainly in outpatient or ambulatory care facilities, such as medical offices and clinics.

Job Responsibilities  |  Medical assistants are cross-trained to perform administrative and clinical duties.

Here is a quick overview (duties vary from office to office depending on location, size, specialty, and state law):

Administrative Duties (may include, but not limited to):

  • Using computer applications
  • Answering telephones
  • Greeting patients
  • Updating and filing patient medical records
  • Coding and filling out insurance forms
  • Scheduling appointments
  • Arranging for hospital admissions and laboratory services
  • Handling correspondence, billing, and bookkeeping.

Clinical Duties (may include, but not limited to):

  • Taking medical histories
  • Explaining treatment procedures to patients
  • Preparing patients for examination
  • Assisting the physician during exams
  • Collecting and preparing laboratory specimens
  • Performing basic laboratory tests
  • Instructing patients about medication and special diets
  • Preparing and administering medications as directed by a physician
  • Authorizing prescription refills as directed
  • Drawing blood
  • Taking electrocardiograms
  • Removing sutures and changing dressings.

PCMH Team Member  |  Medical assistants are essential members of the Patient-Centered Medical Home team. According to a survey by the Healthcare Intelligence Network, medical assistants ranked as one of the top five professionals necessary to the PCMH team.

CMA (AAMA) Certification  |  Many employers of allied health personnel prefer, or even insist, that their medical assistants are CMA (AAMA) certified.

The American Association of Medical Assistants (AAMA) offers certification to graduates of medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES).

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MAs

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Our heart is your heart

To spread the spirit of Medical Assistants Recognition Week, we are sharing the MARWeek logo with you. Use the logo to promote the week. Your options are endless!

  • Print the logo on T-shirts, bumper stickers, buttons, and flyers.
  • Embroider it on hats and apparel items.
  • Print it on giveaway gifts for patients and colleagues.

The logos are provided in three file formats:

  • JPEG: This low-resolution (72 dpi) format is standard for web page design and PowerPoint presentations.
  • TIFF: This high-resolution (300 dpi) format is standard for professional offset printing or home and office laser printing.
  • EPS: The EPS format is resolution independent and can be dramatically resized for use on signage.

Downloading instructions:

Right-click on the link to the desired logo below and select “Save Target As…” to save the image to your hard drive.

2-color logo (JPEG) Black-and-white logo (JPEG)
2-color logo (TIFF) Black-and-white logo (TIFF)
2-color logo (EPS) Black-and-white logo (EPS)

Patient Liaison 

Medical assistants are also instrumental in helping patients feel at ease in the physician’s office and often explain the physician’s instructions.

marweek-logo-2c-jpg

Assessment

Medical assisting is one of the nation’s fastest growing careers, according to the United States Bureau of Labor Statistics, attributing job growth to the following:

  • Predicted surge in the number of physicians’ offices and outpatient care facilities.
  • Technological advancements.
  • Growing number of elderly Americans who need medical treatment.

More:

Conclusion

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Much More Ado About Healthcare Business Buy–Sell Insurance Agreements

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HOW THEY SHOULD BE STRUCTURED?

By Dr David Edward Marcinko MBA CMP™

Dr. DEMwww.CertifiedMedicalPlanner.org

A buy–sell agreement provides a ready market for the sale of a medical practice or healthcare business interest, provides liquidity on a timely basis, and provides for a smooth transfer to the desired successors.

A buy–sell agreement may be funded to insure retirement, disability, and death protection. A properly designed agreement may help provide for a smooth financial and managerial transition.

The buy–sell agreement should also include the method for determining the value of the medical office or healthcare business-entity; and the payment terms. A buy–sell agreement may be structured in one of two ways: [1] redemption or a [2] cross-purchase agreement.

Redemptions

A redemption is an agreement between the medical business owner in which insurance proceeds, or other corporate funds, are used to buy out the deceased or retired physician owner’s interest. If life insurance proceeds are to be used to fund the buy-out of a deceased owner, the potential risks that need to be considered include:

  • The possibility of alternative minimum tax (AMT) that would only affect a C corporation.
  • The potential for insurance proceeds to be exposed to corporate creditors.
  • The possibility that undesirable dividend treatment may occur if the constructive ownership rules of Code Section 318 are met. (This requires close scrutiny of Sections 302, 303, and 318 when structuring a plan.)

Private medical business owners who currently have redemptions in their estate plans may desire to switch to a cross-purchase agreement. This modification prevents exposure of the insurance proceeds to corporate creditors and the potential for corporate AMT.

Cross-Purchase Agreements

A cross-purchase agreement between or among the parties, unlike the redemption agreement, provides a stepped-up outside basis. It may be cumbersome to coordinate funding with many shareholders because life insurance policies must be acquired on each particular life. Some CPAs, financial advisors, insurance agents and attorneys suggest that a business insurance trust can solve this, but the current popular solution is a partnership.

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Buy-Sell

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Example:

Drs. Jon, Bob, and Brent are three unrelated physicians who are shareholders in a professional corporation. They sign a cross-purchase buy–sell as shareholders, agreeing to purchase the outstanding stock of a deceased shareholder based upon a formula including the prior year’s earnings and the current net worth. They purchase life insurance policies on one another so that they have a way to fund the purchase of the shares from the decedent’s estate. The policies are an approximation of the required funds and are reviewed annually to verify that sufficient insurance exists to cover the needs. They have created a funded cross-purchase agreement.

The shareholders considered having a disability buy-out clause also, but have been unable to agree upon appropriate dollar amounts and have had problems selecting disability insurance coverage. They felt that it was best to have a signed contract on the portion that they could agree on, rather than tie the whole process up seeking agreement on everything.

“Wait and See” Buy–Sell Agreements

The less frequently used option of the “wait and see” buy–sell agreement postpones the decision on how to transfer the business until after the death of the business owner, when more information is available. The purchase price and funding are established currently, but the identity of the purchaser is left open. Typically, the business has the first option to buy. Then, after a set period, the owners have the option to buy. Finally, to protect the heirs of the deceased, if neither of the first two options is exercised, the business must purchase the stock.

Estate Valuation

Certain criteria must be met for a buy–sell to fix the value of the medical business interest for estate tax purposes. For agreements entered before October 9, 1990, that have not been substantially modified, the values established in the buy–sell agreement should serve to establish the value for estate tax purposes, unless the agreement was a device to transfer the business to a family member below fair market value or if the agreement is not a bona fide business arrangement.

For agreements substantially modified after October 8, 1990, or those entered into after that date, the value of the property is determined without regard to any option, agreement, or right to acquire or use the property at less than fair market value or any restriction on the right to sell or use such property, unless the option, agreement, right, or restriction:

  • Is a bona fide business arrangement, and
  • Is not a device to transfer such property to members of a decedent’s family for less than full and adequate consideration in money or money’s worth, and
  • The terms of the option, agreement, right, or restrictions are comparable to similar arrangements entered into by persons in an arm’s length transaction.

If the buy–sell option meets these requirements, its terms may be utilized in the valuation of the interest transferred for estate or gift tax purposes. [IRC § 2703]

If these specific tests are not satisfied, the buy–sell agreement will not establish the value for estate tax purposes and the valuation factors of Revenue Ruling 59-60 probably would prevail. This may leave the estate in the position of having to litigate if the taxing authorities set a value higher than the actual sale value.

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Business

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To assist in meeting the three criteria, advisors should not encourage the use of formulas as in the past; but individual appraisals and personalized valuations. Some practices or entities even fix the value of the business annually and justify this by pointing out that nobody knows whether there will be a purchaser or a seller. They have every incentive to try to make a fair valuation. But, the advisor should keep in mind that such a valuation could be used against an owner in the event of a divorce or separation, so he or she should use prudence before publishing a stated value.

In most cases, the IRS will argue that the agreement doesn’t meet the requirements of Code Section 2703 because of the need for the agreement to be comparable to similar arrangements. This means the buy–sell agreement may not be solely determinative in valuation issues, regardless of how carefully it is constructed.

Assessment

A buy–sell between unrelated parties who are not the “natural objects of each other’s bounty” is deemed to have met the three tests for exclusion from Code Section 2703. This means that the new rules generally only apply to intrafamily transfers, although some experts believe that this term may be broad enough to include any potential heir.

More:

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JOIN THE “THIS IS PUBLIC HEALTH” CAMPAIGN

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What it Is – How it Works?

By Dr. David Edward Marcinko MBA

Dr. DEMMost people don’t understand what public health is or how it impacts their daily lives. So, with the Ebola crisis of a few years ago finally reduced, it may be just the right time to review this important specialty.

Referencing Ebola

According to Wikipedia, Ebola virus disease (EVD), Ebola hemorrhagic fever (EHF) or simply Ebola is a disease of humans and other mammals caused by ebolavirus. Signs and symptoms typically start between two days and three weeks after contracting the virus, with a fever, sore throat, muscle pain and headaches. Then, vomiting, diarrhea and rash usually follows, along with decreased function of the liver and kidneys. Around this time, infected people may begin to bleed both within the body and externally. Death, if it occurs, is typically six to sixteen days after symptoms appear and is often due to low blood pressure from fluid loss.

The virus is acquired by contact with blood or other body fluids of an infected human or other animal. This may also occur by direct contact with a recently contaminated item. Spread through the air has not been documented in the natural environment. Fruit bats are believed to be the normal carrier in nature, able to spread the virus without being affected. Humans become infected by contact with the bats or a living or dead animal that has been infected by bats. Once human infection occurs, the disease may spread between people as well. Male survivors may be able to transmit the disease via semen for nearly two months. To diagnose EVD, other diseases with similar symptoms such as malaria, cholera and other viral hemorrhagic fevers are first excluded. Blood samples are tested for viral antibodies, viral RNA, or the virus itself to confirm the diagnosis.

Outbreak control requires a coordinated series of medical services, along with a certain level of community engagement. The necessary medical services include rapid detection and contact tracing, quick access to appropriate laboratory services, proper management of those who are infected, and proper disposal of the dead through cremation or burial. Prevention includes decreasing the spread of disease from infected animals to humans. This may be done by only handling potentially infected bush meat while wearing proper protective clothing and by thoroughly cooking it before consumption. It also includes wearing proper protective clothing and washing hands when around a person with the disease. Samples of body fluids and tissues from people with the disease should be handled with special caution.

No specific treatment for the disease is yet available. Efforts to help those who are infected are supportive and include giving either oral rehydration therapy (slightly sweetened and salty water to drink) or intravenous fluids. This supportive care improves outcomes. The disease has a high risk of death, killing between 25% and 90% of those infected with the virus (average is 50%). EVD was first identified in an area of Sudan (now part of South Sudan), as well as in Zaire (now the Democratic Republic of the Congo). The disease typically occurs in outbreaks in tropical regions of sub-Saharan Africa. From 1976 (when it was first identified) through 2013, the World Health Organization reported a total of 1,716 cases. The largest outbreak to date is the ongoing 2014 West African Ebola outbreak, which is currently affecting Guinea, Sierra Leone, and Liberia.

As of 14th October 2014, 9,216 suspected cases resulting in the deaths of 4,555 have been reported. Efforts are under way to develop a vaccine; however, none yet exists.

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This Is Public Health

The “This Is Public Health” campaign was designed by ASPPH to let people know that public health affects them on a daily basis and that we are only as healthy as the world we live in. Over 750,000 stickers have been sent around the world to public health students and professionals eager to spread the word about the importance of public health.

Get Started

To start your own campaign,  follow the easy steps below.  Click for campaign ideas. Easy steps to join our campaign: https://thisispublichealth.org/

  1. Request “This Is Public Health” stickers. Please specify how many stickers and a mailing address. You will also be sent an invitation to join our Flickr group.
  2. Place these stickers in strategic locations that highlight examples of public health in action and snap a picture.
  3. Upload your pictures to our Flickr website and geomap them so that others can see where the pictures were taken. Click on the following links for information about the uploading process:

 

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Body-Home1

Assessment

That’s it! We encourage educational institutions and public health organizations to spread the message about this opportunity.

Conclusion

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“The Wall Street Casino”

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Am I Scolded?

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

Rick Kahler MS CFPJust recently I heard from an insurance salesman who scolded me for never giving any investment advice except to put all your money into “The Wall Street Casino.”

The impetus for this admonishment was the “up-down”, “buy-sell”, market craziness of this past week; no doubt.

My Story

Over the past 23 years, I’ve penned scores of columns about the benefits of a diversified portfolio of asset classes (Wall Street being just one of them). Still, I would far rather invest 100% of my retirement funds in a diversified portfolio of US stocks than speculate on a roulette wheel. There is a big difference between investing and speculating.

I learned that difference the hard way when I was in my early twenties. I had some money in savings and some mutual funds in an IRA, but they weren’t building wealth fast enough for me. Gold prices were up and going higher, so I took $1000 out of my savings and put it into gold futures. In just a few days, my $1000 had turned into $3000.

My broker suggested putting the $3000 into pork bellies. I didn’t really know what they were, but he seemed to know what he was talking about, so I bought pork bellies. For a few days, everything was fine. Then the price of pork bellies tanked. For five days straight, the price fell so dramatically that trading was stopped at the beginning of the day. I couldn’t even sell. There was nothing to do except watch the losses pile up.

By the time trading resumed, I had a margin call for $12,500 ($50,000 today, adjusted for inflation). To pay it, I had to wipe out my savings and cash in my IRA. At least I had savings, so I didn’t have to go borrow the money.

I had made a classic rookie mistake—speculating instead of investing.

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blackjack

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The Money Options Triad

There are three things you can do with money you wish to set aside: save, invest, or speculate.

  1. Saving is putting money away for future needs, often in a bank savings account or CDs. The primary purpose isn’t building wealth; it’s having money when you need it for emergencies or large purchases.
  2. Investing is diversifying money into stocks, bonds, real estate, commodities, and other asset classes. The purpose is to build wealth over the long term, so investing is boring. While you will see the value of your money decline as well as increase, it is unlikely that over a long period of time you will actually suffer a permanent loss of capital. Your returns over time will probably be more than you would earn from simple savings.
  3. Speculating is putting money into a high-risk investment in the hope of building wealth quickly. It’s exciting, dramatic, and risky. Examples of speculating include trying to time the markets through day trading, putting everything you have into one investment, and borrowing to buy stocks, real estate, or commodities. True, great fortunes have been made through speculating, but many more fortunes have been lost. Not only can you lose your initial investment, you can—as I did with my pork bellies—lose way more money than you had to begin with.

When novices skip from saving to speculating, chances are good that they’ll lose big. Unfortunately, too many of them learn the wrong lesson. They decide, “Investing is too risky,” never realizing they were speculating rather than investing.

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American Flag

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The Savings Trap

As a result, in the future they may limit themselves to saving. Their money stays safe, but over time they lose in a big way, especially through decreased purchasing power. Investing is not a “casino,” but a way to earn the long-term returns that are so important for building net worth and achieving financial security.

Assessment

So, have I been scolded; my bad?

Conclusion

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National Mammography Day

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Within National Breast Cancer Awareness Month

[By Staff Reporters]

Annually observed on the third Friday in October, as part of National Breast Cancer Awareness Month, October 17th 2014 is National Mammography Day. This day serves as a reminder to all women that the best defense is early detection.

What to Do

  • Perform regular monthly self-examinations.
  • Make sure you get your regular physician checkups.
  • Make your mammography appointment today!

History

President Bill Clinton proclaimed the first National Mammography Day in 1993.

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Don’t forget male breast cancer

Male breast neoplasm is a relatively rare cancer in men that originates from the breast. As it presents a similar pathology as female breast cancer, assessment and treatment relies on experiences and guidelines that have been developed in female patients. The optimal treatment is currently not known.

Incidence

According to Wikipedia, about one percent of breast cancer develops in males. It is estimated that about 2,140 new cases are diagnosed annually in the United States (US) and about 300 in the United Kingdom (UK). The number of annual deaths in the US is about 450. In a study from India, eight out of 1,200 (0.7%) male cancer diagnoses in a pathology review represented breast cancer. Incidences of male breast cancer have been increasing which raise the probability of other family members developing the disease. The relative risk of breast cancer for a female with an affected brother is approximately 30% higher than for a female with an affected sister. The tumor can occur over a wide age range, but typically appears in men in their sixties and seventies. Known risk factors include radiation exposure, exposure to female hormones (estrogen), and genetic factors.

High estrogen exposure may occur by medications, obesity, or liver disease, and genetic links include a high prevalence of female breast cancer in close relatives. Chronic alcoholism has been linked to male breast cancer. The highest risk for male breast cancer is carried by men with Klinefelter syndrome. Male BRCA mutation carriers are thought to be at higher risk for breast cancer as well, with roughly 10% of male breast cancer cases carrying BRCA2 mutations, and BRCA1 mutation being in the minority.

Conclusion

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Today is [Health] “Dictionary Day” 2014

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Promoting the … Health Dictionary Series™

By Dr. David Edward Marcinko FACFAS MBA CMP™

[Editor-in-Chief]

DEM blue

A day for lexicographers everywhere, Dictionary Day was founded to celebrate the achievements and contributions of Noah Webster – the father of the modern dictionary.

The objective of this day is to emphasize the importance of dictionary skills, and seeks to improve vocabulary.

History

Webster began to write his dictionary at the age of 43. It took him 27 years to finish it! In addition to traditional English vocabulary, it contained uniquely American words.

Our Health Dictionary Series™

The HDS Consists of three handbooks:

  1. Dictionary of Health Insurance and Managed Care
  2. Dictionary of Health Information Technology and Security
  3. Dictionary of Health Economics and Finance

Each has 10,000 terms, definitions and initialisms!

Dictionary Foreword Links:

Assessment

Why not take the opportunity to learn some new health administration terms, words and definitons? Designated as Doody’s Core Titles.

“Health care economist Dr. David Edward Marcinko, MBA, and his colleagues at the Institute of Medical Business Advisors, Inc., should be complimented for conceiving and completing this laudable project. The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion, therefore, is to “read it, refer to it, recommend it, and reap.”

-Dictionary of Health Insurance and Managed Care

Michael J. Stahl, PhD
[Director, Physician Executive MBA Program]
William B. Stokely Distinguished Professor of Business
College of Business Administration
The University of Tennessee

Conclusion

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Should Tom Frieden of the CDC Resign [VOTE]?

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A Voting and Opinion Poll

[By ME-P Staff Reporters]

Thomas R. Frieden MD is the Director of the U.S. Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR).

250px-Thomas_Frieden_official_CDC_portrait

He served as Commissioner of the New York City Department of Health and Mental Hygiene from 2002–2009.

Conclusion

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Career Advice for those Interested in Chiropracty

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What is a Chiropractor?

[By Cheryl S.]

A chiropractor is a doctor who specializes in treating the spine this includes the neck, back and lumbar region and the connecting muscles. The theory is that poorly aligned joints in the spine cause muscular-skeletal problems that can impact on other areas of health. Through regular manipulation a chiropractor can improve bone alignment and posture and this in turn improves health and wellbeing.

With stimulating, fulfilling work and high demand for their services, chiropractors are a well-regarded part of the care community. Many people consider the practice as being closer to a complementary healthcare service than conventional medicine, but it certainly does provide comfort and healing for many people. They do this by means of a practice called spinal adjustment.

The Bureau of Labor Statistics predicts that there will be a growth in demand for medical professionals across all medical fields over the next six years; this is certainly a good time for anybody who is considering studying in this sector.

Brief history

Daniel David Palmer developed Chiropracty in 1895. He believed that “95 percent of diseases are caused by displaced vertebrae; the remainder by luxations of other joints”. The first school of chiropracry was set up in the Palmer Infirmary in Davenport, Iowa. Today, the Palmer College of Chiropractic is one of the leading establishments in this field.

Chiropracty developed a bad reputation during the 1970s, mostly because of poor regulation; many people claimed to be able to cure many illnesses and diseases. However, these people have since been discredited. What remains is a professional industry that provides invaluable treatments to people suffering from chronic pain and discomfort.

Requirements to work as a Chiropractor

An individual must have completed at least four years of study to work as a chiropractor. The agency that regulates courses in chiropractic is The Council on Chiropractic Education; this agency has been certified by the Department of Education.

The Department of Education has approved 15 chiropractic programs at just 18 locations. Any chiropracty course that has not been officially approved will not provide a valid qualification so students must take care to ensure that they only enroll on approved courses.

Chiropracty has some special educational requirements. An individual must train for at least four years towards becoming a doctor before they can start treating patients. Chiropractic training is done in four parts.

Part 1 is the initial two years of basic sciences that all student doctors must complete. This covers all areas of medicine and healthcare and is really a foundation year before students start to specialize and focus on their chosen career subjects.

Part 2 covers clinical subjects such as general diagnosis, diagnostic imaging, and principles of chiropracty and chiropractic practice.

Part 3 includes case history, physical examination and diagnostics. It also starts to teach chiropractic techniques, supportive techniques and case management. This part is sometimes completed during a clinical internship; it is at this time that a chiropractry student can first start working with patients, although this should always be under supervision from an experienced doctor.

Part 4 covers more advanced diagnosis and techniques and is done during a clinical phase. It is during this phase of training that students receive most of their work experience before they eventually go on to become a chiropractic doctor.

No drugs

Many people are drawn to chiropracty because the treatment avoids the use of drugs; instead the emphasis is on repairing the body through external manipulation. It actually has some similarities with Eastern medicine in this respect. Also, the even increasing cost of drugs and medical diagnosis, especially for chronic pain and other incurable conditions, means that chiropracty is a very valid option for many people today.

Similar roles

There are several roles that are similar to chiropracty, one of which is physiotherapy. In fact, because of new research and understanding, chiropractic is being used more in sports therapy and replacing some physiotherapy procedures. Physiotherapy is mostly focused on manipulation of muscles to aid and speed healing following injuries and surgery. Chiropracty often goes direct to the source of the problem and manipulates the bones that in turn manipulate muscles and tendons.

Successful Chiropractors

Many people have managed to build successful chiropractic services after obtaining their qualifications. New centers, such as Detroit Chiropractic  are springing up all the time and these are bringing the latest new techniques and providing patients with an excellent service http://www.healthquest.us/ChiropracticCare.html

Chiropracty is developing into a well-respected profession and every year thousands of people benefit from the treatment. With an ever aging population that is often sedentary and overweight, spinal problems will only worsen and the role of the chiropractor becomes more important.

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Conclusion

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Saving Private Medical Practice?

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Can the EHR Save this Business Model?

[Dr. David Edward Marcinko MBA]

Dr David E Marcinko MBAHealthcare insurance reform from the Obama Administration – as incremental as it will be on both the Federal Medicare and State Medicaid levels from 2014 to 2018 – forces medical providers to look for more efficient ways to provide services, as well as additional sources of revenue in a margin-diminishing business model.

Total federal spending for both programs, under current Office of Management and Budget [OMB] assumptions, are growing. Skepticism is prevalent throughout the healthcare industry about the benefits and the role of market competition in the provision of healthcare services, despite pronouncements by the Federal Trade Commission (FTC) and Department of Justice (DOJ) that competition has positively affected healthcare quality and cost-effectiveness, and recommendations that many of the barriers to competition that prevent it from fully benefiting consumers be removed.

And so, according to Cimasi, Alexander and Zigrang of Health Capital Consultants LLC, and others; this growing economic tension has threatened the traditional private medical practice business model.

[Private communication: http://www.HealthCapital.com]

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EHR

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Link: http://www.medicalpracticeinsider.com/news/infographic-can-ehr-save-private-practice

Assessment

The “tipping point” has been reached, according to some experts, as the private practice model falls below 50/50.

Rhetorical Questions

  • What will save private medical practice as we know it.
  • Does it need to be saved, at all?
  • Will EHRs be the salvation?

Conclusion

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Drilling Down on Camouflaged Annuity Taxation

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A Fee by any other Name

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

Rick Kahler CFPWe South Dakotans can be smug about the economic advantages of residing in our income tax-free state. While those advantages are big, we do have a few lesser-known taxes.

These include a 6% franchise tax on banks and a 4.5% energy minerals severance tax on mining and oil companies. Like many other states, we also tax life insurance premiums; our rate is 2.5%.

The Hidden Annuity Premium Tax

I recently learned about another “hidden” tax, one on annuity premiums. A recent article in Investment News lists the eight states or territories that have such a tax: California, Florida, Maine, Nevada, Puerto Rico, South Dakota, West Virginia, and Wyoming. The tax ranges from 1% in Florida, West Virginia, and Wyoming to a whopping 3.5% in Nevada. South Dakota’s rate is 1.25%.

If you have purchased an annuity while living in one of these jurisdictions, you’ve paid this tax. You may have not been aware of it, as there are many hidden fees associated with purchasing annuities.

The Fee that is a Camouflaged Tax

I learned about the tax when our client service specialist questioned a 1.25% expense charged by the company on a new “no load” annuity. I thought the company had charged a commission of some type to the account, which was puzzling since we don’t accept any commissions. After sorting things out, we discovered the fee was actually the 1.25% premium tax that South Dakota charges on every contribution going into an annuity.

Impact

While states charge the tax just once on new money invested into the annuity, it still serves to decrease the total return of the annuity. If you held an annuity for a year, the premium tax would reduce your overall return by 1.25%. If you held the annuity for 10 years, the overall impact would be much less, reducing the return by 0.125% annually.

Specifics

The states leave the method of collecting the tax up to the annuity company. Most annuity companies that pay a salesperson a commission to sell the product build the fee into the overall costs. This is often easy, since the upfront commissions can range up to 10% and annual expenses up to 7% a year. I have seen more than one annuity where the fees and commissions eat up the majority of any potential return. Many no-load annuities, like Jefferson National, charge the tax to their customers.

The States

If you live in a state that taxes annuity premiums, you might have the idea of buying an annuity in a non-taxing state. This isn’t an option, as companies must levy the tax based on your state of residency.

On the surface, there appears to be some good news for residents of Maine, Nevada, South Dakota, and Wyoming. Residents who purchase an annuity in a qualified plan like an IRA or 401(k) don’t pay the tax. That benefit is somewhat moot, as owning an annuity in a qualified plan is rare. It generally makes little sense for a tax-deferred qualified plan to own a tax-deferred annuity, especially considering the annuity fees.

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Tax

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Rule-Outs?

If you live in a state that taxes annuity purchases, should you automatically rule out annuities? Not necessarily. Just be aware you will have to pay the piper. For residents of South Dakota, Florida, and Wyoming, lawmakers argue that maybe the tax isn’t such a heavy burden since these states don’t have an income tax.

Assessment

Still, no matter how you want to figure it, a tax is a tax. It’s one more factor to consider in deciding whether a given annuity product is right for you. Whatever amount you pay in state taxes is just that much less of your money that goes to work for you.

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.

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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Why You Should Schedule an Autumn Road Trip Tune-Up

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Getting Ready for Fall Leisure Travels

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Lexus – Roswell, GA]

DEM in his 1990 MiataMany doctor and other drivers believe that there is no need to send their car to a technician unless there is a noticeable problem. I used to be of this mind set. But, I soon learned this philosophy often ends up costing money and peace of mind in the long run.

So, as a surgeon with NO mechanical automobile aptitude, I believe in preparing a vehicle for the road ahead – so that you can concentrate on what’s really important – having a great autumn ride to see the mountains and leaves this season.

Why?

Here are the main reasons why you should schedule a tune-up prior to a summer road trip.

Sometimes, you have to spend money to save money–and while a tune-up isn’t free, it will diagnose minor problems before they become major problems. This could range from parts approaching the end of their expected life to car part damage. Regardless of the issue, if there is something wrong with your car, then it is going to need to be fixed in due course.

For instance, even if only one part is faulty, then it can eventually cause problems with other parts of your car if you do not resolve the issue immediately.

You cannot put a price on peace of mind, and if you are about to set out with your family on an exciting road trip, the last thing you want to do is worry about whether or not your car is going to endure the long distance. A tune-up, ahead of your getaway, will allow you to drive long distances, devoid of stress.

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Nikon D800, AF-S Nikkor 16-35mm F/4 VR

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Overall, the most important consideration in scheduling a road trip tune-up is your safety, the safety of your passengers and the safety of other drivers.

If you are driving for an extended period of time, it is important to ensure that your car is not only reliable, but that it is also safe to drive.

If you need to use your anti-lock braking system while on the road, for example, you need to be certain that it is working efficiently. Similarly, you want to be sure that your comfort features, such as air conditioning, are running properly as well.

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The Health Economics of Moderate Coffee Consumption

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Financial and Life Expectation Advantages?

By http://www.MCOL.com

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coffee

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Conclusion

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Today is World Mental Health Day 2014

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World Federation for Mental Health

[By Dr. David Edward Marcinko MBA CMP™]

dem2World Mental Health Day was established in 1992 by the World Federation for Mental Health.

In some countries around the world, it forms just one part of the larger Mental Illness Awareness Week.

A Range of Issues

Mental health problems, ranging from issues like depression and anxiety disorders to conditions like schizophrenia, affect millions of people around the world.

In fact, according to current statistics, 1 in 4 people will experience some kind of mental health problem during their lifetime and many more will see friends of family members affected.

The Cause

The purpose of World Mental Health Day is to raise awareness of mental health issues, increase education on the topic and attempt to eliminate the stigma attached. It is hoped that this, in turn, will encourage sufferers to seek help and support.

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world-mental-health-day

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Assessment

A number of fundraising events take place globally, so why not check if there is an event happening near you and show your support for this serious issue?

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Acknowledging Ada Lovelace Day [“Mother” of HIT?]

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Today is Ada Lovelace Day 2014

[By Dr. David Edward Marcinko MBA CMP™]

demAda Lovelace Day was created to celebrate one of the first female computer programmers. As the daughter of the poet Lord Byron, Augusta Ada Byron, was brought up by her mother, Annabella, after he passed.

Her mother feared that she would inherit her father’s poetic temperament, and gave Ada a strict upbringing of logic, science and mathematics. Ada became fascinated with mechanisms and designed steam flying machines, poring over the scientific magazines of the time and embracing the British Industrial revolution.

The Analytical Engine

In 1833, Ada Lovelace was introduced to Charles Babbage whom she helped to develop a device called The Analytical Engine; an early predecessor of the modern computer. Lovelace and Babbage worked together closely for many years in order to refine the Engine. Ada found relative fame in 1842 when she expanded on an article by an Italian mathematician, in which she elaborated on the use of machines through the manipulation of symbols. Although Babbage had sketched out programs before, Lovelace’s were the most elaborate and complete, and the first to be published; so she is often referred to as “the first computer programmer”.

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ADA LOVELACE

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Death

Ada Lovelace died of cancer at the age of 36 a few short years after the publication of “Sketch of the Analytical Engine, with Notes from the Translator”. The Analytical Engine remained a vision for many but until Ada’s notes inspired Alan Turing to work on the first modern computers in the 1940’s.

Assessment

Her passion and vision for technology have made her a powerful symbol for women in the modern world of technology. But, was she the “mother” of Health Information Technology? You decide.

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ME-P Publisher Marcinko Nominated for WEGO Health Awards – VOTE

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Helping Patients, Colleagues, Health Entities and all ME-P Readers and Subscribers

[By Ann Miller RN MHA]

About WEGO

The WEGO Health Community — is a network of over 100,000 of the most influential members of the online health community. They are composed of bloggers, tweeters, pinners, and leaders of Facebook pages; etc — all are empowered to drive the healthcare conversation online, across virtually every health topic and condition.

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Health Activists

Nominees for the fourth annual WEGO Health award are those exceptional health activists who make a difference in the lives of patients, medical providers and health caregivers.

They say it is an honor just to be nominated, but we think the honor is all in the nominating itself!

Endorse and Vote for David of the ME-P

If you believe in the servant-leadership of Dr. David Edward Marcinko, WEGO Health and the mission of this Medical Executive-Post, feel free to vote and endorse him here:

VOTE Link: https://awards.wegohealth.com/nominees/5721

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Is it Time to Reduce Your Bond Exposure?

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On Investment Portfolio Analysis

By Lon Jefferies MBA CFP®

Lon Jefferies

For the last half-decade, investors have been continually concerned about rising interest rates and the effect they may have on the bond portion of their investment portfolio.

The fear is that if interest rates rise, the bonds currently held by investors will be outdated and provide investment returns that are less than what new bonds issued at the higher yields would return.

Concerned?

There is validity to this concern – if an investor could buy a bond yielding 4% on the open market, why would anyone buy a bond that yields only 3%, unless they could do so at a significant discount? Given that today’s interest rates are considerably lower than historical averages and expected to rise in the future, would now be a good time to sell some of the bonds in your portfolio?

Consider the Timing

First, let’s consider one of the most basic principles of investing – that markets are unpredictable. Are we certain that interest rates will rise, and are we confident this rate increase will happen soon? I’d contend the answer to both questions is no.

Actually, the majority of investors have believed interest rates would rise since the first round of quantitative easing took place in 2009, and have suspected rates would rise in every calendar year since.  Quite simply, this has not happened. In fact, interest rates are currently lower than they were during the majority of 2009 despite five years of buzz about interest rate hikes.

During this five-year period, how have bonds performed? From 2009 through 2013, the Barclays Aggregate Bond Index (AGG) returned 5.93%, 6.54%, 7.84%, 4.22%, and -2.02%, respectively. Bonds only declined once during the five-year period, by a relatively nominal -2.02%, and still averaged a compound rate of return of 4.86%—not bad for the conservative portion of a portfolio.

Additionally, various bond categories have done even better than the Aggregate Bond Index, which consists of just U.S. government and corporate bond holdings. For instance, emerging market bonds (EMB) achieved a compounded return of 9.30%, while high yield bonds (HYG) returned 12.26% annually over the same five-year span. An investor whose bond portfolio was diversified among a range of asset categories has far from suffered since the expectation of a rate increases began.

Will You Miss the Stability of Bonds?

Let’s also consider the consistency of bonds. Since 1980, the Aggregate Bond Index has achieved a positive return an astonishing 31 out of 34 years (91% of the time!). Given this data, perhaps bonds aren’t as likely to decline in value as some investors think.

Equally amazing, although the bond index has achieved an annual return as high as 32.65% during this time period (in 1982), the largest loss it ever suffered in a calendar year over the same period was just -2.92% (in 1994). Over the entire 34-year period, the index obtained an average annual gain of 8.42%. Bottom line: Over the last 34 years, bonds have offered a lot of return for relatively little risk.

Diversification: the Most Important Factor

Not putting all your eggs in one basket is another basic principal of investing, and the primary motivation for having a significant portion of your portfolio allocated in bonds. It is important to remember that for an investor with a long-term perspective, equities will likely provide the majority of investment growth and return in a portfolio while bonds are needed to reduce volatility and risk.

For example, while a portfolio that was 100% stocks suffered a 38.6% loss in 2008, a portfolio that was 50% stocks and 50% bonds suffered a loss of only 14.5% the same year—still not pleasant, but much more manageable.

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healthcare costs

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Correlation

Bonds reduce risk in a portfolio because their return has a low correlation to the return of stocks. How low? Since 1928, both the S&P 500 and the 10-year treasury note have lost value during a calendar year only three times (in 1931, 1941 and 1969). That is less than 4% of all annual periods!

Further, since the Barclays Aggregate Bonds Index was created in 1973, the index has never decreased in value in the same year as the S&P 500. Amazing, but true! Clearly, bonds are fulfilling their role as a diversifier and reducing the volatility in your portfolio.

There is Always a Role for Bonds

Despite the continuous threat of rising interest rates, bonds have continued to perform. More importantly, history illustrates that mixing bonds with stocks smoothes out the investment results of your portfolio.

Assessment

Don’t get sucked in by the media buzz. Bonds are too valuable an asset to disregard.

The Author:

Lon Jefferies is a Certified Financial Planner with a fee-only approach to ensure the client’s best interest is the top priority. He isn’t paid commission and gains nothing through recommendations but his client’s satisfaction. He has contributed to national publications like The Wall Street Journal, The New York Times, USA Today, Morningstar.com and Investment News.   

Conclusion

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Today is “Physician Assistant” Day 2014

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Celebrating PA Day

[By Dr. David Edward Marcinko MBA CMP]

Dr. DEMPhysician Assistant Day, or PA Day, is a celebration of those who assist doctors in their work.

This important event, begun by the American Academy of Physicians’ Assistants, aims to raise awareness of the PA profession, and inform people about healthy living.

A Work Horse – Not a Show Horse

Physician assistants are less high-profile and glamorous than doctors themselves, but the work that they do is essential for the smooth running of hospitals and performing of healthcare.

Many medical establishments are in need of more people to enter the profession, and one of the main aims of PA Day is to get this message across, encouraging people to consider assistance as a career.

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Assessment

The main celebration takes place on Rockefeller Plaza in New York. You can join in by being there on the day, arranging an event to raise awareness at your local hospital or social hub.

Link: http://www.cute-calendar.com/event/physician-assistant-day/16354.html

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EHRs – AMA versus ADA

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Will Electronic Health Records Ever Be Usable?

[By Darrell K. Pruitt DDS]

1-darrellpruittThe American Medical Association

The AMA attempts to address the frustration EHRs create, especially for doctors and other healthcare workers. ‘It’s easy to use, once you know where everything is,’ the instructor said during an EHR training session I recently attended.

Most EHR companies seem to believe this is an acceptable way to design software. EHR usability has been greatly ignored by vendors, and last week the American Medical Association issued eight usability priorities in an attempt to address the issue.

This directive comes as a result of a joint study by the RAND Corporation and the AMA highlighting EHRs as a significant detractor from physicians’ professional satisfaction.” Commentary by Stephanie Kreml for InformationWeek, September 26, 2014.

http://www.informationweek.com/healthcare/electronic-health-records/will-electronic-health-records-ever-be-usable/a/d-id/1316071

The American Dental Association

On the other hand, “EHRs provide long-term savings and convenience,” no byline, ADA News, December 6, 2013.

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

boxing-gloves-1053702

[POW – SPLAT – BIFF – UGH]

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs
  5. Borges versus Kvedar Video eHR Debate

EHRs versus the Federal Government

Government mandated EHRs – what a waste!

“Doctors, Hospitals Went Digital, But Still Can’t Share Records – After spending billions to switch from paper to digital records — much of it taxpayer subsidized through the economic stimulus package — providers say the systems often do not share information with competitors.”

[Kaiser Health News, October 1, 2014]

http://www.kaiserhealthnews.org/Daily-Reports/2014/October/01/marketplace.aspx

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October is “Cut Out Dissection” Month

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Appreciating the Pros and Cons of Animal Dissection

[Brought to you by PETA]

Every year, millions of frogs, rats, cats, mice, and other animals suffer and are killed for dissection. Luckily, there are far better ways to learn biology than by torturing animals, damaging the environment, and teaching insensitivity. With more and more states enacting dissection-choice policies, it’s never been easier to avoid dissection.

And so, October is “Cut Out Dissection Month” and PETA wanted to arm you with the “facts” on animal dissection in the easiest, most eyeball-friendly, sharable way—with our handy-dandy infographic!

Assessment by Dr. David Edward Marcinko MBA

As a Board-Certified surgeon, and Fellow of the American College, I disagree with this sentiment. Of course, I am not in favor of the wanton torture or harm of any animal. But, I still remember the first time I operated on a living, but anesthetized, German Shepard at Temple University in Philadelphia, almost 40 years ago. And, I still can feel the animal’s heart beating in my hands – powerful!

Of course, the anti-vivisectionist crowd scrawled graffiti on the anatomy building walls – the entire semester – to no avail. I also dissected frogs, fetal pigs, sharks, rabbits and several cats before reaching medical school.  

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Finding a Fiduciary Financial Advisor

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A Critical Life Skill? 

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

Rick Kahler CFPIn today’s complex world of technology, regulations, and finance, a critical life skill is finding advisors and service providers we can trust.

Few of us know how to repair a laptop, grasp the details of income tax regulations, or understand the nuances of selecting the best mutual fund.

We must rely on others to help us out.

Trust Owed

In the legal sense, there are very few people who “owe” us their trust. Certainly, those selling us goods owe us accuracy and honesty. When I buy a 48-ounce bottle of 100% pomegranate juice from Safeway, I expect it to contain exactly 48 ounces and be 100% pomegranate juice, not a blend of pomegranate, grape, and apple. However, I cannot trust Safeway to know whether the health claims behind pomegranate juice are accurate or whether I can find it cheaper elsewhere.

Sales People

In a similar fashion, salespeople for appliances, cars, or cable service have one basic goal, to sell products to their customers. They owe us honesty about the costs, features, and condition of their wares. But it is up to us to research products and decide whether they are good values for us.

Professionals

Professionals in some fields give unbiased advice about certain products or services as they relate specifically to you. In a legal sense, such professionals do owe you trust. They have a “fiduciary” duty to be your advocate. The law requires a professional held to a fiduciary duty to work solely in the consumer’s interest. Examples of such professionals are physicians, attorneys, accountants, trustees, trust officers, and most real estate consultants.

When a professional has a fiduciary duty to you, you are called a client. When a professional is selling you a product or service, you are a customer.

Conflicts of Interest

One of the primary issues affecting how easily fiduciaries can advocate for you is their level of freedom from a conflict of interest. At times a potential conflict of interest can be so significant that a fiduciary will decline the engagement. Attorneys, for example, will turn you down if you want to sue someone they have represented in the past. The past association may cloud their ability to effectively advocate for you.

Compensation

One of the greatest potential conflicts of interest is how you compensate the fiduciary. Typically, paying a flat or hourly fee is the easiest way to insure there is no compensational conflict. Compensating a fiduciary with commissions almost always carries some type of potential conflict. The greater the compensation from a commission, the greater the potential conflict.

pennies

Example:

For example, Real Estate Agent A acts as a buyer’s broker with a fiduciary duty to a buyer, who pays her an hourly fee plus 1% of any amount that the final purchase price is reduced from the list price. Agent B, also a fiduciary buyer’s broker, is only compensated by a commission if there is a sale. Which agent has the larger potential conflict of interest? Without a question, Agent B. He may face a situation where his client’s interest would be best served by a sale with a lower commission or even no sale at all. Advocating for his client would mean a direct financial loss for Agent B.

To minimize such potential conflicts, in most states real estate agents are required to clearly disclose fees and get clients’ written acknowledgement. Unfortunately, the total fees charged by investment advisors, and whether you are their customer or a client, is seldom clear, often even when the advisor assures you that you will be a client. Many advisors don’t know the difference.

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Assessment

What can you do to protect yourself? Next time I will give you a five-minute solution.

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Today is “Name Your Car” Day

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Anthropomorphizing Your Vehicle?

[By Dr. David Edward Marcinko MBA CMP™]

DEM blue tieUnfortunately, many people do not think about naming their cars. Name Your Car Day has been set aside especially for those of you who may have forgotten this little ritual.

It’s very common for people to name their boats so why is it that some people forget to name their car?

Let’s face it, our cars do a lot for us and many of us would be lost without them so why not take the time to think of a good name for your daily companion. If it weren’t for him/her how would you get to work? How would you go shopping? How would you take the kids to soccer practice? How would you get to the office, clinic or hospital?

Back in the Day

When I was a kid, we were poor and had seven vehicles, or “beaters”, parked on the public inner-city side streets.  Our hope was that on any given day – two would start-up and be drivable.  There were six of us in the family, although only two had valid driver licenses for our little car pool

Obviously, we never named any of em’.

Today, my wife, daughter and I have four very serviceable cars; three are daily drivers, and one, our Jaguar 2000  sedan [XJ-V8-L], is special – used occasionally or only on the weekends. All have names; a tradition started by my daughter when she was a kid. There is Snow Rachel,  Mr. Ed, Blackie and Ellie [short for elegant]

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Waxed Jaguar

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Ellie

[My “ELLIE” –  Just waxed for NYCD]

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At the Ready

Yes, we are blessed today. All four automobiles are always there for us whenever we need them; unlike when I was a kid. Who could ask for more dependability than that?

So, on “Name Your Car Day”, take the time to choose a name that your car, and you, will be proud to call your own.

Link: http://www.holidayinsights.com/moreholidays/October/nameyourcarday.htm

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Problems with Health Plan Member Data Accuracy

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On Health Insurance

By http://www.MCIOL.com

data

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