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12 Email Marketing Tips for MDs and FAs

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To Ensure Your Campaign Isn’t a Waste of Time and Money

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The success of your email marketing campaign will depend on a number of things, from how you grow your list, the times and days you send them, to the type of content you send.

To ensure your email marketing campaigns aren’t a waste of time and money make sure you read the tips in this infographic from Vertical Response.

***

eMail tips

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2015 Health Plan Premium Increases

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The Impact of Gratitude on Financial Behavior

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Overspending? Try a Little Gratitude 

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

Rick Kahler MS CFPDo you want to more easily change your over-spending behavior? According to some new research, maybe all you need is a bit of gratitude.

Gratitude

Before you brush this idea aside as just another “feel good” theory, you may want to consider a 2013 study that suggests practicing gratitude is a powerful way to increase your happiness and decrease temptations. Northeastern University’s David DeSteno led the research project, which was published in June 2014 in the journal Psychological Science.

Logic versus Emotions

Many of us believe we ought to make decisions, especially financial ones, logically rather than emotionally. We assume emotions get in the way of decision-making, so we try to set them aside. We may think the best way to resist temptation, such as wanting to buy something we can’t afford, is to use self-control to clamp down our emotions.

The Research?

Yet research has shown that emotions play a significant role in all our decision-making. Some of that research is discussed in an article by Ray Williams published September 25, 2011, in Psychology Today.

Trying to ignore our emotions and make cold and calculating decisions is fear-based behavior. The gratitude research, however, suggests that emotions can be used instead to help us resist temptation. Perhaps being less fearful and more grateful can actually produce better decisions.

The Study

DeSteno’s study gave 75 participants a classic test of their financial self-control. They were told they could have either $54 right now or $80 in 30 days. Before they made their decision, the researchers put the participants into one of three emotional states: grateful, happy, or neutral.

The Results

Those who were either happy or neutral showed a strong preference for taking the $54 now. The fact that by waiting 30 days and getting $80 they would receive a one-month return of 48%, which is equal to an annualized return of 576%, wasn’t even a consideration. Behavioral economists tell us this is normal. Our brains are generally wired to “kill and eat.” Having something now, even though it’s less, is better than having more later, even if it will be much more. That is some strong wiring!

***

mind-investing-behavioral-finance

***

The Surprise

However, the surprise was that the people in the state of gratitude were much more likely to wait 30 days to receive the $80. Results also showed that the more gratitude the participants reported feeling, the more willing they were to wait for the larger gain.

The Grateful Difference

One conclusion of the study is that just cultivating the emotion of happiness isn’t enough to make wise financial decisions. It is specifically the emotion of gratefulness that makes a difference. According to one of the study’s authors, Professor Ye Li, this research “. . . opens up tremendous possibilities for reducing a wide range of societal ills from impulse buying and insufficient saving to obesity and smoking.”

We don’t know why gratitude has this effect. Psychologist Dr. Jeremy Dean, in a June 18 post at PsyBlog about the research, says, “. . . it may be because it makes us feel more social, co-operative and altruistic. In other words: gratitude may make us feel less selfish, which gives us more patience.”

Personally, I wonder whether another possibility may be that feeling gratitude reminds us of how much we already have, which tends to reduce our desire to get something more.

Assessment

If you’d like to do some experimenting of your own, consider practicing some gratitude exercises. Dr. Dean describes some at PsyBlog. These may be as simple as making daily lists of things you have to be grateful for. It’s possible that fostering gratitude could do more than just promote happiness. It might even change the way you spend and invest.

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Employee Health Benefits for Same Sex Domestic Partners

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Why Your Medical Internet Marketing Campaign Isn’t as Effective as It Used to Be

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On the Crucial Online Presence

[By John Deutsch]

John DeutschA strong online presence is crucial to running a successful business, and healthcare is no exception.

However with constant change, especially in the past two years, many businesses are experiencing underperforming campaigns and struggling to figure out where to spend their marketing dollars. Should you invest heavily in pay-per-click (PPC) advertising, focus your efforts on search engine optimization (SEO) or hit the ground running with social media?

The answer is that you should never focus solely on one marketing channel, as it could take months or even years to recover when changes in the marketing industry occur – and they inevitably will occur. Another reason to diversify your efforts is that the success of some channels depends on the success of others – for example, social media influences your search rankings and display advertising heavily influences your brand recognition.

As a healthcare marketing company with over ten years of experience in internet marketing, we have seen the industry get flipped upside down more than once and have seen it affect organizations that have weak marketing campaigns with little to no diversification. A good mix of tactics is the best way to reach your target audience while allowing you to adapt quickly in the face of changes.

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Three Elements Crucial to Any Marketing Campaign

Search marketing, direct marketing and social media are three components that healthcare organizations should incorporate for a healthy marketing campaign. Here’s what you need to know about these marketing elements, including the changes each channel has gone through in the last few years and what we could expect to see in the future.

  1. Search Marketing

Search marketing typically refers to PPC and SEO, the paid and unpaid efforts used to increase online visibility in search engine results. Early marketers were able to easily leverage SEO to gain top search engine rankings and also invest minimally in PPC for quick leads, but the search marketing landscape has changed significantly in the last three to four years, altering the online marketing game.

We might say it all started when Google modified its PageRank algorithm in 2011 and then again in 2012 (the update often referred to as “the death of SEO”), causing many organizations’ rankings to plummet. Marketers were forced to rethink their organic SEO efforts to stay in Google’s good graces. Instead of relying heavily on getting backlinks (even from low-quality websites) and stuffing content with keywords, the focus switched to creating quality content in order to get real clicks and page views.

Meanwhile, companies like Google started trying harder than ever to monetize their services. The highly saturated market contributed to driving advertising costs up – and beyond that, the actual efficacy of online ads went down. In some of our own campaigns, we have seen over 30% inflation in ad prices per year and a loss of efficacy (decreased traffic and leads) despite increasing ad spend to match inflation – and this isn’t just a result of market saturation. It also has to do with the fact that consumers are less and less receptive to online advertising due to the over publicizing of ads.

As a result of this, organizations have to constantly innovate so that their ads are seen among all the online advertising noise. This, in addition to rising ad prices means that a return on investment can be difficult to realize. Working with a true PPC expert who knows your industry well is the only way to make your budget go a long way.

The bottom line: SEO and PPC are still the number one ways to draw leads online, but they have both seen significant change in the past years and are likely to keep changing, so your marketing strategy should not depend on either channel alone.

  1. Direct Marketing

With SEO having lost some importance and PPC advertising requiring a skill set that many health organizations lack, we are seeing trends shifting towards a more direct form of marketing. This is evident by the number of lead generation companies that have cropped up in the last few years, such as Healthgrades and Vitals, which allow providers to attract more patients and referrals, often for a nominal fee. Similarly, in the medical software industry, SoftwareAdvice dominates the SEO/PPC channels.

Organizations are also increasingly employing alternative marketing channels like email newsletters and direct email marketing to reach out to clients and potential opportunities. This starts with a simply crafted email addressing a very specific issue to a specific audience. It is an extremely effective and budget-friendly tactic to diversify a marketing strategy.

  1. Social Media

Just like other marketing channels, social media is constantly evolving and also increasing in price. This is due, in large part, to major social media companies becoming publicly traded companies in recent years (i.e. Facebook in 2012 and Twitter in 2013), but also to market saturation.

According to a LinkedIn study, 81 percent of small- and medium-sized businesses are using social media and, of those, 94 percent do so for marketing purposes. While networks like Facebook and Twitter remain free to use, they have started trying to capitalize on their popularity by pushing paid advertisement, often to the point of risking the integrity of their sites.

Whereas prior to companies like Facebook and Twitter having gone public, a well-crafted social media post (text, video or image) could go “viral” naturally, we are now seeing this happen less and less, often requiring an initial advertising spend to get the ball rolling. Facebook is a good example of this. In December 2013, Facebook changed the algorithm that determines what stories and updates users see in their News Feeds. This resulted in business pages losing viewership of their posts, as Facebook decided that brands would have to “pay to play.”

Stethoscope on a laptop keyboard

Assessment

While we don’t recommend social media being the focal point of any healthcare organization’s marketing campaign, much less the only element, it is an integral component – and definitely one you should stay on top of if you want to remain competitive. Social media is also a major factor in Google’s algorithm for organic search engine rankings, so there is some added value to having a strong social media presence.

More:

About the Author

John is the President and CEO of Medical Web Experts, developer of Bridge Patient Portal, the leading 2014 ONC certified solution for patient engagement and improved practice profitability. A vital component in the exponential growth of numerous healthcare IT and Internet companies over the last ten years, John has benefited immensely from a unique mix of professional experiences, boasting a strong background in both marketing and technology.

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Conclusion

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Video on Doctors, Money and Conflicts of Interest

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Medical Ethics – Ever on Guard
By Aaron Carroll MD, MS
 ***
I’m a doctor. My father is a doctor. My colleagues are doctors, the people I train are doctors, lots and lots of my friends are doctors.
 ***
But, that doesn’t meant that doctors sometimes aren’t blind to certain issues like their own financial conflicts of interest. Sometimes we have to poke doctors with a stick. That’s how we show our love.
 ***
Conflicts of interest are the topic of this Healthcare Triage video.

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ECON

Assessment

This video episode is adapted from Aaron’s NYT piece on the topic. References can be found in the links there: http://www.nytimes.com/2014/09/09/ups…

John Green — Executive Producer
Stan Muller — Director, Producer
Aaron Carroll — Writer
Mark Olsen — Graphics

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About the Author

Dr. Carroll has published some of the seminal work on various types of health care reform, and continues to be a sought after speaker on cost, quality and access-and the Affordable Care Act and its implications for our future. Considered one of the leading pediatric informaticists in the U.S. he has received millions of dollars in grants to explore the use of information technology in health care. Dr. Carroll was the Primary Investigator on a grant from the Agency for Healthcare Research and Quality to study the true impact of malpractice claims on the practice of medicine.

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Medical Claims Payment Data Differences

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How Financial Advisors Build Trust with Physician Prospects and Clients

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Niche Career Development for Financial Advisors

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[By Vicki Rackner MD]

Attention Physician Focused Financial Advisors

If you are a financial advisor who would like to acquire more physician clients, consider these facts:

  • Fact: Half of physicians are behind where they would like to be in retirement planning.
  • Fact: About half of physicians work with professional financial advisors.
  • Fact: Physicians who work with financial advisors are better prepared for retirement.

The Survey

How can YOU build trust and be found by more physician prospects? Here are some steps. Trust is an abstract concept. It begs the question: Trust to do what? I asked my physician colleagues and friends, “When you say you trust your financial advisor, what do you mean?”

Here are some of the answers:

  • You may trust your hairdresser to give you a great look, but you would not trust her to take out your gallbladder.
  • Ask, “Trust to do what?”
  • A recent survey offers insights. Almost half of physicians said that they do not work with advisors because they cannot find someone they trust.
  • This leads to an obvious question: Why would physicians–smart professionals who spend their days identifying problems and fixing them–fail to take action and get on track for retirement?
  1. I trust that she cares about me.
  2. I trust he puts my best interests before his own.
  3. I trust he knows what he’s doing.
  4. I trust he understands the challenges I face.
  5. I trust that she’s honest and direct. A person of integrity.
  6. I trust that he’ll challenge me if I’m about to make a dumb financial move.
  7. I trust the person who gave me his name.
  8. I trust that I’ll keep more money than I spend in fees.

***

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***

Take steps to build rapport and trust – Be authentic

Tell the story of how and why you came to offer financial advice to physicians.

Here are a few examples from my own clients:

  • Show you care. A famous quote among physicians is, “For the secret in the care of the patient is caring for the patient.” Your first step in building trust with physician prospects and clients is demonstrating you care about them.
  • You can survey your clients and Identify how they how they see your trust-building strengths.
  • An advisor tells the story of his surgeon father who outlived his money. That inspired him to help other surgeons enjoy true financial security.
  • A cancer survivor tells physicians he’s giving back to the doctors who helped his kids grow up with a father.
  • An advisor tells the story of always wanting to be a cardiologist. Now he’s using his real gift–making money grow–to help cardiologists build wealth.

More Tips:

Keep your promises

As my grandmother said, “Keep every promise you make, and only make promises you can keep.”

Conduct yourself like a physician

What does your personal physician do to win your trust? Do the same!

Be consistent

Conservative physicians may need to be exposed to you and your message six to ten times before they take action. Do you have lists of prospects and clients? Have you built an automated way of delivering something of value to them on a regular basis?

Quote other physicians

The most influential person in a physician’s life is another physician. If a physician offers a great idea or a best practice, ask permission to share this pearl of wisdom with other physicians. You want to be known as the financial advisor who rubs shoulders with physician leaders.

Regularly ask

Ask MD prospects and clients, “How can I do better?”

Take steps to be found

Physicians find financial advisors in much the same way you find a personal physician. You begin with someone you trust. Like me, most physicians turn to their own colleagues for names of financial advisors.

Address painful problems that need to be fixed TODAY

Busy people tend to put off problems that are asymptomatic today, even when they know the neglected problems will lead to pain in the future. Retirement is years away for most physicians. However, they seek relief from the acute financial pain of ObamaCare today.

Partner with experts and offer solutions to the problems of falling reimbursements, rising practice costs and heavier tax burdens. When physicians have more money to invest, they build wealth more quickly.

Interview key physician opinion leaders

Ask top physicians how ObamaCare impacts their day-to-day practice and their plans for the future. Uncover specific active problems. These are all opportunities for you. A key physician could introduce you to many physicians.

Listen to physicians

Active listening builds trust. Further, when you express true curiosity in others, they will want to learn about you.

Go to places physicians gather

Offer to speak at medical meetings about topics that the key physician opinion leaders identify. Submit articles for association publications. Join conversations on social media if that’s where your physician prospects gather.

What this means for you

Here’s why you may want to build trust and be found among physicians: you can mine the treasures in the medical market.

  • Fact: Doctors make up 9 of the top 10 earners in the US.
  • Fact: 500,000 US practicing physicians and dentists are financial do-it-yourself’ers.
  • Fact: 40% of practicing physicians are age 55 or older.Physicians’ acute financial pain is your business opportunity. Someone will offer financial leadership to physicians. Why not you?
  • Assessment
  • Every physician is actively developing a personal ObamaCare plan; this is complex personal financial plan for which physicians solicit expert opinions.

Assessment

Enter the Certified Medical Planners

About the Author

Vicki Rackner MD, author, speaker and President of Targeting Doctors, helps financial advisors accelerate their practice growth by acquiring more physician clients. She calls on her experience as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and nationally-noted expert in physician engagement to offer a bridge between the world of medicine and the world of business.

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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Understanding the “Least” Important Issues for Physician-Investors

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A Dimensional Fund Advisors Survey

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

Rick Kahler MS CFPIn this ME-P, I will focus on the three least important things investors want to know. The rankings came from a survey of investors, funded by Dimensional Fund Advisors, conducted in March 2014 by Advisor Impact.

All three deserved to be much higher on the list. In my experience, they are what most physicians and all investors really need to know.

The factors

These three factors are:

  • What are the chances the investment will lose money? Only 10% of investors thought it was important to ask about factors that contributed to historic performance. Just one-third thought it important to even ask about historical performance in general.
  • What type of volatility can they expect? Only 17% of investors considered this important.
  • How and why did the advisor select the investment for their portfolio? Only 21% of survey respondents thought this was important, and just 8% asked about the investment managers chosen.

Drilling Down and Going Granular

Some of these factors may seem difficult to understand, but they do matter. Give your financial advisor a chance to explain them; it can help you become a more informed investor.

ME-P Physicians

  1. Chances of losing money

This factor could be better addressed by asking about the specific factors that influenced historic performance of the security over various long-term economic climates. True, looking at the past performance of an investment is never a guarantee of future performance.

Yet, if the historical periods evaluated contain a variety of economic conditions (high inflation, various economic cycles, various political influences, etc.) and long-term holding periods (at least 10 years or more), looking backward may give you a reasonable idea of what future performance might look like.

  1. Volatility

Most investors will cognitively agree they fully understand that most investments that carry any chance of real (after inflation) significant long-term return will fluctuate. I say “cognitively” because, once that fluctuation happens on the downside, all cognitive understanding sometimes goes out the window and the emotional brain takes control.

One way of internalizing the potential fluctuation of an investment is to ask about its volatility. Specifically, it’s standard deviation. This measure of the amount of variation from the average is something an advisor can easily find out for almost every bond, stock, and mutual fund. Take the standard deviation times three, then subtract that number from the average return. This is the amount of value over one year your investment could drop (or rise) in 99% of all years. Stated conversely, there is only a 1% chance your investment would drop further in any one year.

  1. Portfolio Fit

I recently sent back a shirt that hung on me like a tent. While it would have been perfect for a larger guy, it was not a fit for me. Investments are similar. While some are perfect matches for one portfolio, they can be lethal in another. An over-allocation to emerging market stocks may make perfect sense for a newborn, but it could be a retirement disaster for a 90-year-old.

Pensive Financial Advisor for Physicians

Assessment

It’s important to ask why an investment belongs in your portfolio. You want investments (asset classes) that complement one another by tending to fluctuate independently of each other.

In an ideal balance of investments, when some decrease in value the other half increase an equal or greater amount, and all of them earn a real return over time.

Conclusion

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A Brief History of Managed Care

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By National Council on Disability

The origins of managed care can be traced back to at least 1929, when Michael Shadid, a physician in Elk City, Oklahoma, established a health cooperative for farmers in a small community without medical specialists or a nearby general hospital. He sold shares to raise money to establish a local hospital and created an annual fee schedule to cover the costs of providing care. By 1934, 600 family memberships were supporting a staff that included Dr. Shadid, four newly recruited specialists, and a dentist. That same year, two Los Angeles physicians, Donald Ross and Clifford Loos, entered into a prepaid contract to provide comprehensive health services to 2,000 employees of a local water company.endnote[i]

Development of Prepaid Health Plans

Other major prepaid group practice plans were initiated between 1930 and 1960, including the Group Health Association in Washington, DC, in 1937, the Kaiser-Permanente Medical Program in 1942, the Health Cooperative of Puget Sound in Seattle in 1947, the Health Insurance Plan of Greater New York in New York City in 1947, and the Group Health Plan of Minneapolis in 1957. These plans encountered strong opposition from the medical establishment, but they also attracted a large number of enrollees.

Today, such prepaid health plans are commonly referred to as health maintenance organizations (HMOs). The term “health maintenance organization,” however, was not coined until 1970, with the aim of highlighting the importance that prepaid health plans assign to health promotion and prevention of illness. HMOs are what most Americans think of when the term “managed care” is used, even though other managed care models have emerged over the past 40 years.

Public Managed Care Plans

The enactment of the Health Maintenance Organization Act of 1973 (P. L. 93-222) provided a major impetus to the expansion of managed health care. The legislation was proposed by the Nixon Administration in an attempt to restrain the growth of health care costs and also to preempt efforts by congressional Democrats to enact a universal health care plan. P. L. 93-222 authorized $375 million to assist in establishing and expanding HMOs, overrode state laws restricting the establishment of prepaid health plans, and required employers with 25 or more employees to offer an HMO option if they furnished health insurance coverage to their workers. The purpose of the legislation was to stimulate greater competition within health care markets by developing outpatient alternatives to expensive hospital-based treatment. Passage of this legislation also marked an important turning point in the U.S. health care industry because it introduced the concept of for-profit health care corporations to an industry long dominated by a not-for-profit business model.endnote[ii]

In the decade following the passage of P. L. 93-222, enrollment in HMOs grew slowly. Stiff opposition from the medical profession led to the imposition of regulatory restrictions on HMO operations. But the continued, rapid growth in health care outlays forced government officials to look for new solutions. National health expenditures grew as a proportion of the overall gross national product (GNP) from 5.3 percent in 1960 to 9.5 percent in 1980.endnote[iii] In response, Congress in 1972 authorized Medicare payments to free-standing ambulatory care clinics providing kidney dialysis to beneficiaries with end-stage renal disease. Over the following decade, the Federal Government authorized payments for more than 2,400 Medicare procedures performed on an outpatient basis.endnote[iv]

Responding to the relaxed regulatory environment, physicians began to form group practices and open outpatient centers specializing in diagnostic imaging, wellness and fitness, rehabilitation, surgery, birthing, and other services previously provided exclusively in hospital settings. As a result, the number of outpatient clinics skyrocketed from 200 in 1983 to more than 1,500 in 1991,endnote[v] and the percentage of surgeries performed in hospitals was halved between 1980 (83.7%) and 1992 (46.1%).endnote[vi]

mind-investing-behavioral-finance

The Influence of Medicare Prospective Payments

Health care costs, however, continued to spiral upward, consuming 10.8 percent of GNP by 1983. In an attempt to slow the growth rate, Congress in 1982 capped hospital reimbursement rates under the Medicare program and directed the secretary of HHS to develop a case mix methodology for reimbursing hospitals based on diagnosis-related groups (DRGs). As an incentive to the hospital industry, the legislation (the Tax Equity and Fiscal Responsibility Act (P. L. 97-248)) included a provision allowing hospitals to avoid a Medicare spending cap by reaching an agreement with HHS on implementing a prospective payment system (PPS) to replace the existing FFS system. Following months of intense negotiations involving federal officials and representatives of the hospital industry, the Reagan Administration unveiled a Medicare PPS. Under the new system, health conditions were divided into 468 DRGs, with a fixed hospital payment rate assigned to each group.

Once the DRG system was fully phased in, Medicare payments to hospitals stabilized.endnote[vii] However, since DRGs applied to inpatient hospital services only, many hospitals, like many group medical practices, began to expand their outpatient services in order to offset revenues lost as a result of shorter hospital stays. Between 1983 and 1991, the percentage of hospitals with outpatient care departments grew from 50 percent to 87 percent. Hospital revenues derived from outpatient services doubled over the period, reaching 25 percent of all revenues by 1992.endnote[viii]

Since DRGs were applied exclusively to Medicare payments, hospitals began to shift unreimbursed costs to private health insurance plans. As a result, average per employee health plan premiums doubled between 1984 and 1991, rising from $1,645 to $3,605.endnote[ix] With health insurance costs eroding profits, many employers took aggressive steps to control health care expenditures. Plan benefits were reduced. Employees were required to pay a larger share of health insurance premiums. More and more employers—especially large corporations—decided to pay employee health costs directly rather than purchase health insurance. And a steadily increasing number of large and small businesses turned to managed health care plans in an attempt to rein in spiraling health care outlays.

Managed Long-Term Services and Supports

Arizona became the first state to apply managed care principles to the delivery and financing of Medicaid-funded LTSS in 1987, when the federal Health Care Financing Administration (later renamed the Centers for Medicare and Medicaid Services) approved the state’s request to expand its existing Medicaid managed care program. Medicaid recipients with physical and developmental disabilities became eligible to participate in the Arizona Long-Term Care System as a result of this program expansion. Over the following two decades, a number of other states joined Arizona in providing managed LTSS, and by the summer of 2012, 16 states were operating Medicaid managed LTSS programs.endnote[x]

Scientists at work

Growth of Commercial Managed Care Plans

During the late 1980s and early 1990s, managed care plans were credited with curtailing the runaway growth in health care costs. They achieved these efficiencies mainly by eliminating unnecessary hospitalizations and forcing participating physicians and other health care providers to offer their services at discounted rates. By 1993, a majority (51%) of Americans receiving health insurance through their employers were enrolled in managed health care plans.endnote[xi] Eventually, however, benefit denials and disallowances of medically necessary services led to a public outcry and the enactment of laws in many states imposing managed care standards. According to one analysis, nearly 900 state laws governing managed health practices were enacted during the 1990s.endnote[xii] Among the measures approved were laws permitting women to visit gynecologists and obstetricians without obtaining permission from their primary care physician, establishing the right of patients to receive emergency care, and establishing the right of patients to appeal decisions made by managed care firms. Congress even got into the act in 1997 when it passed the Newborns’ Mother Health Protection Act, prohibiting so-called “drive-through deliveries” (overly restrictive limits on hospital stays following the birth of a child).endnote[xiii]

Research studies have yielded little evidence that managed health care excesses have undermined the quality of health care services. For example, in a survey of 2,000 physicians, Remler and colleagues found that managed care insurance plans denied only about 1 percent of recommended hospitalizations, slightly more than 1 percent of recommended surgeries, and just over 2.5 percent of referrals to specialists.endnote[xiv] In another study, Franks and colleagues found that medical outcomes were similar for participants in HMOs versus FFS health plans.endnote[xv] Franks also reported that HMO patients were hospitalized 40 percent less frequently than FFS patients, and the rate of inappropriate hospitalizations was lower among HMO patients.

Link: http://www.ncd.gov/publications/2013/20130315/20130513_AppendixB

Recent Developments

Over the past 15 to 20 years, the public outcry against draconian managed care practices has waned, primarily due to the expanded out-of-network options afforded to participants in HMOs, PPOs, and POS health plans. But the perception that managed care represents an overly cost-conscious, mass market approach to delivering medical services lingers among the American public, even though more than 135 million people with health insurance coverage now receive their primary, preventive, and acute health services through a managed care plan.endnote[xvi]People with disabilities, especially high users of medical care and LTSS, share many of the same negative perceptions of managed care as the general public.

More:

Footnotes

[i]. R. Kane, R. Kane, N. Kaye, R. Mollica, T. Riley, P. Saucier, K. I. Snow, and L. Starr, “Managed Care Basics,” in Managed Care: Handbook for the Aging Network (Minneapolis: Long-Term Care Resource Center, University of Minnesota, 1996).

[ii]. D. Mitchell, Managed Care and Developmental Disabilities: Reconciling the Realities of Managed Care with the Individual Needs of Persons with Disabilities (Homewood, IL: High Tide Press, 1999).

[iii]. M. Freeland and C. Schendler, “Health Spending in the 1980s,” Health Care Financing Review 5 (Spring 1984): 7.

[iv]. D. Drake, Reforming the Health Care Market: An Interpretive Economic History (Washington, DC: Georgetown University Press, 1994).

[v]. Ibid.

[vi]. Mitchell, Managed Care and Developmental Disabilities.

[vii]. Drake, Reforming the Health Care Market.

[viii]. L. Weiss, Private Medicine and Public Health (Boulder, CO: Westview Press, 1997).

[ix]. Employee Benefits Research Institute, EBRI Databook on Employee Benefits (Washington, DC: Employee Benefits Research Institute, 1992).

[x]. P. Saucier, “Managed Long-Term Services and Supports,” a presentation to the National Policy Forum, May 11, 2012.

[xi]. J. Iglehart, “Physicians and the Growth of Managed Care,” The New England Journal of Medicine 331, no. 17 (1994): 1167–71.

[xii]. R. Cauchi, “Where Do We Go From Here?” State Legislatures (March 1999): 15–20.

[xiii]. U.S. Department of Labor, Fact Sheet: Newborns’ and Mothers’ Protection Act, http://www.dol.gov/ebsa/newsroom/fsnmhafs.html.

[xiv]. D. Rembler, K. Donelan, R. Blendon, L. Lundberg, D. Leape, K. Binns, and J. Newhouse, “What Do Managed Care Plans Do to Affect Care: Results of a Survey of Physicians,” Inquiry 34 (1997): 196–204.

[xv]. P. Franks, C. Clancy, and P. Nutting, “Gatekeeping Revisited: Protecting Patients from Overtreatment,” The New England Journal of Medicine 337, no. 6 (1992): 424–9.

[xvi]. Statistics taken from Managed Care Online, http://www.mcol.com/factsheetindex.

Conclusion

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How Physicians Prepare for Retirement?

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ME-P SPECIAL REPORT

On Physician DIY’s

[By Vicki Rackner MD]

VR MD

Dear ME-P Readers and Subscribers,

Employed physicians who use professional financial advisors v.s. physician financial do-it-yourself-ers):

Did you know the following:

  • Feel better prepared for retirement
  • Have more in emergency savings
  • Have more diverse financial investments and
  • Feel more confident about their personal financial decisions?

Did you also know:

Here are some other key survey findings:

  • 60% of practicing physicians are employed by hospitals, groups and medical schools.
  • 42% of of employed physicians are behind where they would like to be in retirement planning.
  • Employed physicians” #1 financial goal is to enjoy a comfortable retirement. Other top concerns include funding long-term care, minimizing losses and ensuring an inheritance for children/ grandchildren.
  • Half of employed physicians believe they have unique or more complex financial needs than other professionals.These finding affirm the intuitively obvious: experts get better results than dabblers.
  • Patients get the best medical outcomes when they work with physicians whom they trust; physicians get the best financial results when they work with financial advisors whom they trust.

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What this means for you

These finding affirm the intuitively obvious: experts get better results than dabblers.

Patients get the best medical outcomes when they work with physicians whom they trust; physicians get the best financial results when they work with financial advisors whom they trust; as a fiduciary advisor.

Assessment

Enter the Certified Medical Planners

About the Author

Vicki Rackner MD, author, speaker and President of Targeting Doctors, helps financial advisors accelerate their practice growth by acquiring more physician clients. She calls on her experience as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and nationally-noted expert in physician engagement to offer a bridge between the world of medicine and the world of business.

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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Financial Planning MDs 2015

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

On The Next Stock Market Correction?

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Remember the Ace Up Your Sleeve!

By Lon Jefferies MBA CFP® CMP®

Lon JeffriesAfter the historic growth the stock market has experienced since early 2009, many physician investors have felt that a healthy pullback may not be a completely negative thing.

After all, we certainly don’t want another bubble, or stock prices that are clearly out of line with the earning potential of the underlying companies.

Unfortunately, market corrections never feel healthy when they occur. Physicians, investors and almost all people get uncomfortable when the market declines, the media fans the flames by giving investors reason after reason to be afraid, and worries that this is the beginning of the next crash begin to develop.

While many investors admit that a 5% pullback is manageably unpleasant, concerns expand when the market decline hits 10% — right when the media can officially throw around the word “correction.”

Of course, we have no idea when the next drop will occur, but why not mentally prepare ourselves by exploring what has traditionally happened to stock prices once that 10% decline is crossed?

The Data

Ben Carlson, an institutional investment portfolio manager, looked at the S&P data going back to 1950, and found that there have been 28 instances when stocks fell by 10% or more. Thus, on average, the market has entered an official correction every 2.25 years. The last market correction occurred in 2011, so another 10% drop at this time would correlate pretty close to the average amount of time between corrections.

Obviously, the market has done pretty well since that last temporary correction in 2011. Clearly, such a drop is quite normal and far from historically concerning.

  • S&P 500 Losses of 10% or More Since 1950
  • Total Occurrences: 28 Times
  • Average Loss: -21.6%
  • Median Loss: -16.5%
  • Average Length: 7.8 Months
  • Greater Than 20% Loss: 9 Times
  • Greater Than 30% Loss: 5 Times

Your Advantage

Are you thinking “I don’t think I can stomach that median loss of 16.5%?” Then it’s time to pull out the ace up your sleeve. Remember that the data above represents the historical performance of the S&P 500 – an index that is composed of 100% stocks. A capable financial planner would ensure you have an asset allocation mix between stocks, bonds, and cash that represents your tolerance for risk.

Consequently, your portfolio likely isn’t 100% stocks. In fact, the appropriate allocation for an average investor approaching or already enjoying retirement might be closer to only 50% stocks. This means that on average, your portfolio should decline only half as much as the S&P 500 during market downturns.

This ace may bring the loss endured by our sample investor with a 50% stock portfolio down to around 8.25% during the median decline. Are you now back in the “manageably unpleasant” range? If so, you likely have an appropriately constructed portfolio. If not, your risk tolerance may need to be reevaluated to ensure you are not exposing your nest egg to a larger loss than you can endure.

Avoid Harmful Reactions to the Market

Although the recent market pullback produces what seems like a foreign feeling, we’ve been here before. The S&P 500 declined in value by 18.64% over a 5 month period in 2011. However, an investor with a 50% stock portfolio likely only saw their account values drop around 9%-10% — still not fun, but manageable.

Assessment

Of course, we don’t know whether the market will continue to bounce back or again drop into official correction territory. If you continue to hear about the broad markets declining, remember that the average historical correction has been far from catastrophic, and that you have the ace of an appropriate asset allocation up your sleeve.

Financial Planning MDs 2015

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

Conclusion

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

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Some Financial Health Insurance Hardships and Concerns of Adults

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Privately Insured

By http://www.MCOL.com

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123

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Assessment

Conclusion

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

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A Financial Planning Curated News Round-Up for MDs

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Interesting news and topics from around the blog-o-sphere

[By Staff Reporters]

  • How 6 Types of Retirement Income Are Taxed
    A common mistake retirees make when calculating their living expenses is forgetting how big a bite state and federal taxes can take out of savings. And how you tap your accounts can make a big difference.
  • Long-term Care by the Numbers
    Seven out of ten people will need long-term care sometime after 65. One expert examines the numbers behind long-term care.
  • Three Retirement Goals People Never Achieve
    New and soon-to-be retirees often set lofty retirement goals based on newfound time and opportunities. However, some of their most common goals and dreams are never even attempted, let alone achieved.
  • How Rising Rates Could Impact 3 Key Sectors
    How might different fixed income sectors respond to rising rates? And how might investors position their portfolios? This article offers a view of three widely held fixed income sectors.

healthfinance

Assessment

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

 

The “ObamaCare Opportunity” for Financial Advisors

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Why Physicians Need Financial Advisors Now!

[By Vicki Rackner MD]

http://www.CertifiedMedicalPlanner.org

VR MDI recently attended a surgical meeting. Most conversations with my physician colleagues turned to the same singular topic: physicians’ new financial reality.

And the message is, “It hurts!”

Physicians’ Financial Plans

Financially savvy physicians execute thoughtful retirement plans. Yet, today about half of surveyed physicians are behind where they would like to be in retirement preparedness. Further, today only about half of physicians work with professional financial planners.

As a physician myself, I understand why smart physicians fail to take smart financial action. We physicians dedicate ourselves to the alleviation of pain and suffering of others. Retirement is a distant personal concern that does not cause immediate financial pain today. We put it off.

Lesson from My Dentist

Years ago my dentist recommended that I undergo a procedure to replace a filling. He explained that the filling material put in my mouth about 40 years ago tends to pull from the tooth over time and allow new cavities to form.

As much as I like my dentist, I actively avoid spending time in his dental chair. I put off the recommended filling replacement year after year. That is, of course, until I experienced vague throbbing from that tooth. I rearranged my schedule so I could tend to this small problem before it became a much bigger problem. Who wants a root canal!

For physicians retirement planning is like that proactive filling replacement. We understand that without action there will be problems down the road. However, the threat of a problem in the distant future does not propel many like myself to action today.

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The ObamaCare [PP-ACA] Opportunity for Financial Advisors

ObamaCare is the source of acute financial pain for physicians. It’s the financial toothache. Practicing physicians are looking at:

  • Higher taxes. Doctors represent 9 of the 10 highest earners in the US.
  • Rising costs of goods and services as businesses address their own higher tax bills.
  • The costs of building the infrastructure that will lead to greater healthcare efficiencies, like converting to electronic medical records, hiring new staff to address new administrative demands and aligning with new compliance requirements.
  • Lower professional fees. The 24% Medicare fee reduction that was averted this year will become reality soon. As Medicare goes, so, too, go the rest of the insurance fee schedules.
  • Decreasing patient referrals as primary care doctors sell their practices.
  • Physicians know they need to act now to avoid the financial root canal. Each physician is in the process of creating a personal ObamaCare plan.

Physicians’ Wants and Needs

As a financial advisor, you know that physicians NEED a retirement plan. Kids need to eat their broccoli, too. It’s good for them.

Physicians WANT a plan to help them achieve the personal, professional and financial goals that drew them to a career in medicine. Engaging physicians by address their ObamaCare plan is about as hard as getting kids to eat ice cream.

What This Means for You

Today physicians actively seek experts to help them create their ObamaCare plans.

Financial advisor are winning new physician clients. As Seattle Seahawks quarterback Russell Wilson asks, “Why not you?”

If you want to work with more physician clients, this is your moment! Seize it. You have a chance to join the high-performing financial advisors mining the treasures in the medical market.

Assessment

Should wish to learn more here’s a video that addresses 4 questions:

  • Why do physicians need you now?
  • What do you need to know about physicians now?
  • How do you engage physicians now?
  • How do you conduct yourself so physicians want to conduct business with you now?

About the Author

Vicki Rackner MD is an author, speaker and consultant who offers a bridge between the world of medicine and the world of business. She helps businesses acquire physician clients.

VIDEO: https://www.youtube.com/watch?v=CeCyidc4JP8&feature=player_embedded

Enter the Certified Medical Planners

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

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

The [Negative] Short-Term Implications of Investment Portfolio Diversification

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Delving Deeper into Asset Allocation

By Lon Jefferies MBA CFP® CMP®

Lon JeffriesAsset allocation is one of the key factors contributing to long-term investment success.

When designing a portfolio that represents their risk tolerance, investors should be aware that a portfolio that is 50% stocks is likely to obtain approximately half of the gain when the market advances but suffer only half the loss when the market declines.

This general principle frequently holds true over extended investing cycles, but can waiver during shorter holding periods.

Case Model

For example, a fairly typical physician client of mine who has a 50% stock, 50% bond portfolio has obtained a return of 4.62% over the last 12 months, while the S&P 500 has obtained a return of 14.31% over the same time period (as of 10/30/14).

An investor expecting to obtain half the return of the index would anticipate a return of 7.15%, and by this measuring stick, has underperformed the market by over 2.50% during the last year.

What caused this differential?

Answer

The issue resides in how we define “the market.” In this example, we use the S&P 500 index as a measure for how the market as a whole is performing. As you may know, the S&P 500 (and the Dow Jones Industrial Average, for that matter) consists solely of large company U.S. stocks.

Of course, a diversified portfolio owns a mixture of large, mid, and small cap U.S. stocks, as well as international and emerging market equities. Consequently, comparing the performance of a basket of only large cap stocks to the performance of a diversified portfolio made up of a variety of different asset classes isn’t an apples-to-apples comparison.

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Stock_Market

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Frequently, the diversified portfolio will outperform the non-diversified large cap index because several of the components of the diversified portfolio will obtain higher returns than those achieved by large cap holdings.

However, the past 12 months has been a case where a diversified portfolio underperformed the large cap index because large cap stocks were the best performing asset class over the time period. In fact, over the last twelve months, there has been a direct correlation between company size and stock performance (as of 10/30/14):

  • Large Cap Stocks (S&P 500): 14.92%
  • Mid Cap Stocks (Russell Mid Cap): 11.08%
  • Small Cap Stocks (Russell 2000): 4.45%
  • International Stocks (Dow Jones Developed Markets): -1.05%
  • Emerging Market Stocks (iShares MSCI Emerging Markets): -1.04%

Since large cap stocks were the best performing element of a diversified portfolio over the last 12 months, in retrospect, an investor would have obtained a superior return by owning only large cap stocks during the period as opposed to owning a diversified mix of different equities. Does this mean owning only large cap stocks rather than a diversified portfolio is the best investment approach going forward? Of course not.

Year after year, we don’t know which asset category will provide the best return and a diversified portfolio ensures we have exposure to each year’s big winner. Additionally, although large caps were this year’s winner, they could easily be next year’s big loser, and a diversified portfolio ensures we don’t have all our investment eggs in one basket.

Financial Planning MDs 2015

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

Assessment

Don’t be overly concerned if your diversified portfolio is underperforming a non-diversified benchmark over a short period of time. As always, long-term results should be more heavily weighted than short-term swings, and having a diversified portfolio is likely to maximize the probability of coming out ahead over an extended period.

Conclusion

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The “Selling-Out” of a Profession [Dentistry]?

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Dentistry …?

[By D. Kellus Pruitt DDS]

1-darrellpruittSeveral years ago, a president-elect of the American Dental Association proclaimed, “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’” (ADA News, October 2008).

Looking back, it is easy to recognize the ADA’s renegade capitulation to HHS as a warning sign of things to come.

The ADA is the same national healthcare institution whose leaders joined Delta Dental in persuading dentists to volunteer for HIPAA’s NPI numbers – never revealing what they are to be used for. It’s the same not-for-profit Chicago corporation which continues to protect non-dues revenue by misleading the nation about the “savings and convenience” of EHRs in dentistry. Among all healthcare organizations, the ADA is alone in their enthusiasm for EHRs and Meaningful Use requirements.

And to top it off, the ADA leadership has progressively become less accessible by the community it serves – NEVER entering into open discussions of urgent dental issues on the internet, even to the extent of ending its commitment to answering dental questions for visitors to Dr. Oz’s Sharecare.com. It’s only dentistry for crying out loud!

As a matter of fact, Dr. Maxine Feinberg, the new ADA President, recently suggested in an interview with the ADA’s Judy Jakush that telephone conversations are “The best kept secret of the ADA which members don’t understand.” What?

Dr. Feinberg: “The best-kept secret is that if you have a problem or complaint, you will likely walk away with a positive experience. And, on the rare occasion that the staff can’t help you, there is a good chance that you will speak to Dr. Kathy O’Loughlin, the executive director. That’s amazing customer service.”

***

Insightful or clueless dentist?

***

What’s not to understand? I understand that ADA membership numbers have taken a hit over the last few years, but nevertheless, the dues of a little over 150,000 dentists still help pay the salaries of ADA employees. That’s a lot of phone calls that will have to be transferred to the right person (the first time), scheduled to call back later or be completely ignored. Isn’t email, or even the US Mail a better idea? Or is lousy communication (unaccountability) with dentists and patients the goal?

About that NPI number

How do you feel about the ADA leading the effort to assess and report your value to your community without ever stepping into your office or talking with a satisfied patient? When you volunteered for your National Provider Identifier at the insistence of the ADA and Delta Dental, you agreed to CMS terms. What? Nobody mentioned that?:

“Spread the mission of the DQA – The DQA, formed in 2008 through a request from the Centers for Medicare & Medicaid Services, is comprised of multiple stakeholders from across the oral health community who are committed to development of consensus-based quality measures.” By Kelly Soderlund for the ADA News, November 3, 2014.

Does “multiple stakeholders” sound as costly to you as it does to me, Doc? I say we already have too many stakeholders. What about the principals (dentists and their patients) who pay the stakeholders’ bills?

***

eHRs

***

Does anyone disagree that DQA looks like the ADA’s desperate mission creep for cash? With the chronic drop in membership, the Chicago corporation has turned to vigorous pursuit of non-dues revenue – probably in the form of federal grants and stimulus money from HHS. The ADA (which prefers clumsy communication via telephone), is asking state and local dental leaders to put their own personal credibility at risk by persuading uninformed dentists to unquestioningly accept multiple stakeholders’ assessment of their value to society – just like clueless dentists cooperated in the NPI effort.

Dr. David Schirmer, chair of the DQA’s education committee, tells ADA News: “Eventually, all of dentistry will need to understand quality measures. But before we reach our grass roots membership, we need our leaders in dentistry to understand.” He adds, “I’m challenging those leaders to pave the way for their younger colleagues and help them understand the long-term impact this will have on dentistry.”

ADA Editor Soderlund: “The DQA has taken the lead on developing quality measures within oral health care. These measures touch every practicing dentist in the United States, and with dentistry, how it’s modeled and how it’s financed changes in the future — specifically as a result of the Affordable Care Act — they’ll become even more prevalent. The mission of the DQA is to advance performance measurement as a means to improve oral health, patient care and safety through a consensus-building process.”

“— specifically as a result of the Affordable Care Act —“ Since you never respond, ADA, how do we know you haven’t sold us out once again for taxpayers’ money?

Assessment

If it’s difficult for the ADA to hold onto membership now, just wait until the nation’s dentists figure out that Obamacare cannot give everyone A’s on their internet report cards. This means the majority of dentists are going to be pissed at the ADA for their bad grades, no matter what.

Conclusion

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Doctors Living With Higher Stock Market Volatility

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Change is afoot in the market, the rally of which lulled many into complacency

DG

By David Gratke

Volatility, on vacation for most of the past few years, is back this fall for physician investors and us all. It hit a new 52-week high in mid-October, double the level of August. That means change is afoot in the market, whose rally lulled many into complacency. So. this is a good time to see where your portfolio stands in risk terms.

The last time volatility really spiked, as measured by the Standard & Poor’s 500 volatility index, or VIX, was the fall of 2011 when the market last corrected by 20%. Then, the VIX level was twice as high as now. Volatility is market price fluctuation, and it signals greater risk.

Financial Risk

financial risk

The root cause of higher volatility is that the world’s major central banks, including our Federal Reserve, have flooded markets with liquidity – printing money, if you will. In other words, in an effort to jump-start local economies, they have kept rates so low that stocks are artificially higher, and thus ripe for a price-churning correction. The insidious side-effect of this money printing has been to greatly reduce, if not extinguish, historical, and normal, market price fluctuations.

As David Kotok, chairman and chief investment officer of Cumberland Advisors, puts it: “An era is ending: for over half a decade, nearly worldwide, zero interest rates suppressed volatilities. That is over.” The initial indication of this, Kotok says, was when then Fed-Chairman Ben Bernanke indicated that his bond-buying stimulus program was coming to an end. Well, now it’s over and the market fears interest rates are on the way up.

Investor Sentiment

Transferrable  Emotions

Stock market volatility can be measured and is used to gauge investor thinking, or what we call investor sentiment.

The VIX gauges investor sentiment. When volatility is low, the implication is that investors are complacent. Said differently, they are not paying attention to the underlying risks in the marketplace. Also during times of low volatility, markets are often fully valued, or even overvalued due to investor contentment.

When the VIX is high, as it was during the 2008-09 financial crisis, investors exhibited great amounts of fear. They sell out of their investments, and markets are typically undervalued.

Volatility was low prior to 2008, hovering around its historical average of 20. The index then zoomed to 90 during the 2008-09 stock market slide. In recent months, however, most notably June and July, we witnessed a historic low in this index, hovering near 10. Sure enough, there were high levels of margin balances and bullish investor sentiments, along with above-average stock valuations, as seen by lofty price/earnings ratios.

Now, the VIX is slightly below average, at about 15.

Since August, volatility rose from its sleepy historic mid-summer lows for many reasons: Middle East tensions, the Ebola outbreak, low gross domestic product growth, central bank stimulus slowing down, corporate stock buybacks, high P/E ratios, just to highlight a few.

Stock_Market

A New Normal?

Assuming this higher volatility is the new normal, what can you do about it? One alternative is to do nothing and ride this out. Another is to trade options, betting on which way the market will cut. But this is very risky and best done by professionals. Kotok says a volatility surge is a good time to examine your portfolio’s risk profile: His firm’s largest positions are in defensive stocks, like utilities and telecoms – ones that don’t tend to rocket around when the market gyrates.

During a recent volatility boost to the current level, in 2013, a Wall Street Journal story offered some market pros’ tips. Examples: putting money in a balanced fund, where stocks and bonds are in roughly equal proportion. Another warned that whenever stock holdings were over 70% of a portfolio, or under 30%, you are most vulnerable.

Regardless, Kotok cautions that “more and exciting volatilities lie ahead.”

Follow AdviceIQ on Twitter at @adviceiq.

About the Author

David Gratke is chief executive officer of Gratke Wealth LLC in Beaverton, Ore.

Conclusion

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Doctors and Rental Cars

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Obtaining and Making the Most of an Upgrade

[By Dr. David Edward Marcinko MBA]

[By Nalley Lexus Roswell, GA]

Dr David E Marcinko MBADoctors and other medical professionals typically rent automobiles; and frequently.

When you rent a car, the rental company will normally have a range of different types available, each priced according to the size and class of car.

While you will almost certainly have booked one class of car, very often the rental company will be in a position to offer you a free upgrade to a larger or more luxurious model.

The Upgrade

So how do you increase your chances of getting a free vehicle upgrade? Here are some ideas:.

  1. Use the same office

If you regularly hire cars, try to make a point of using the same company. If you use a local office (or the same rental office) then the staff members will probably start to recognize you, which might increase your chances of being offered a free upgrade. The car rental business is very competitive, especially in certain locations, so these businesses will be looking to find ways to please you.

  1. Get to the office early

While car rental offices are turning over a number of cars throughout the day, most cars will be returned between the hours of 9 a.m. and midday. If you get to the office early, the staff members may actually have a shortage of cars in the class that you have ordered, which could force them to offer you something larger or more luxurious.

  1. Join loyalty schemes

Some car rental companies have loyalty schemes or member’s clubs, where you may be offered special deals. In exchange for a few personal details, you will receive regular mailings about discounts and offers, some of which will include a free upgrade if you fulfill certain conditions. Even if there is no offer in place, make sure the staff members know that you’re a member of the scheme, as it may just sway their opinion.

  1. Use the personal touch

The way in which you interact with the office personnel may influence the likelihood that you will get a free upgrade. Bear in mind that staff members deal with hundreds of people every day. Somebody that smiles and is patient and friendly is much more likely to be welcome in the office and may be rewarded. Chat with the staff member dealing with you and, if necessary, show your interest in one of the larger, more luxurious cars. It might just sway them in your favor!

  1. Choose a popular model

When you make a reservation, make a point of talking to the office directly so that you can use the staff member’s local knowledge. Ask the office which class or type of car is the most popular and then book that one. That way, there is a higher likelihood that the office will be out of stock when you arrive.

***

001

[Classic Jaguar XJ-V8 Luxury Touring Sedan]

***

Assessment

In all cases, be aware that many offices will try and push an upgrade charge on you, which may range from $5 upwards per day. Don’t be bullied into accepting this charge!

Conclusion

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Understanding the Scientific Publication “H” Index, and others

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How to evaluate the academic performance of individual scientists

[By Dr. David Edward Marcinko MBA]

Dr. MarcinkoThe “h-index” was introduced in 2005 as a metric for estimating “the importance, significance and broad impact of a scientist’s cumulative contributions.” It takes into account both the number of an individual’s publications and their impact on peers, as indicated by citation counts.

Origination

Its creator, Jorge Hirsch (UC-San Diego) asserts that a “successful scientist” will have an h-index of 20 after 20 years; an “outstanding scientist” will have an index of 40 after 20 years; and a “truly unique individual” will have an index of 60 after 20 years or 90 after 30 years. You can read more about it in Nature and PhysicsWeb.

Web of Science

Curious to know your own h-index? You can easily determine it using Web of Science. Select “Science Citation Index Expanded.” Click “General Search” category and search for your name as author (e.g., SMITH J*). Use “Refine Your Results” by Institution to differentiate yourself from other scientists with the same initial(s). (This is an important step, otherwise your publications will be intermingled with unrelated papers and your h-index will be inaccurate.) Click on “Citation Report” in the box on the right side. Your h-index will be calculated automatically.

An alternative method is to sort your citations by “Times Cited”, using sort box on the right side. Scan down the list until the number of the paper exceeds the number of citations to that paper. For example, your h-index is 20 if your 21st paper has been cited 20 or fewer times, but your 20th paper has been cited 20 or more times.

Critique

Although effective and simple, the h-index suffers from some drawbacks that limit its use in accurately and fairly comparing the scientific output of different researchers. These drawbacks include information loss and low resolution: the former refers to the fact that in addition to h2 citations for papers in the h-core, excess citations are completely ignored, whereas the latter means that it is common for a group of researchers to have an identical h-index.

***

Financial Planning MDs 2015

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

***

Fixing the Bias

To solve these problems, Chun-Ting Zhang proposed the “e-index“, where e2 represents the ignored excess citations, in addition to the h2 citations for h-core papers. Citation information can be completely depicted by using the h-index together with the e-index, which are independent of each other. Some other h-type indices, such as a and R, are h-dependent, have information redundancy with h, and therefore, when used together with h, mask the real differences in excess citations of different researchers.

Link: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0005429

Assessment

Google Scholar is another useful source of citation data.  A.-W. Harzing’s Publish or Perish software is a free application for Windows, Mac OS, and GNU/Linux that uses Google Scholar to compute citation counts, h-indexes, journal impact factors, and many other citation metrics.

Conclusion

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

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The PP-ACA [Game Changer for Health Care Financing]

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The fuel which fires the self-funded engine of employee health and welfare plans

[By William Rusteberg]

A SPECIAL ME-P REPORT

PP-ACA Taxes for 2015

Introduction

The Affordable Care Act (ACA) has had a fundamental impact on health care financing in this country. It has effectively provided added incentives for plan sponsors to consider modified self-funding arrangements for their employee health and welfare plans in lieu of fully-insured plans. The advantages of doing so are clear.

Health care costs continue to rise despite passage of the ACA. While the ACA addresses many aspects surrounding the delivery of health care, it does little or nothing to identify and offer solutions to constantly rising costs. On the contrary, many ACA provisions are driving cost up.

Plan sponsors have a choice between assuming a passive strategy with little or no control through fully-insured funding arrangements or the alternative. The alternative affords more control and less cost. It rewards innovation and creativity. It utilizes all the tools a risk manager requires as part of his trade.

More plan sponsors are turning to self-funding in response to the ACA.

Product DetailsProduct DetailsProduct Details

The Market Leading Up To the ACA

The financial and benefit advantages of self-funded health and welfare plans became evident with the passage of the Employee Retirement Income Security Act (ERISA) of 1974. Dramatic growth in self-funding occurred when ERISA preemption, clarified legal environment, rising health care costs, widespread use of risk management, the cost containment movement (Managed Care) and high interest rates were all being experienced.

Fully insured plans continued to be a large segment of the market, especially among smaller employer groups. However, a significant number larger groups remaining fully-insured moved towards minimum premium plans, or plans which were rated retrospectively on an administration cost plus basis. This approach among larger employers mirrored self-funding advantages to some degree, however the insurance companies ultimately bore the entire risk and maintained full control over plan expenses and claim costs. These types of fully-insured funding arrangements were the carrier’s response to the growing phenomenon and popularity of self-funding.

With the advent of managed care in the early 1980’s, the entire dynamics of health care delivery changed. Third party intermediaries became an important element in the health care equation.  These intermediaries performed valuable services in cost containment which initially had a positive impact on health care benefits and costs to the advantage of both the consumer and payer.

Carefully selected health care givers were aggregated into exclusive networks of preferred providers. The theory behind the scheme was valid; selected health care providers would agree to discount their usual fees for service in return for more patients. Steerage was accomplished by rewarding consumers with improved benefits when seeking care through these “preferred” providers. All worked well, with health care costs temporarily softening.

Consumers no longer had to satisfy deductibles to receive most care. Instead, co-pays as low as $10 to see a doctor became the norm. Prescription drugs benefits, now accounting for as much as 25% of a plan’s total spend in today’s market, were easily accessed by paying a small co-pay. Access to care became easier and affordable. Utilization increased.

With increased utilization, consumers began to demand more doctors and hospitals to be added to networks. Over time, just about every doctor and hospital in a given geographic area were all on networks. Competition among insurance companies hinged upon who had the broadest network. The pressure to add medical providers became intense. A seller’s market for medical providers became an established trend that continues to this day. Preferred Provider Organizations (PPO) thus gained the advantage of a seller’s market they created while end users became subject to a weakened and impotent buyer’s market.

Over time PPO’s lost their core characteristic. There was no longer any steerage. The scheme that worked so well in the beginning began to unravel. Costs increased dramatically, year after year.

Plan sponsors failed to recognize the slow progression towards failure of managed care. They continued to subscribe to the theory behind managed care based upon reliance of advice and guidance from “trusted” insurance companies, third party administrators, agents, brokers and insurance experts posing as consultants. Unfortunately, and unknown to plan sponsors, these trusted advisors maintained a vested interest in continuing the scheme. A de facto conspiracy of third party intermediaries formed. The conspiracy continues to this day. It is one of the health care industry’s best kept secrets.

No one can dispute that managed care has failed. Health care costs have continued to increase at double digits year after year, becoming unaffordable for most Americans. Plan Sponsors, concerned and desperate for answers and solutions continue to rely on advice and guidance from third party intermediaries whose vested interests is in maintaining the status quo. To more and more employers health care costs can mean the difference between profit and loss.

The perception that private enterprise has failed in reining in costs is widespread. Private and public budgets can no longer sustain the current level of spending, let alone future health care inflation.

Pointing to failure of the market to keep medical costs affordable, many looked to government for solutions.

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The Affordable Care Act & The Impact on Health Care Financing

With the passage of the ACA, we find ourselves in a dynamic and somewhat unpredictable market, particularly the political dimensions as the ACA continues to evolve. However, we do know to a large degree, how the market will be affected and what plan sponsors must do to maintain affordable health care for their employees.

The ACA’s most significant impact centers upon how group medical plans will be financially structured for years to come. The ACA effectively makes fully-insured plans less attractive while providing advantages to self-funded arrangements. Carriers have come to recognize this and are moving to increase their market share. Currently the BUCA’s (Blue Cross, United HealthCare, Cigna and Aetna) administer more self-funded business than fully-insured business on their respective large group blocks of business. They are now actively expanding this funding method to the small group market.

The ACA’s universal intent is to provide government mandated means for affordable health care for all Americans. However, the ACA as it is now written does not address cost of care nor does it mandate parameters around which cost of care is to be based. Instead, the ACA mandates rigid requirements that address what insurance companies can offer in the way of benefits, as well as profit and operating margins. There is nothing in the Act that addresses what medical providers charge and what they are paid.

These far reaching rules have dramatically impacted fully-insured plans. All ACA mandates apply to these plans, whereas self-funded plans are exempt from many of them. Fully-insured plans are effectively handcuffed affording little leeway to be proactive and innovative in plan design and cost basis. Unlike self-funded plans, little can be done to control costs under fully insured plans.

An example of a reverse outcome of good intentions pertains to the Minimum Loss Ratio mandate required of all fully insured plans but exempted under self-funded plans. Fully insured large groups are required to maintain a loss ratio wherein health care claims cannot be less than 85% of premium leaving insurance companies with15% of premium to cover their costs and earn profits. However this has had a reverse effect, the opposite of which is higher costs. The greater the cost (claims), the greater the profit to the insurance company. Fifteen percent of a larger number is larger than 15% of a smaller number.

Insurance companies remaining in the fully-insured market have little or no incentive to reduce health care costs except to remain competitive in the market. With only a handful of fully-insured carriers in any given market there is less competition. Shadow pricing between competitors can very often be an effective means of maximizing insurance company profits at the expense of the plan sponsor and plan participants. A 15% operating and profit margin becomes greater when insurance rates are higher.

A good example of a constricted market can be found in San Antonio, Texas, a market we know well. There are only four major players in the fully-insured market: Blue Cross, United Healthcare, Aetna and Humana. Employer groups who continue to fully-insure will contract with one of these four carriers.

The Lower Rio Grande Valley in deep South Texas, on the other hand, has only one major carrier in the fully-insured market. Blue Cross is the dominant carrier, with occasional, cyclical and short lived forays into the Valley by Aetna and Humana..

Fully insured health insurance carriers have developed proprietary provider networks as an integral part of their insurance plans. None to our knowledge market plans that do not utilize their PPO network as part of the offering. There is an economic reason for this and it has nothing to do with lowering health care costs.

To insure continuing higher profits, health claim costs must continue to escalate. Third party intermediaries negotiate provider agreements in secrecy with both parties agreeing to non-disclose of terms, conditions and pricing to the public. It is our opinion that if you are not allowed to see a contract you are probably paying more than you should. Plan sponsors have simply become third party beneficiaries, accessing provider agreements they cannot see, examine or audit.

Fully insured group medical insurance in today’s market requires accessing proprietary, secretive PPO contracts. These contracts drive costs up each year primarily due to automatic escalator clauses. Other contract provisions include provider re-pricing fees and shared savings provisions based on egregious charge master rates no one ever pays. There are other contract provisions that guarantee continued cost increases but we will save that discussion for another day.

Self-funding provides plan sponsors a means to comply with the ACA with less restrictive mandates and lower costs. In addition, plan sponsors have the ability to design benefits that are far more flexible. They gain the freedom to choose provider reimbursement methods based on transparency, benchmarked off costs instead of phony discounts based on inflated sticker prices no one ever pays. They have the ability to eliminate expensive third party intermediaries that bring no value, They have the ability to directly contract with willing providers based on transparent benchmarking, achieving savings of 20% or more.

The ACA’s adverse impact on fully insured plans include community rating and minimum essential benefit requirements, 3:1 age band rating, pre-existing condition inclusion, and benefit expansions. All of these mandates drive cost up.

A self-funded plan is not subject to community rating nor are they required to include all ten (10) essential benefits. In addition, self-funded plans are not subject to the 3:1 rating rule and can mitigate pre-existing inclusion through selective lasers. Lasers are an underwriting technique that increases exposure/costs only when a loss occurs. If no loss occurs, there is no effective additional load to plan costs unlike fully-insured plans that load the premium costs at the beginning of the plan year, effectively passing on a cost that may or may not be necessary.

Complementing the advantages of self-funding under the ACA, ERISA preempts the state’s ability to mandate health insurance contract terms and benefits, impose premium taxes, impose underwriting constraints and mandated premiums (varies by state) and limit employee benefit plan options.

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The Future under the ACA

Health care costs continue to escalate. Both private and public sector budgets can no longer sustain the current level of spending, let alone future health care inflation.

Over 170 million Americans are insured through employer sponsored health plans today. These employers, fearing the effects of the ACA on their bottom line, are concerned and desperate for answers and solutions to ever increasing health care costs. To more and more of them health care costs can mean the difference between profit and loss.

Acceptance to change, historically, has been slow among employers who have traditionally relied on third party intermediaries to guide them through the complicated maze of our health care system. The ACA has effectively changed that mindset among many plan sponsors.

We are seeing a movement away from managed care by some employers, and to a lesser degree, by health care providers, particularly health care professionals. Employers, for the first time, are questioning managed care contracts they cannot see but upon which their health care costs are based.

We are seeing a major shift to self-funded arrangements which enable plan sponsors to effectively manage costs through avoidance of certain ACA requirements, underwriting advantages, and pro-active risk management.

Assessment

Product Details

Although ERISA was passed into law over 35 years ago, with the advent of the ACA more plan sponsors are accepting full fiduciary responsibility to assure that plan assets are expended prudently and in the best interests of plan participants.

Conclusion

As it stands today, the ACA is the fuel which fires the self-funded engine of employee health and welfare plans, providing flexibility, control and lower costs. It is the parking brakes of fully-insured plans.

About the Author

Bill Rusteberg is a fee based insurance consultant and principal of RiskManagers.us since 1998. He has been involved in the insurance industry for over 41 years specializing in self-funded employee welfare plans. Bill has spoken nationally on continuing changes affecting our health care delivery system, most recently at the Physician Hospital of America (PHA) annual forum in 2013 and the Health Care Administrators Association (HCAA) Executive Forum in 2014. Bill walks his audience through the complicated maze of the American health care delivery system. He exposes industry secrets that drive costs by outlining specific findings not generally known to Plan Sponsors. Bill offers common sense solutions to ever increasing health care costs. Armed with the knowledge industry insiders have kept hidden for years, Plan Sponsors are, for the first time, empowered to negotiate with insurance companies, managed care organizations and other third party intermediaries from a position of strength and can better achieve cost effective health care for their employees while often improving benefits at the same time. Bill is a licensed Risk Manager, Life & Health Counselor, Property & Casualty / Life & Health Insurance agent and Surplus Lines broker in Texas. He holds reciprocal licenses in several other states.

About RiskManagers.us

RiskMangers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

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

Year End MEGA Tax Planning “Tips” for Physicians

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For Medical Professionals … and Us All

[By PERRY D’ALESSIO CPA] http://www.dalecpa.com

A SPECIAL ME-P REPORT

perry-dalessio-cpaYear-end tax planning is especially challenging this year, for EVERYONE, because Congress has yet to act on a host of tax breaks that expired at the end of 2013. Some of these tax breaks may be retroactively reinstated and extended, but Congress may not decide the fate of these tax breaks until the very end of this year (and, possibly, not until next year).

For Individuals

These breaks include, for individuals: the option to deduct state and local sales and use taxes instead of state and local income taxes; the above-the-line-deduction for qualified higher education expenses; tax-free IRA distributions for charitable purposes by those age 70- 1/2 or older; and the exclusion for up-to-$2 million of mortgage debt forgiveness on a principal residence.

For Businesses

For businesses, tax breaks that expired at the end of last year and may be retroactively reinstated and extended include: 50% bonus first year depreciation for most new machinery, equipment and software; the $500,000 annual expensing limitation; the research tax credit; and the 15-year write-off for qualified leasehold improvement property, qualified restaurant property, and qualified retail improvement property.

Bigger Earners

Higher-income-earners, like some doctors, have unique concerns to address when mapping out year-end plans. They must be wary of the 3.8% surtax on certain unearned income and the additional 0.9% Medicare (hospital insurance, or HI) tax that applies to individuals receiving wages with respect to employment in excess of $200,000 ($250,000 for married couples filing jointly and $125,000 for married couples filing separately).

The surtax is 3.8% of the lesser of: (1) net investment income (NII), or (2) the excess of modified adjusted gross income (MAGI) over an un-indexed threshold amount ($250,000 for joint filers or surviving spouses, $125,000 for a married individual filing a separate return, and $200,000 in any other case). As year-end nears; a taxpayer’s approach to minimizing or eliminating the 3.8% surtax will depend on his estimated MAGI and net investment income (NII) for the year. Some taxpayers should consider ways to minimize (e.g., through deferral) additional NII for the balance of the year, others should try to see if they can reduce MAGI other than NII, and other individuals will need to consider ways to minimize both NII and other types of MAGI.

The additional Medicare tax may require year-end actions. Employers must withhold the additional Medicare tax from wages in excess of $200,000 regardless of filing status or other income. Self-employed persons must take it into account in figuring estimated tax. There could be situations where an employee may need to have more withheld toward year end to cover the tax.

For example, an individual earns $200,000 from one employer during the first half of the year and a like amount from another employer during the balance of the year. He would owe the additional Medicare tax, but there would be no withholding by either employer for the additional Medicare tax since wages from each employer don’t exceed $200,000.

Also, in determining whether they may need to make adjustments to avoid a penalty for underpayment of estimated tax, individuals also should be mindful that the additional Medicare tax may be over-withheld. This could occur, for example, where only one of two married spouses works and reaches the threshold for the employer to withhold, but the couple’s income won’t be high enough to actually cause the tax to be owed.

The Checklist[s]

I’ve have compiled a checklist of additional actions, for ME-P readers, based on current tax rules that may help you save tax dollars if you act before year-end. Not all actions will apply in your particular situation, but you (or a family member) will likely benefit from many of them.

***

Next-Gen Physicians

[Future High Income-Earners?]

***

Year-End Tax Planning Moves for Individual Medical Providers 

Realize losses on stock while substantially preserving your investment position. There are several ways this can be done.

For example, you can sell the original holding, then buy back the same securities at least 31 days later. It may be advisable for us to meet to discuss year-end trades you should consider making.

Let’s consider the following:

  • Postpone income until 2015 and accelerate deductions into 2014 to lower your 2014 tax bill. This strategy may enable you to claim larger deductions, credits, and other tax breaks for 2014 that are phased out over varying levels of adjusted gross income (AGI). These include child tax credits, higher education tax credits, and deductions for student loan interest. Postponing income also is desirable for those taxpayers who anticipate being in a lower tax bracket next year due to changed financial circumstances. Note, however, that in some cases, it may pay to actually accelerate income into 2014. For example, this may be the case where a person’s marginal tax rate is much lower this year than it will be next year or where lower income in 2015 will result in a higher tax credit for an individual who plans to purchase health insurance on a health exchange and is eligible for a premium assistance credit.
  • If you believe a Roth IRA is better than a traditional IRA, and want to remain in the market for the long term, consider converting traditional-IRA money invested in beaten-down stocks (or mutual funds) into a Roth IRA if eligible to do so. Keep in mind, however, that such a conversion will increase your adjusted gross income for 2014. If you converted assets in a traditional IRA to a Roth IRA earlier in the year, the assets in the Roth IRA account may have declined in value, and if you leave things as is, you will wind up paying a higher tax than is necessary. You can back out of the transaction by re-characterizing the conversion, that is, by transferring the converted amount (plus earnings, or minus losses) from the Roth IRA back to a traditional IRA via a trustee-to-trustee transfer. You can later reconvert to a Roth IRA, if doing so proves advantageous.
  • It may be advantageous to try to arrange with your PHO, medical group, clinic, hospital or employer to defer a bonus that may be coming your way until 2015.
  • Consider using a credit card to pay deductible expenses before the end of the year. Doing so will increase your 2014 deductions even if you don’t pay your credit card bill until after the end of the year.
  • If you expect to owe state and local income taxes when you file your return next year, consider asking your employer to increase withholding of state and local taxes (or pay estimated tax payments of state and local taxes) before year-end to pull the deduction of those taxes into 2014 if doing so won’t create an alternative minimum tax (AMT) problem.
  • Take an eligible rollover distribution from a qualified retirement plan before the end of 2014 if you are facing a penalty for underpayment of estimated tax and having your employer increase your withholding isn’t viable or won’t sufficiently address the problem. Income tax will be withheld from the distribution and will be applied toward the taxes owed for 2014. You can then timely roll over the gross amount of the distribution, i.e., the net amount you received plus the amount of withheld tax, to a traditional IRA. No part of the distribution will be includible in income for 2014, but the withheld tax will be applied pro rata over the full 2014 tax year to reduce previous underpayments of estimated tax.
  • Estimate the effect of any year-end planning moves on the alternative minimum tax (AMT) for 2014, keeping in mind that many tax breaks allowed for purposes of calculating regular taxes are disallowed for AMT purposes. These include the deduction for state property taxes on your residence, state income taxes, miscellaneous itemized deductions, and personal exemption deductions. Other deductions, such as for medical expenses, are calculated in a more restrictive way for AMT purposes than for regular tax purposes in the case of a taxpayer who is over age 65 or whose spouse is over age 65 as of the close of the tax year. As a result, in some cases, deductions should not be accelerated.
  • You may be able to save taxes this year and next by applying a bunching strategy to “miscellaneous” itemized deductions (i.e., certain deductions that are allowed only to the extent they exceed 2% of adjusted gross income), medical expenses and other itemized deductions.
  • You may want to pay contested taxes to be able to deduct them this year while continuing to contest them next year.
  • You may want to settle an insurance or damage claim in order to maximize your casualty loss deduction this year.
  • Take required minimum distributions (RMDs) from your IRA or 401(k) plan (or other employer-sponsored retired plan) if you have reached age 70- 1/2. Failure to take a required withdrawal can result in a penalty of 50% of the amount of the RMD not withdrawn. If you turned age 70- 1/2 in 2014, you can delay the first required distribution to 2015, but if you do, you will have to take a double distribution in 2015-the amount required for 2014 plus the amount required for 2015. Think twice before delaying 2014 distributions to 2015-bunching income into 2015 might push you into a higher tax bracket or have a detrimental impact on various income tax deductions that are reduced at higher income levels. However, it could be beneficial to take both distributions in 2015 if you will be in a substantially lower bracket that year.
  • Increase the amount you set aside for next year in your employer’s health flexible spending account (FSA) if you set aside too little for this year.
  • If you are eligible to make health savings account (HSA) contributions in December of this year, you can make a full year’s worth of deductible HSA contributions for 2014. This is so even if you first became eligible on Dec. 1st, 2014.
  • Make gifts sheltered by the annual gift tax exclusion before the end of the year and thereby save gift and estate taxes. You can give $14,000 in 2014 to each of an unlimited number of individuals but you can’t carry over unused exclusions from one year to the next. The transfers also may save family income taxes where income-earning property is given to family members in lower income tax brackets who are not subject to the kiddie tax.

***

Target MD

[Future IRS Targets?]

***

Year-End Tax-Planning Moves for Medical Practices & Physician Executives 

  • Medical practices, clinics and businesses should buy machinery and equipment before year end and, under the generally applicable “half-year convention,” thereby secure a half-year’s worth of depreciation deductions for the first ownership year.
  • Although the business property expensing option is greatly reduced in 2014 (unless legislation changes this option for 2014), don’t neglect to make expenditures that qualify for this option. For tax years beginning in 2014, the expensing limit is $25,000, and the investment-based reduction in the dollar limitation starts to take effect when property placed in service in the tax year exceeds $200,000.
  • Businesses may be able to take advantage of the “de minimis safe harbor election” (also known as the book-tax conformity election) to expense the costs of inexpensive assets and materials and supplies, assuming the costs don’t have to be capitalized under the Code Sec. 263A uniform capitalization (UNICAP) rules. To qualify for the election, the cost of a unit-of-property can’t exceed $5,000 if the taxpayer has an applicable financial statement (AFS; e.g., a certified audited financial statement along with an independent CPA’s report). If there’s no AFS, the cost of a unit of property can’t exceed $500. Where the UNICAP rules aren’t an issue, purchase such qualifying items before the end of 2014.
  • A corporation should consider accelerating income from 2015 to 2014 where doing so will prevent the corporation from moving into a higher bracket next year. Conversely, it should consider deferring income until 2015 where doing so will prevent the corporation from moving into a higher bracket this year.
  • A corporation should consider deferring income until next year if doing so will preserve the corporation’s qualification for the small corporation alternative minimum tax (AMT) exemption for 2014. Note that there is never a reason to accelerate income for purposes of the small corporation AMT exemption because if a corporation doesn’t qualify for the exemption for any given tax year, it will not qualify for the exemption for any later tax year.
  • A corporation (other than a “large” corporation) that anticipates a small net operating loss (NOL) for 2014 (and substantial net income in 2015) may find it worthwhile to accelerate just enough of its 2015 income (or to defer just enough of its 2014 deductions) to create a small amount of net income for 2014. This will permit the corporation to base its 2015 estimated tax installments on the relatively small amount of income shown on its 2014 return, rather than having to pay estimated taxes based on 100% of its much larger 2015 taxable income.
  • If your business qualifies for the domestic production activities deduction for its 2014 tax year, consider whether the 50%-of-W-2 wages limitation on that deduction applies. If it does, consider ways to increase 2014 W-2 income, e.g., by bonuses to owner-shareholders whose compensation is allocable to domestic production gross receipts. Note that the limitation applies to amounts paid with respect to employment in calendar year 2014, even if the business has a fiscal year.
  • To reduce 2014 taxable income, consider disposing of a passive activity in 2014 if doing so will allow you to deduct suspended passive activity losses. If you own an interest in a partnership or S corporation consider whether you need to increase your basis in the entity so you can deduct a loss from it for this year.

Assessment

These are just some of the year-end steps that you can take to save taxes. So, contact your CPA to tailor a particular plan that will work best for you. We also will need to stay in close touch in the event Congress revives expired tax breaks, to assure that you don’t miss out on any resuscitated tax saving opportunities.

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

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

I’m a 47 year old MD – Can you help me?

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cmp-program1

A Real-Life Case Model

By Ann Miller RN MHA

http://www.CertifiedMedicalPlanner.org

As a generic financial advisor, how would you answer this client prospect’s inquiry?

QUESTION: I’m a 47 year old MD – Can you help me?

TRADITIONAL ANSWER: I am a stock-broker [aka financial advisor] or insurance agent, and I sell financial products and insurance policies on a commission basis.

What do you want to buy?

CURRENT ANSWER: I am a financial planner, and I charge a percentage amount on the assets I “manage” for you. But, I have a minimum portfolio amount.

So how much money do you have to invest?

DEEP NICHE ANSWER: Yes! I am a fully CERTIFIED MEDICAL PLANNER™ practitioner.  I understand holistic financial planning for medical professionals and current health industry tumult. And, as an informed fiduciary – with transparent fees – I can help with your medical practice, business and/or personal financial planning matters.

When can we meet to discuss your needs?

***

Financial Planning MDs 2015

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

***

ENTER THE CMPs

Enter the CMPs

Conclusion

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

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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2014 Midterm Elections [Information Project VOTE Today]

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Election Day: November 4, 2014

[By iMBA, Inc and the ME-P]

dave-and-hope9We at iMBA Inc., the ME-P and WordPress.com have teamed up with the The Pew Charitable Trusts, who, along with Google, and election officials nationwide, have developed the The Voting Information Project (VIP).

Together, we’re offering cutting-edge tools that give you access to the customized information you need to cast a ballot on or before Election Day and then tell the world you voted by embedding the custom WordPress.com I Voted badge.

Click on the link below to find out more about this important iniaitive so that you and WordPress.com users across America can ensure that your voices are heard on Election Day.

Since 2004, iMBA, Inc., and WordPress have set out with an ambitious goal in mind — to democratize publishing and put state-of-the-art tools in front of publishers both large and small across the planet. We believe strongly in this vision because when more people have access to powerful tools on the web, that in-turn empowers them to do great things and publish amazing content. We feel the same way when it comes to democratizing, well, democracy — and in just a few weeks, citizens across the United States will have a unique opportunity to flex their political muscle and vote in the 2014 Midterm Elections.

For our part, we want to provide our US-based users a set of resources to help them make a smart, informed decision when it comes to who they will vote for. We also want to provide a toolkit so that they can get more information on where to vote, which issues are at stake and of course, after voting occurs, a way to show their pride and encourage others to go get out the vote.

We’ve teamed up with the good folks from The Pew Charitable Trusts, who, along with Google, and election officials nationwide, have developed the The Voting Information Project (VIP). Together, we’re offering cutting-edge tools that give voters access to the customized information they need to cast a ballot on or before Election Day. The Voting Information Project is offering free apps and tools that provide polling place locations and ballot information for the 2014 election across a range of technology platforms. The project provides official election information to voters in all 50 states and the District of Columbia and voters can find answers to common questions such as “Where is my polling location?” and “What’s on my ballot?” through the convenience of their phone or by searching the web.

The only way a set of resources will be effective is if they make it into the right hands, so if you’re eligible to vote in the US Midterm Elections, take advantage of these tools and share them with your readers.

i-voted-sticker

After you vote, either by mail, or in early voting, OR on Election Day, please embed the I Voted badge into your WordPress.com site or other blog and share it with your audience, along with friends throughout your social network. Here’s how to install the I Voted badge:

  1. Go to your blog’s dashboard.
  2. Look under the Appearance menu for the “Widgets” option.
  3. Locate the “I Voted” widget and drag it to the sidebar of your choosing.
  4. Give the widget a title (optional) and hit the save button. Your badge will now be displayed for all your readers to see.

Voting is our most fundamental responsibility as citizens — without it, our American democracy wouldn’t exist. WordPress.com is an ME-P and iMBA Inc.,  platform that gives everyday people the ability to share their voice and we’re asking you to take advantage of this voice — by exercising your right to vote. We’re asking you for your help to spread the word, encourage participation and get out the vote on November 4th, 2014.

If you have any questions, please let them in the comments and we’ll be sure you help wherever we can. Thanks!


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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The Benefits of Dentistry Unhurried

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And Medicine, too?

[By Kellus Pruitt DDS]

1-darrellpruittThe hidden truth about managed care dentistry: Unhurried dentistry is generally of higher quality than hurried dentistry; anyone up to challenging this economic law?

Dental Handiwork

Dental care includes intricate handwork performed to exacting tolerances in sensitive mouths of nervous patients. When dentists compete on discounts (fast dentistry) instead of quality (slow dentistry), fear of bankruptcy fuels the race to the bottom with clueless, vulnerable patients.

 “‘Slow medicine’ strikes a chord – Nearly 500 people — doctors, nurses and ordinary people with an interest in health care — attended a forum Thursday to hear Dr. Victoria Sweet, a physician and author, talk about how ‘slow medicine’ could improve the quality of life of patients. Sweet is Associate Clinical Professor of Medicine at University of California, San Francisco.”

Melinda Morales for the Visalia Times-Delta

[Visalia, California – October 16, 2014]

http://www.visaliatimesdelta.com/story/news/local/2014/10/17/slow-medicine-strikes-chord/17400861/

Morales writes: “When Sweet told the audience she had once wondered to herself, ‘If I could do one thing to improve the quality of health care, what would it be?’ and then followed it up with her solution, ‘I would put time back into the hands of physicians,’ the audience burst into applause.”

***

Insightful or clueless dentist?

***

Enjoy the Teeth

Dentistry is far more enjoyable for all concerned when it is not rushed in order to squeeze out a profit from unsustainable pay offered by unaccountable, conniving discount dentistry brokers … like CIGNA.

“Cigna to launch rating system that ADA calls scientifically flawed – Cigna will launch in 2015 what it calls a cost-effectiveness designation program that rates in-network dentists based on cost and utilization patterns. These ratings will appear as stars within Cigna’s provider directory. According to Cigna, dentists who receive a three-star rating have a fee schedule that results in greater potential cost savings within their geographical area.”

Kelly Soderlund

[ADA News, October 13, 2014]

http://www.ada.org/en/publications/ada-news/2014-archive/october/cigna-launches-rating-system-that-ada-calls-scientifically-flawed

Good reporting, ADA News

This isn’t the first time CIGNA has been busted for selling intentionally misinformed, captive patients discount healthcare with no quality control – depriving Americans of the opportunity to choose providers which most patients prefer. Seven years ago, CIGNA and other insurers were reprimanded for employing Ingenix, UnitedHealth Group’s wholly-owned ranking algorithm designed to drive clients from out-of-network providers to cheaper in-network providers:

“Attorney General Cuomo Announces Agreement With Cigna Creating A New National Model For Doctor Ranking Programs – NEW YORK, NY (October 29, 2007) – Attorney General Andrew M. Cuomo today announced an agreement with one of the nation’s largest health insurers, CIGNA HealthCare (NYSE: CI), as part of his industry-wide investigation into doctor ranking programs. Under the agreement, CIGNA will enhance its doctor ranking program, fully disclosing to consumers and physicians all aspects of its ranking system. Additionally, CIGNA will retain an oversight monitor known as a Ratings Examiner (‘Rx’) who will oversee compliance with all aspects of the agreement and will report to the Attorney General every six months.”

Eric T. Schneiderman

[Office of Current NY State Attorney General]

http://www.ag.ny.gov/press-release/attorney-general-cuomo-announces-agreement-cigna-creating-new-national-model-doctor

See also, “UnitedHealth Group Shenanigans – Ingenix’s Lack of Independence”

Dr. David Edward Marcinko MBA

[Medical Executive-Post, January 16, 2009]

https://medicalexecutivepost.com/2009/01/16/unitedhealth-group-shenanigans/

As you can see, history reveals that Cuomo fruitlessly reminded CIGNA that price is only one variable in “cost-effectiveness.” As dentists and their patients know, correcting careless mistakes is always more costly than doing the job right the first time with the best materials for reasonable pay.

***

slow down

***

CIGNA Speaks

Cigna spokeswoman Karen Eldred tells ADA News,

“Cigna remains committed to introducing enhancements to the mycigna.com’s dental network directory that provide customers with cost [but not quality] transparency and insights when using their dental benefits.”

If anyone in the ADA is allowed to consider non-member dentists’ advice, I would recommend publicly confronting CIGNA with an easy to document comparison of the popularity of CIGNA’s one, two and three star, cost-effective dentists with competitors using doctoroogle.com – arguably the most transparent dentist-rating site in the nation.

http://texas.doctoroogle.com/

Anyone who is interested in performing the simple, consumer-friendly study is almost certain to discover a direct correlation between the amount of time dentists can afford to invest in their work and their preference by patients in the community.

More:

Assessment

Have you ever experienced a cost-effective injection of local anesthetic?

Hurried Care?

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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Open Call for ME-P Contributors

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Call for Manuscripts, Articles, Essays, Comments or Opinions,

Dear Medical and Financial Services Colleagues, Health Economists, CPAs, JDs, Insurance Agents and Consultants,

pc

The Medical Executive-Post (ME-P), supported by iMBA Inc., with (ISSN 13: 978-1-4665-5873-1] is currently accepting manuscripts for publication.

The ME-P is an open access, multidisciplinary, international, blind peer-reviewed and non-peer-reviewed electronic forum which publishes high-quality solicited and unsolicited research, commentary, opinions, curated news and review articles in English, in all areas of Physician Focused Financial Planning, health economics, finance, accounting, medical practice management, health law, IT, policy and administration. We have over 50 topic channels.

Rapid Response Peer-Review

ME-P is a rapid response forum that publishes daily. One of our objectives is to inform contributors (authors) of the decision on their manuscript(s) within 48 hours of submission. Following acceptance, a paper would be published in the next available issue. The ME-P provides immediate open access to published articles without any barrier.

***

escalators

[ME-P Fast Review, Turn-Around and Publishing Time]

***

Broad Exposure Potential

Publishing your news, opinions or comments, essays or articles with the ME-P means that they will be available to millions of readers and researchers because our large and diverse readership base comprises millions of collaborators. Our forum supports the free downloading of published articles by scholars for use as materials for lecture, by government officials for policy making, professors, colleges, universities and educators, and by corporate researchers and FAs to selected firms and organizations world-wide.

Blog Citations

blog citations

Assessment

Also, ME-P is a member of several local and international organizations, making it possible for the far and wide distribution of published materials. We ask you to support this initiative by publishing your thoughts, comments, articles and original paper(s) 0n this forum, and in our textbooks and white-papers, etc.

More:

Authors should send their materials or manuscript(s) as attached MSFT Word files to the following email: MarcinkoAdvisors@msn.com

Best regards,

Ann Ann Miller RN MHA

[Executive-Director]

770.448.0769

http://www.MedicalExecutivePost.com

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10 Atomobile Facebook Pages to Follow

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For the Physician Aficionado

david balt 09 005[By Dr. David Edward Marcinko MBA]

[By Nalley Lexus Roswell, GA]

Remember back in the day when the only way to get information on automobiles was to buy magazines with girls in bikinis washing motorcycles on the cover? With the advent of the Internet, the two subjects were separated. With the advent of social media, the automotive information comes to you.

Top Ten

Here are 10 automotive Facebook pages that we think you might be interested in.

  1. http://www.AutoBlog.com. Interested in Andre Agassi’s customized, Hemi-powered Jeep Wrangler? If you followed Autoblog.com’s Facebook page, you’d have known it was on eBay. Not just any auto blog, Autoblog.com “obsessively” follows the automotive industry, featuring car reviews, auto shows, eBay’s find of the day, and more.
  2. WorldCarFans. WorldCarFans.com is an online magazine that features “daily editorial coverage of emerging products and industry news, spy photos, motor shows, high resolution photos, videos, and more.” Follow their Facebook page to see photos of cars you’ll probably never drive. It doesn’t hurt to dream.
  3. Car and Driver Magazine. Even those with little interest in cars other than it getting them to and from work five mornings a week know that a car that lands on the Car and Driver top automobile lists is a car worth owning. That’s just one reason the Car and Driver Facebook page is a page worth following.
  4. Motor Trend Magazine. Auto manufacturers covet the Motor Trend Car of the Year award, which is why those who want the latest automotive news covet Motor Trend’s Facebook page. Unlike winning the Motor Trend Car of the Year award, however, anyone can gain access to Motor Trend’s Facebook page.
  5. com. Conceptcarz specializes in following vehicles from concept to production. Its in-depth look at automobiles features high-interest automobiles such as the Popemobile, a 1955 Scuderia Lancia, and a 1971 Porsche Spyder as well as automobiles coming out in the next few months.
  6. comEdmunds claimsyou can “enhance your research and shopping experience by connecting with Facebook to get advice from your friends and local car experts.” In addition to researching your next car, Edmunds invites you to review your current or past vehicles.
  7. Motor Authority. Whether you own a high-performance or luxury car or just like to dream, Motor Authority is the authority to consult. Unlike similar blogs, Motor Authority focuses on the products as opposed to industry news. And unlike most Facebook friends who make things up to impress you, the cars on Motor Authority actually exist.
  8. Jalopnik. With thousands of websites and magazines on cars, it’s difficult to carve out a niche. That’s why Jalopnik has been so successful. Jalopnik is “obsessed with the cult of cars” and their Facebook page allows others with like obsession to share their opinion on topics like the coolest cars of all time that never happened, a rapper destroying his Lamborghini, and the best and worst cars you’ve driven.
  9. Autoweek. Autoweek has been online since 1995. It’s obvious their vision includes the use of newer technology to share car news, photos, reviews, and more.
  10. Road and Track. Road and Track provides car news, photos, reviews, and a car lovers community. Get behind-the-scenes peeks at luxury and cutting-edge automobiles years before they’re unveiled. Follow their Facebook page to find this information first.

*** Millionaire's Jaguar

 DEM's Jaguar

My Jaguar's engine after a steam

[Jaguar 2000 XJ V8-L Autumn Touring Sedan]

***

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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