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Beware Physicians and all Investors
[By Paladin Research]

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NPCs Info-Graphic on Comparative Effectiveness Research

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National Pharmaceutical Council

[By Staff Reporters]

The National Pharmaceutical Council’s fourth annual survey of health care stakeholders sheds some light on the environment for comparative effectiveness research (CER) and health care decision-making.

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CER-Survey

***

Questions

  • How important is CER?
  • Which organizations play key roles in the CER effort?
  • How long will it take to see the impact of CER on decision making?

Assessment

Find the answers to these questions and more in this info graphic. (Source: National Pharmaceutical Council, 2014)

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18 Financial Planning Tips For Physicians from a DR-CPA

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For Personal and Medical Practice Management Modernity

Dr. Gary Bode; CPA, MSA, CMP

By Dr. Gary L. Bode CPA MSA CMP [Hon] PA

http://garybodecpa.com/

http://www.CertifiedMedicalPlanner.org

1. Consider establishing an employee stock ownership plan (ESOP).

If you own a clinic or medical practice or business and need to diversify your investment portfolio, consider establishing an ESOP. ESOP’s are the most common form of employee ownership in the U.S. and are used by companies for several purposes, among them motivating and rewarding employees and being able to borrow money to acquire new assets in pretax dollars. In addition, a properly funded ESOP provides you with a mechanism for selling your shares with no current tax liability. Consult a specialist in this area to learn about additional benefits.

2. Make sure there is a succession plan in place.

Have you provided for a succession plan for both management and ownership of your medical practice, clinic or business in the event of your death or incapacity? Many business owners or physician-executives wait too long to recognize the benefits of making a succession plan. These benefits include ensuring an orderly transition at the lowest possible tax cost. Waiting too long can be expensive from a financial perspective (covering gift and income taxes, life insurance premiums, appraiser fees, and legal and accounting fees) and a non-financial perspective (intra-family and intra-company squabbles).

3. Consider the limited liability company (LLC) and limited liability partnership (LLP) forms of ownership.

These entity forms should be considered for both tax and non-tax reasons.

4. Avoid nondeductible compensation.

Compensation can only be deducted if it is reasonable. Recent court-decisions have allowed physician executives or business owners to deduct compensation when (1) the corporation’s success was due to the shareholder-employee, (2) the bonus policy was consistent, and (3) the corporation did not provide unusual corporate prerequisites and fringe benefits.

5. Purchase corporate owned life insurance (COLI).

COLI can be a tax-effective tool for funding deferred executive compensation, funding clinic or company redemption of stock as part of a succession plan, and providing many employees with life insurance in a highly leveraged program. Consult your insurance and tax advisers when considering this technique.

6. Consider establishing a SIMPLE retirement plan.

If you have no more than 100 employees and no other qualified plan, you may set up a Savings Incentive Match Plan for Employees (SIMPLE) into which an employee may contribute up to $12,500 per year if you’re under 50 years old and $15,500 a year if you’re over 50 in 2015. As an employer, you are required to make matching contributions. Talk with a benefits specialist to fully understand the rules and advantages and disadvantages of these accounts.

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7. Establish a Keogh retirement plan before December 31st.

If you are self-employed and want to deduct contributions to a new Keogh retirement plan for this tax year, you must establish the plan by December 31st. You don’t actually have to put the money into your Keogh(s) until the due date of your tax return. Consult with a specialist in this area to ensure that you establish the Keogh or Keoghs that maximize your flexibility and your annual contributions.

8. Section 179 expensing.

Businesses and medical practices may be able to expense up to $25,000 in 2015 for equipment purchases of qualifying property placed in service during the filing year, instead of depreciating the expenditures over a longer time period. The limit is reduced by the amount by which the cost of Section 179 property placed in service during the tax year 2015 exceeds $200,000.

9. Don’t forget deductions for health insurance premiums.

If you are self-employed (or are a partner or a 2-percent S corporation shareholder-employee) you may deduct 100 percent of your medical insurance premiums for yourself and your family as an adjustment to gross income. The adjustment does not reduce net earnings subject to self-employment taxes, and it cannot exceed the earned income from the business under which the plan was established. You may not deduct premiums paid during a calendar month in which you or your spouse is eligible for employer-paid health benefits.

10. Review whether compensation may be subject to self-employment taxes.

If you are a sole proprietor, an active partner in a partnership, or a manager in a limited liability company, the net earned income you receive from the entity may be subject to self-employment taxes.

11. Don’t overlook minimum distributions at age 70½ and rack up a 50 percent penalty.

Minimum distributions from qualified retirement plans and IRAs must begin by April 1 of the year after the year in which you reach age 70½. The amount of the minimum distribution is calculated based on your life expectancy or the joint and last survivor life expectancy of you and your designated beneficiary. If the amount distributed is less than the minimum required amount, an excise tax equal to 50 percent of the amount of the shortfall is imposed.

12. Don’t double up your first minimum distributions and pay unnecessary income and excise taxes.

Minimum distributions are generally required at age seventy and one-half, but you are allowed to delay the first distribution until April 1 of the year following the year you reach age seventy and one-half. In subsequent years, the required distribution must be made by the end of the calendar year. This creates the potential to double up in distributions in the year after you reach age 70½. This double-up may push you into higher tax rates than normal. In many cases, this pitfall can be avoided by simply taking the first distribution in the year in which you reach age 70½.

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buckets cash

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13. Don’t forget filing requirements for household employees.

Employers of household employees must withhold and pay social security taxes annually if they paid a domestic employee more than $1,900 a year in 2015 (same as 2014). Federal employment taxes for household employees are reported on your individual income tax return (Form 1040, Schedule H). To avoid underpayment of estimated tax penalties, employers will be required to pay these taxes for domestic employees by increasing their own wage withholding or quarterly estimated tax payments. Although the federal filing is now required annually, many states still have quarterly filing requirements.

14. Consider funding a nondeductible regular or Roth IRA.

Although nondeductible IRAs are not as advantageous as deductible IRAs, you still receive the benefits of tax-deferred income. Note, the income thresholds to qualify for making deductible IRA contributions, even if you or your spouse is an active participant in a employer plan, are increasing.

The $100,000 income test for converting a traditional IRA to a ROTH IRA was permanently eliminated in 2010, allowing anyone to complete the conversion.

You can withdraw all or part of the assets from a traditional IRA and reinvest them (within 60 days) in a Roth IRA. The amount that you withdraw and timely contribute (convert) to the Roth IRA is called a conversion contribution. If properly (and timely) rolled over, the 10 percent additional tax on early distributions will not apply. However, a part or all of the distribution from your traditional IRA may be included in gross income and subjected to ordinary income tax.

Caution: You must roll over into the Roth IRA the same property you received from the traditional IRA. You can roll over part of the withdrawal into a Roth IRA and keep the rest of it. However, the amount you keep will generally be taxable (except for the part that is a return of nondeductible contributions) and may be subject to the 10 percent additional tax on early distributions.

15. Calculate your tax liability as if filing jointly and separately.

In certain situations, filing separately may save money for a married couple. If you or your spouse is in a lower tax bracket or if one of you has large itemized deductions, filing separately may lower your total taxes. Filing separately may also lower the phase out of itemized deductions and personal exemptions, which are based on adjusted gross income. When choosing your filing status, you should also factor in the state tax implications.

16. Avoid the hobby loss rules.

If you choose self-employment over a second job to earn additional income, avoid the hobby loss rules if you incur a loss. The IRS looks at a number of tests, not just the elements of personal pleasure or recreation involved in the activity.

17. Review your will and plan ahead for post-mortem tax strategies.

A number of tax planning strategies can be implemented soon after death. Some of these, such as disclaimers, must be implemented within a certain period of time after death. A number of special elections are also available on a decedent’s final individual income tax return. Also, review your will as the estate tax laws are influx and your will may have been written with differing limits in effect. In 2015, estates of $5,430,000 (up from $5,340,000 in 2014) are exempt from the estate tax with a 40 percent maximum tax rate (made permanent starting in tax year 2013).

18. Check to see if you qualify for the Child Tax Credit.

A $1,000 tax credit is available for each dependent child (including stepchildren and eligible foster children) under the age of 17 at the end of the taxable year. The child credit generally is available only to the extent of a taxpayer’s regular income tax liability. However, for a taxpayer with three or more children, this limitation is increased by the excess of Social Security taxes paid over the sum of other nonrefundable credits and any earned income tax credit allowed to the taxpayer. For 2015 (as in previous years), the income threshold is $3,000.

For more information concerning these financial planning ideas, please call or email us.

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ABOUT  DR. GARY L. BODE MSA CPA CMP [Hon]

Dr. Gary L. Bode was Chief Executive Officer of Comprehensive Practice Accounting, Inc., a firm specializing in providing tax solutions to medical professionals. Originally, he was a board certified podiatrist and managing partner of a multi-office medical practice for a decade before earning his Master of Science degree in Accounting from the University of North Carolina. He then served as Chief Financial Officer [CFO] for a private mental healthcare facility. Today, Dr. Bode is a nationally known Certified Public Accountant, financial author, educator, and speaker. Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings, and innovative financial accounting as well as proactive tax positioning and tax return preparation for healthcare facilities. He has been quoted in Newsweek.

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What is a Rapid Learning Health System?

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The RLH – From Concept to Action

[By Staff Reporters]

According to Greene, Reid and Larson, clinicians and health systems are facing widespread challenges, including changes in care delivery, escalating health care costs, and the need to keep up with rapid scientific discovery.

Re-organizing U.S. health care and changing its practices to render better, more affordable care requires transformation in how health systems generate and apply knowledge. The “rapid-learning health system” is posited as a conceptual strategy to spur such transformation – leverages and recent developments in health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes to promote innovation and health system change on the basis of rigorous research.

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TLHCS

[A Rapid Learning Health System]

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The Essay

This article describes an evolving learning health system at Group Health Cooperative, the 6 phases characterizing its approach, and examples of organization-wide applications.

Link: http://www.ncbi.nlm.nih.gov/pubmed/22868839

It is a practical model that promotes bidirectional discovery and an open mind at the system level, resulting in willingness to make changes on the basis of evidence that is both scientifically sound and practice-based.

Assessment

Rapid learning must be valued as a health system property to realize its full potential for knowledge generation and application.

Citation

Implementing the learning health system: from concept to action. Greene SM1, Reid RJ, Larson EB. Author information: Group Health Cooperative, 320 Westlake Avenue North, GHQ E2N, Seattle, WA 98109, USA. greene.sm@ghc.org

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More: http://onlinelibrary.wiley.com/doi/10.1002/hast.134/abstract

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Take the Geneia “Joy of Medicine” Challenge

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Bryan Vartabedian, MD's avatar By Bryan Vartabedian MD

It’s a fact, there’s not a lot of joy out there among today’s physicians. 84 % of you report that ‘quality patient time’ may be a thing of the past. And, 67 % of you know a colleague who’s actually thinking about giving it all up.

Timeline

  • about 2 months until voting ends on Wednesday, May 13th, 2015 at 7:00 PM

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hospital

VOTING LINK HERE:

https://medstro.com/groups/joy

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Assessment

At Geneia,we’re working hard to find the answers. And; we need a second opinion — yours. Submit your ideas to the Geneia Joy of Medicine Challenge today!

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ABOUT

Dr. Bryan Vartabedian is considered one of health care’s most influential voices on technology and medicine. His insight and thought leadership has made him a sought after keynote speaker in the area of medicine and new media. Dr. V has developed unique expertise in understanding how new media can be leveraged by organizations and individual stakeholders in health care. He consequently has served on the advisory board of Stanford’s Medicine X conference and currently serves on the External Advisory Board of the Mayo Clinic Center for Social Media. Dr Vartabedian currently serves as a founding advisor to the Health Care Track at the SXSW Interactive Festival. You can find him quoted in outlets such as The Wall Street Journal, The New York Times, US News and World Report and CNN.

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Women Retirement Confidence

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Financial Preparation

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

Rick Kahler MS CFPWhen it comes to being financially prepared for retirement, Chinese women are the most confident women in the world. In fact, they are almost twice as confident as their US counterparts.

The Survery

This conclusion comes from a 2014 global survey, the Aegon Retirement Readiness Index. It found that the percentage of women saying they are very confident or extremely confident about retirement is 42% in China, 35% in India, 29% in Brazil, 22% in the US, and 18% in Canada.

The survey included responses from 16,000 employees and retirees in 15 countries, half of whom were women. About 62% of the women were married, 52% had some higher education, and 80% took an active role in managing the household finances.

The Insights

Several aspects of this survey really caught my attention:

  • I was puzzled that only two developed countries—the US and Canada—made the top five. The first three—China, India, and Brazil—were  emerging markets with little or no social safety nets in place.
  • Even more notable is that, in the US and Canada, the number of women who do not feel prepared to retire (38% in the US and 36% in Canada) is almost twice as high as the number that are confident about retirement.
  • And more notable yet is that the bottom five includes three developed countries with strong social safety nets. In France, Japan, and Spain, less than 6% of women reported retirement confidence, while 60% or higher said they had no confidence.

It seems puzzling that the countries with large social safety nets spawned less retirement confidence than did developed countries with little or no safety net. Why isn’t it the opposite? Why aren’t women in countries where government plays a big part in retirement income more confident?

The Answer?

Therein may lay the answer. Possibly because of the lack of government retirement programs, people in the emerging market countries like China, India, and Brazil realize they cannot count on anyone but themselves in retirement. They know they must begin saving a significant amount of their income, starting early in life, to be able to sustain themselves in retirement. A failure to do so will result in them literally being “thrown out onto the street” or into the “poor house.” As harsh as that may sound to our Western ears, the reality must be a powerful motivator.

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Depression

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The Reality

This reality was brought home to me by two people I met on visits to China and India. One Chinese woman in her 20’s told me she saved a third of her income. She said, “People in America don’t need to save. China doesn’t have the social safety nets you have.” Part of surviving in their society is to learn money skills and how to save early in life for emergencies and retirement. A man I met in India told me much the same story; he had his retirement fully funded by age 45.

In the US and most other developed countries, government programs like Social Security have become the retirement plan of the masses. Yet the majority of women in developed countries don’t seem to find comfort in those programs.

However, neither do they save like their emerging market counterparts. In fact, 56% of Americans live hand to mouth, according to a 2005 survey of retirement savings for baby boomers and others, by Sharon A. Devaney and Sophia T. Chiremba, reported at the US Bureau of Labor Statistics [USBLS].

Assessment

What might motivate women globally to gain confidence in their retirement preparedness? I don’t know. But based on the results of this survey, the answer won’t be found in more government programs.

Conclusion

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Meet Next-Gen Healthcare Powered by the Industrial Internet

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This is Your Body Online

[By GE Healthcare IT]

A couple of years ago, the Kadlec Health System in Washington State started testing a new cloud-based technology that mashes up professional networking and diagnostics. The system allows doctors to create a professional profile, store patient images and data together in one place, view them from anywhere and access intuitive analytics.

“It’s like LinkedIn professional networking meets diagnostic imaging,” said Jeanine Banks, general manager of Commercial Cloud Solutions at GE Healthcare IT, which developed the technology. “There is a lot of waste in the system. We want to help rein in the costs and make the system far more efficient.”

A study published in the Journal of American Medical Association found that almost 40 percent of patients are misdiagnosed in primary care [1]. Another report by the American College of Physicians discovered that unnecessary testing and medical procedures, and extra days in the hospital caused by wrong diagnoses could add up to $800 billion per year, close to one-third of all U.S. healthcare costs [2].

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At a panel of experts, John Dineen, president and CEO of GE Healthcare, Bill Ruh, who runs GE’s Global Software Center, and Michael Leavitt, the former secretary of U.S. Health and Human Services discussed the state of American healthcare and the ways to improve it with technology. Their panel, which was moderated by technology investor and philanthropist Esther Dyson, was part of GE’s conference focused on IT in healthcare.

Ruh and Dineen reminded everyone that over the last two decades many consumer-facing industries got thoroughly remade and that healthcare won’t be different. “There was an architectural shift of technology,” Ruh said. “We changed how we deliver and interact with music and books.”

Dineen said that the healthcare landscape was also changing “from cost plus to profit and loss. The consumer will start making buying decisions,” Dineen said. “There’s going to be transparency. There is going to be a real focus on productivity and customer satisfaction and that’s going to require tremendous investment …The industry will pivot over the next few years.”

Industrial Internet systems like the GE technology that’s now working at Kadlec will be one driver of change. But, former Sec. Leavitt said collaborative tools that bring together patients, insurers and providers will help distribute the risk associated with healthcare costs.

“Exchanges will allow consumers to make trade-offs,” Leavitt said. “If you stay with me and get your body in a better shape, I’ll give you a better [insurance] price.”

***

tumblr_inline_nhs0a2MZUr1qzgziy

***

Next-generation healthcare will also focus on outcomes. Dineen said that engineers used to be concerned chiefly with building better machines and “taking the technology to the next level.” But, medical systems in the future will have to combine high quality and lower costs with results.

Dineen and Ruh stressed the need to focus on predictive analytics, which has started empowering other industries. Dineen said that in aviation, Industrial Internet systems can already see “a signature of a problem and get it fixed when [the aircraft] comes to a shop and not on a mountain top.”

“It’s not that you get this magic answer that something is going to break,” Ruh said. “You get early indicators. You still need to have experts in the loop.”

Dineen said that right now, the healthcare industry was going through “this clumsy period when the incentives have not kicked in” yet. He listed three stages of the IT revolution in healthcare that need to take place. They include connecting machines and digitizing data, getting data from siloes like primary care providers, as well as the “rich stage,” which involves analysis and learning from the data.

Assessment

Researchers estimate that the majority of healthcare costs stem from preventable chronic health conditions rather than disease prevention and early detection. Dineen called the status quo “unproductive.” The new system will have the rewards and the incentives to change that, he said.

Citations:

1 Journal of American Medical Association 2012

2 Reuter’s, citing study by American College of Physicians

Conclusion

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Seeking Authors by “Crowd-Sourcing” our Proposed Medical Marketing TextBook

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MEDICAL PRACTICE MARKETING MANAGEMENT, ADVERTISING, SALES, COMMUNICATION AND SOCIAL MEDIA SKILLS

[New-Wave Success Strategies for Savvy Doctors]

***

[By Dr. David Edward Marcinko MBA CMP]

[By Prof Hope Rachel Hetico RN MHA CMP]

dave-and-hope10

Dear ME-P Readers and Subscribers,

No – We’ve not been in blog-silence mode lately.

Instead, we’ve been hard at work on our soon-to-be-released and major new 800 page print text book:

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

A Recent Project

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

***

And now, we are just working on our newest book proposal: MEDICAL PRACTICE MARKETING MANAGEMENT, ADVERTISING, SALES, COMMUNICATION AND SOCIAL MEDIA SKILLS – [New-Wave Success Strategies for Savvy Doctors]. © IMBA, Inc. All rights reserved.

Format and Style

This is the most journalistic styled book we’ve ever attempted. We’ve already completed about 10 chapters that need updating. They are all fascinating. So, it seems a shame to leave so much great stuff on the cutting room floor. Therefore, we are seeking about 12-15 additional de-novo chapters from you, our esteemed ME-P readers and subscribers.

Crowd-Sourcing the Book

Therefore, for the next few months we will be soliciting author-experts and contributions via this on-line Crowd Sourcing campaign to either update existing chapters; or submit totally new chapters, success stories and essays.

Of course, the existing chapters are more traditional in nature; while de-novo contributions will be more new-wave, innovative and grounding-breaking in their thought leadership marketing ideas.

We are Hoping you Can Help Us

If you have deep knowledge, experience or education in medical marketing; or an amazing story about how new sales, PR or modern channels of advertising distribution [electronic age] are transforming and changing your medical practice, clinic or hospital for the better; please do let us know. Either by posting a comment or emailing Ann, directly.

Tenor and Tone

These kinds of chapters can help bring a subject to life. To give you a sense of the range of topics we’ll be covering, as well as the book’s tone, we’ve pasted below a tentative draft of the Table of Contents. If all goes well, the print hardcover textbook it will be published in about a year.

Table of Contents: © IMBA, Inc. All rights reserved.

TOC(1)

Format Specs and Style Sheet: © IMBA, Inc. All rights reserved.

Author SPECS(1)

Recent ME-P Works: © IMBA, Inc. All rights reserved.

ME-P Text Books

Our Deep Healthcare Niche Notoriety

And, our books have used by professional organizations like the Medical Group Management Association (MGMA), American College of Medical Practice Executives (ACMPE), American College of Physician Executives (ACPE), American College of Emergency Room Physicians (ACEP), Health Care Management Associates (HMA), and PhysiciansPractice.com;

and by academic institutions like the UCLA School of Medicine, Northern University College of Business, Creighton University, Medical College of Wisconsin, University of North Texas Health Science Center, Washington University School of Medicine, Emory University School of Medicine, and the Goizueta School of Business at Emory University, University of Pennsylvania Medical and Dental Libraries, Southern Illinois College of Medicine, University at Buffalo Health Sciences Library, University of Michigan Dental Library, and the University of Medicine and Dentistry of New Jersey, among many others.

All are archived in the Library of Congress, Institute of Health and Library of Medicine.

More on the ME-P Publishing Service

Assessment

Regardless of your decision to contribute, we remain apostles promoting our mutual core interests whenever possible.  And, we are all doing our best to make it a fascinating and important book, and appreciate your help.

If interested in contributing, updating or as a peer reviewer; please contact Ann:

Ann Miller RN MHA [Project Manager]

Institute of Medical Business Advisors, Inc.

MarcinkoAdvisors@msn.com

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

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

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

Five Most Costly Domestic Surgeries

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USA Aggregate Hospital Stays for 2011

By http://www.MCOL.com

ImageProxy

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On Physicians and Automobile Leases

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Advantages, Disadvantages and Types

[By Dr. David Edward Marcinko MBA CMP™]

Dr. Marcinko 1972 VetteThe Rites of Spring!

As a former licensed state insurance agent, and financial advisor, I know that leasing a car may have advantages to a physician – and others – such as convenient maintenance, low down and monthly payments, no resale responsibility, and tax savings since you pay sales tax on the lease portion rather than the purchase price of the car.

It might also be worthwhile if the after tax borrowing cost of a home equity loan is less than the lease financing rate.

***

Spring 2011 - NIH

[First Days of Spring 2017]

May Day Weekend 2011 [Dr. David E. Marcinko MBA]

***

Types of Leases

There are two major types of leases: open and closed ended. In the former type, if the car is worth more than the set price upon expiration of the lease, you are responsible for the underage or coverage. In the more advantages later type, the responsibility of the value of the car is shifted to the leasing company. Other tips on care leasing include:

  • Inform the lessor how you want the auto equipped; do not accept unwanted options.
  • Obtain all delivery, and other, charges in advance, including down payment, security.
  • Deposit, registration fees, interest rates, residual value, rebates and all taxes (sales, personal property, use and gross receipt).
  • Know the capitalized cost (selling price) of the car
  • Know annual mileage limits, usually 15-18,000 miles, and all excess use charges.
  • Avoid maintenance and service contracts, and arrange for your own insurance.
  • Understand that terms, such as money factor, or interest factor, may be used instead of the term interest rate. In this case, simply multiple the rate by 24 for an estimate of the true interest rate involved.
  • Read the contract and understand all penalties, especially for premature or late termination, purchase or return terms, and consequences of theft.
  • Check the lease terms through an independent company, such as First National Lease Systems.

Rough Rules of Thumb

A rough rule of thumb to determine whether to buy or lease involves multiplying all the payments required by the number of months you will have to pay, and add the down payment to yield the total amount of the purchase. Then, multiply the lease payment by the number of months, and add required up-front costs, as well as residual value (end of lease buyout cost), to determine the total amount to lease. Compare the two figures to determine the most economical deal.

Typically, a cash deal is less expensive in the long run, providing a higher after tax rate of return is not available, as an alternate investment, for the funds.

***

Jaguar Touring sedan XJ-V8-LWB***

Dis-Advantages

But, there are dis-advantages to auto leasing, too!

Perhaps the worse reason to lease a car is to drive one that you could not otherwise afford to drive. This is because most low monthly payments are only composed of two portions: interest on the note and the prorated cost of auto depreciation. No money is applied to ownership of the vehicle.

Assessment

Finally, beware Spring-Fever and do not likely buy “gap” insurance to cover the difference between what your auto insurer would pay if your car was totaled, and what you would owe the leasing firm. It’s usually too expensive and the risk is minimal.

More:

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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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***

On the FBI’s Medicare Fraud Strike Forces

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$6.5 Billion in Cash

Edward Bukstel

[By Edward Bukstel]

ME-P SPECIAL REPORT

FBI’s Medicare Fraud Strike Forces Strikes $6.5 Billion in Cash.

***

Miami based Home Health Agency owner guilty of Medicare fraud,  The Medicare Fraud Strike Force since its inception in March 2007, is now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion.

***

benjamin-bills3

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 In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

***

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***

Money

***

More:

Conclusion

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More on “Passive Investing” for Physicians

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Basic Financial Concepts

tim

By Timothy J. McIntosh; CFPMBA MPH CMP [hon]

By Jeffery S. Coons; PhD CFA

By Dr. David E. Marcinko; MBA CMP™

Passive investing is a monetary plan in which an investor invests in accordance with a pre-determined strategy that doesn’t necessitate any forecasting of the economy or an individual company’s prospects.

Premise

The primary premise is to minimize investing fees and to avoid the unpleasant consequences of failing to correctly predict the future. The most accepted method to invest passively is to mimic the performance of a particular index. Investors typically do this today by purchasing one or more ‘index funds’. By tracking an index, an investor will achieve solid diversification with low expenses.  Thus, a physician-investor could potentially earn a higher rate of return than an investor paying higher management fees.

Passive management is most widespread in the stock markets.  But; with the explosion of exchange traded funds on the major exchanges, index investing has become more popular in other categories of investing. There are now literally hundreds of different index funds.

***

Bull Markets

[Domestic Bull Markets – Historical USA]

***

Passive management is based upon the Efficient Market Hypothesis theory.  The Efficient Market Hypothesis (EMH) states that securities are fairly priced based on information regarding their underlying cash flows and that investors should not anticipate to consistently out-perform the market over the long-term.

The Efficient Market Hypothesis evolved in the 1960s from the Ph.D. dissertation of Eugene Fama.  Fama persuasively made the case that in an active market that includes many well-informed and intelligent investors, securities will be appropriately priced and reflect all available information. If a market is efficient [even emerging and/or world markets], no information or analysis can be expected to result in outperformance of an appropriate benchmark.

***

World Markets

[USA versus World Index]

***

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The Author

Timothy J. McIntosh is Chief Investment Officer and founder of SIPCO.  As chairman of the firm’s investment committee, he oversees all aspects of major client accounts and serves as lead portfolio manager for the firm’s equity and bond portfolios. Mr. McIntosh was a Professor of Finance at Eckerd College from 1998 to 2008. He is the author of The Bear Market Survival Guide and the The Sector Strategist.  He is featured in publications like the Wall Street Journal, New York Times, USA Today, Investment Advisor, Fortune, MD News, Tampa Doctor’s Life, and The St. Petersburg Times.  He has been recognized as a Five Star Wealth Manager in Texas Monthly magazine; and continuously named as Medical Economics’ “Best Financial Advisors for Physicians since 2004.  And, he is a contributor to SeekingAlpha.com., a premier website of investment opinion. Mr. McIntosh earned a Bachelor of Science Degree in Economics from Florida State University; Master of Business Administration (M.B.A) degree from the University of Sarasota; Master of Public Health Degree (M.P.H) from the University of South Florida and is a CERTIFIED FINANCIAL PLANNER® practitioner. His previous experience includes employment with Blue Cross/Blue Shield of Florida, Enterprise Leasing Company, and the United States Army Military Intelligence.

Conclusion

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Understanding State Medical Board Structures

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 “The Tale of Two Boards”

[By Eric A. Dover MD]

[By Michael Lawrence Langan MD]

SOAR

***

The great majority of States have in reality two Medical Boards. All States have a “Board Proper” and all but a handful have an “Administrative Board”.

First Board

The “Board Proper” is, depending on the State, made up of seven to sixteen individuals. There will be a President (Chairperson) and President Elect. The Board Members are “volunteers”, typically placed by the State Governor. The individuals who constitute the Board may vary greatly and are somewhat determined by the medical disciplines overseen by the Medical Board. Oklahoma presently separates Medical Doctors (M.D.) and (D.O.) into two Boards http://www.okmedicalboard.org/

Other Medical Boards may oversee Physician Assistants (P.A.), Midwives, Respiratory Therapists, Podiatrists, Athletic Trainers, etc., who may or may not have direct Board representation. All States have M.D.s on the Board, and some Boards are all M.D.s. Others members of the Board may include D.O.s, P.A.s, Podiatrists, Midwives, Respiratory Therapists, a representative from the Secretary of State’s office, the Commissioner of State Boards or an Educational Director. Many, but not all Medical Boards, will have anywhere from one to three Public Members.

Some States require Public Member(s) come from a specific profession such as a lawyer or hospital administrator. Other States have no such qualifications; therefore the Public Member can be from any profession.

Second Board

The “Administrative Board” is the other Medical Board. They run the operation throughout the year. Their personnel, structure and operation vary widely from State to State.

Most States will have an Executive Director who supervises the Board.   Some states, such as New Mexico http://www.nmmb.state.nm.us/ or Indiana http://www.in.gov/pla/3638.htm, use a State Board Director for all boards, and don’t have a specific Executive Director.

Pennsylvania uses a State Administrator in lieu of an Executive Director. Individuals filling these positions are either legally or administratively trained.

http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/default.aspx#.VOO-ZfZ0zIU

Many States have a Medical Director. They are physicians whose tasks, for example, may include working with Investigators, lending medical expertise or working on Board Committees. Many other State Medical Boards, such as Delaware don’t have one. http://dpr.delaware.gov/boards/medicalpractice/members.shtml

Medical Boards are divided regarding in-house Legal Staff. Oregon has in-house legal staff, but also relies upon a single Assistant Attorney General from the State Department of Justice   http://www.oregon.gov/OMB/Pages/index.aspx.

In Pennsylvania, all State Boards use the Office of General Council for legally related issues. http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/default.aspx#.VOO-ZfZ0zIU.

***

professor

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Assessment

Each State handles their Medical Board investigations differently. Some have in-house investigators. They may be ex-police officers, which are common, but they don’t have to be.

California’s Investigators are called “Peace Officers” and they aren’t typically ex-police http://www.mbc.ca.gov/

In North Dakota, the Board Members act as the investigative staff and will hire outside investigators if necessary https://www.ndbomex.org/

In Delaware, investigations are handled for all Boards by the Division of Professional Regulation http://dpr.delaware.gov/boards/medicalpractice/members.shtml.

About the Authors

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

Dr. Michael L. Langan graduated from Oregon Health Sciences University School of Medicine, Portland Oregon as a Medical Doctor 21 years ago. He had his residency training of Geriatric Medicine-Internal Medicine at Beth Israel Deaconess Medicine Center and Internal Medicine at St Vincent Hospital Medicine Center.

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Conclusion

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

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Investment Adviser v. Mutual Fund Manager

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“What’s the difference … and why pay fees to both?”

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

Rick Kahler MS CFPQuestions – from doctors – like these remind me that the workings of the financial services industry which I tend to take for granted but can be confusing to people outside the field.

The following analogy may help to explain.

Orchestra Analogy

Think of an orchestra. The investment adviser is the equivalent of the director/conductor and the money managers are the instrumentalists. Each one is a specialist who plays a particular type of instrument, and it takes a variety of these specialists to make up the orchestra.

Specialists

The broad specialties are the types of instruments, such as strings, brass, winds, and percussion. These are the equivalent of fund managers who specialize in asset classes like equities, bonds, real estate, commodities, and absolute returns.

Sub-Specialists

Within each specialty are a variety of subspecialists. Winds, for example, include clarinets, oboes, and saxophones—which are further divided into alto, soprano, tenor, and bass. The brass section has French horns, trumpets, and trombones. The divisions and sub-divisions go on and on. Similarly, within the various asset classes are a great many mutual fund managers who specialize in narrower subcategories.

Conductor

The task of the orchestra conductor-director is to pick, not just the best musicians, but the best mix of musicians. A group with only trumpets or every subspecialty of percussion, no matter how skilled, isn’t an orchestra. Before auditioning a single musician, the director’s first task is to clarify the purpose of the ensemble being created. A different mix of instruments will be required for a symphony, a marching band, an intimate chamber group, or a dance band. It all depends on what the audience wants.

The conductor-director needs to weigh the various musicians’ abilities against their cost and their specific specialties against the needs of the orchestra. When the right mix of players has been chosen, the director needs to pick the appropriate music, assemble the group, and rehearse. The director’s talent, experience, and leadership skills all serve to help the right players produce the right sound for their audiences.

***

globe

***

It takes similar coordination and skill to put together the right mix of asset classes and mutual fund managers to produce the best results for various clients, especially since there are some 17,000 mutual funds to choose from.

Fees

Just as both the orchestra director and the musicians are paid based on their skills and their work, both mutual fund managers and investment advisers are paid based on the assets they manage. Mutual fund managers earn 0.05% to 3.0%. Financial advisers earn 0.30% to 3.0%. An informed consumer could pay as low as 0.35% while an uninformed consumer could pay up to 6% a year, which would eat up most of the investment returns.

One essential responsibility for an adviser, then, is to choose mutual fund managers whose fees are low.

However, the cost of the mutual fund manager isn’t the be-all and end-all. One must also weigh performance, just as an orchestra director might pay more to get an outstanding musician who would add significant value to the performances.

Example:

For example, my firm’s overall average fee for mutual fund managers is 0.5%. We could get that as low as 0.1%, which might be impressive at first glance.

However, we would give up 0.25% to 1.00% of net return in some areas, resulting in poorer outcomes for the clients.

***

INV_03_15_XMIT.indd

***

Assessment

Skilled direction of an orchestra is obviously more art than science. Skilled coordination of mutual fund managers is the same. Both require knowledge, integrity, and commitment to the quality of the final product.

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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:

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

Understanding the National Practitioner Data Bank (NPDB)

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What it Is – How it Works?

[By Eric A. Dover MD]

The NPDB, also known as the Data Bank, was written into HCQIA [Health Care Quality Indicators].  It is the national database for all physician reports.

Reporting Entities

Entities that are required to report physicians to this government program are:

  • Medical malpractice payers
  • State health care practitioner licensing and certification authorities
  • Hospitals
  • Other health care entities with formal peer review (HMOs, group practices, managed care organizations)
  • Professional societies with formal peer review
  • Federal and State Government agencies
  • Health insurance companies
  • The information collected by the NPDB includes:
  • Medical malpractice actions against a healthcare provider
  • Any adverse licensure actions by Medical Boards or peer review entities, including revocation, reprimand, censure, suspension, probation or dismissal or closure of any proceedings by reason of the practitioner surrendering the license or leaving the State or jurisdiction.
  • Adverse clinical privileging actions
  • Adverse professional society membership actions
  • Private accreditation organization negative actions or findings against health care practitioners
  • Criminal convictions that are health care-related
  • Exclusions from Federal or State health care programs
  • Entities that can query the NPDB include:
  • Hospitals, health care entities and professional societies with formal peer review
  • State health care practitioner licensing and certification authorities
  • Agencies or contractors administering Federal health care programs
  • State agencies administering State health care programs
  • State Medicaid Fraud Units
  • U.S. Comptroller General, U.S. Attorney General and other law enforcement
  • Self query by health care practitioner
  • Plaintiff’s attorney/pro se plaintiffs, but under limited circumstances
  • “Quality Improvement Organizations”
  • Researchers (statistical data only)
  • Federal and State Government agencies
  • Health plans
  • Researchers (Statistical data only)

Source: http://www.npdb.hrsa.gov/

***

npdb

***

Physician Reportage

Once a physician is reported to the NPDB, their career, if they still have one, is dramatically changed forever.  There is no expungement process to remove defamatory physician reports, whether true or not.  The stain is there forever.  You have the opportunity to write a rebuttal for what it’s worth.  Actions reported to the National Practitioner Data Bank by one entity will most likely trigger cross investigations and actions by other entities.

Source: http://www.drlaw.com/Articles/White-Paper—The-Targeting-of-Physicians—Insigh.aspx

Assessment

It is easy to extrapolate the simplicity of destroying a physician’s career, psyche and family with the untenable protections afforded by HCQIA to those responsible for the destruction.

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About

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

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

The Impact of Medical Identity Theft on Health Care

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Health Plan Related Breaches Since 2009

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Is there a Migration of Patients to Paper-Based Dentists?

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Paper Medical Records Become Popular Again?

[By Kellus Pruitt DDS]

1-darrellpruitt

Starting long ago, I warned that as more dental patients are notified of data breaches – some more than once – we are likely to witness an event mandate stakeholders said would never happen: A migration of patients to paper-based dentists.

Now, because of the rapidly escalating costs and liabilities, defiant, slow adopters of electronic dental records [EDRs] can not only expect to provide dental care at a lower cost than “paperless practices,” but patients are on course to learn that some dentists do not put their patients at risk of medical identity theft by putting identities on computers.

Just sit back and watch!

The Ponemon Institute

In February, the Ponemon Institute published  their “Fifth Annual Study on Medical Identity Theft.”

 “Consumers expect healthcare providers to be proactive in preventing and detecting medical identity theft. Although many respondents are not confident in the security practices of their healthcare provider, 79 percent of respondents say it is important for healthcare providers to ensure the privacy of their health records. Forty-eight percent say they would consider changing healthcare providers if their medical records were lost or stolen. If such a breach occurred, 40 percent say prompt notification by the organization responsible for safeguarding this information is important.”

The Paper-Gold Standard? 

So if your patients start asking you not to put their identities – including medical records – on your computers, what will you do, Doc?

Since encryption is a non-starter in dentistry for solid, business reasons, and will make paperless practices even less competitive with paper-based, would you consider employing staff which knows how to use pegboard, ledger cards and lots of carbon paper (The gold standard of security)?

Or, would you prefer not to give up computerization, yet keep your patients safe?

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Assessment

De-identification of primary electronic dental records is sounding better all the time. Am I right? If patients’ identities are not available, they cannot be hacked.

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Socio Economic Status, Payment Reform and Medical Records

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Yet Another Component of the Medical Record?

[Dr. David Edward Marcinko MBA CMP™]

http://www.CertifiedMedicalPlanner.org

Dr David E Marcinko MBAHistorically, medical records [paper or electronic] were previously used to aid in the quality of medical care.

Now they are also the basis for payment for services, not as a record or reflection of the care that was actually provided, but as a separate justification for billing. The lack of appropriate documentation now no longer threatens just non-payment for services but risks civil money penalties and criminal charges.

Enter S.E.S.

Today, the idea known as Socio Economic Status [SES] is conceptualized as the social standing, or class of an individual or group. It is often measured as a combination of education, income and occupation. Examinations of socioeconomic status often reveal inequities in access to medical resources, plus issues related to privilege, power and control.

Assessment

SES is increasingly being considered as another payment component [CPT® codes] to medical providers, as reflected in the paper medical record, EMR and elsewhere.

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eMRs

[Electronic Medical Records]

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How Stock-Brokers Execute Trades

What Every Physician-Investor Should Know

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And … Why Trade Execution Isn’t Instantaneous!

By Dr. Gary L. Bode MSA CPA CMP [Hon]; PC

Dr. Gary Bode; CPA, MSA, CMP

Many physician investors who trade through online brokerage accounts assume they have a direct connection to the securities markets.

But, they don’t. When you press “enter,” your order is sent over the Internet to your broker – who in turn decides which market to send it to for execution. A similar process occurs when you call your broker to place a trade.

While trade execution is usually seamless and quick, it does take time. And prices can change quickly, especially in fast-moving markets. Because price quotes are only for a specific number of shares, MD investors may not always receive the price they saw on their screen or the price their broker quoted over the phone. By the time your order reaches the market, the price of the stock could be slightly – or very – different.

Note: No SEC regulations require a trade to be executed within a set period of time. But if firms advertise their speed of execution, they must not exaggerate or fail to tell investors about the possibility of significant delays.

Tip: To avoid buying or selling a stock at a price higher or lower than you wanted, place a limit order rather than a market order. A limit order is an order to buy or sell a security at a specific price. A buy limit order can only be executed at the limit price or lower, and a sell limit order can only be executed at the limit price or higher. When you place a market order, you can’t control the price at which your order will be filled.

Example: You want to buy the stock of a “hot” IPO that was initially offered at $9, but don’t want to end up paying more than $20 for the stock. Place a limit order to buy the stock at any price up to $20. By entering a limit order rather than a market order, you will not be caught buying the stock at $90 and then suffering immediate losses as the stock drops later in the day or the weeks ahead.

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Caution: Your limit order may never be executed because the market price may quickly surpass your limit before your order can be filled. But by using a limit order you also protect yourself from buying the stock at too high a price. 

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ABOUT

Dr. Gary L. Bode was Chief Executive Officer of Comprehensive Practice Accounting, Inc., a firm specializing in providing tax solutions to medical professionals. Originally, he was a board certified podiatrist and managing partner of a multi-office medical practice for a decade before earning his Master of Science degree in Accounting from the University of North Carolina. He then served as Chief Financial Officer [CFO] for a private mental healthcare facility. Today, Dr. Bode is a nationally known Certified Public Accountant, financial author, educator, and speaker. Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings, and innovative financial accounting as well as proactive tax positioning and tax return preparation for healthcare facilities. He has been quoted in Newsweek.

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On Physicians Texting [SMS]

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Some Technical Considerations

By Carol Miller BSN RN MBA PMP [Miller Consulting]

Carol S. Miller

Text (SMS = Short Message Service) Messaging has become nearly ubiquitous on mobile devices. According to one survey, approximately 72 percent of mobile phone users send text messages (TMs).

Clinical medical care is not immune from the trend, and in fact physicians appear to be embracing texting on par with the general population. Another survey found that 73 percent of physicians text other physicians about work.

(Source:  Journal of AHIMA, “HIPAA Compliance for Clinician Texting”, by Adam Green, April 2012)

Advantages

Texting can offer providers numerous advantages for clinical care. It may be the fastest and most efficient means of sending information in a given situation, especially with factors such as background noise, spotty wireless network coverage, lack of access to a desktop or laptop, and a flood of e-mails clogging inboxes.

Further, texting is device neutral—it will work on personal or provider-supplied devices of all shapes and sizes. Because of these advantages, physicians may utilize texting to communicate clinical information, whether authorized to do so or not.

Risks

All forms of communication involve some level of risk. Text messaging merely represents a different set of risks that, like other communication technologies, needs to be managed appropriately to ensure both privacy and security of the information exchanged.

Text messages, like all digital data,  may reside on a mobile device indefinitely, where the information can be exposed to unauthorized third parties due to theft, loss, or recycling of the device. Text messages often can be accessed without any level of authentication, meaning that anyone who has access to the mobile phone may have access to all text messages on the device without the need to enter a password.

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Texts also are generally not subject to central monitoring by the IT department. Although text messages communicated wirelessly are usually encrypted by the carrier, interception and decryption of such messages can be done with inexpensive equipment and freely available software (although a substantial level of sophistication is needed.

If text messages are used to make decisions about patient care, then they may be subject to the rights of access and amendment. There is a risk of noncompliance with the privacy rule if the covered entity cannot provide patients with access to or amend such text messages.

The Wireless Association

According to 2012 data from CTIA–The Wireless Association, U.S. citizens alone exchange nearly 200 billion text messages every month. So it’s not surprising that an increasing number of clinicians are using text messaging to exchange clinical information, along with a wide range of other modes — smartphones, pagers, computerized physician order entry, emails, etc. Electronic communication is certainly faster, can be more efficient, enhances clinical collaboration and enables clinicians to focus on patient care. But with these benefits comes an increased risk of security breaches.

(Source:  Clarifying the Confusion about HIPAA – Compliant Texting, by Megan Hardiman and Terry Edwards, May 2013)

Unfortunately, vendor hype about the Health Insurance Portability and Accountability Act [HIPAA] is causing many hospitals and health systems to implement stop-gap measures that address part — but not all — of a problem. To identify all vulnerabilities, health care leaders need to consider not only text messaging, but all mechanisms by which protected health information in electronic form is transmitted — as well as the security of those mechanisms.

Mobile device-to-mobile device SMS text messages are generally not secure because they lack encryption.  The sender does not know with certainty that his or her message is indeed received by the intended recipient.  In addition, telecommunications vendor/wireless carrier may store the text messages.

Recent HHS guidance indicates text messaging, as a means of communicating PHI, can be permissible under HIPAA depending in large part on the adequacy of the controls used.  A hospital or provider may be approved for texting after performing a risk analysis or implementing a third-party messaging solution that incorporates measures to establish a secure communication platform that will allow texting on approved mobile devices.

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The Ponemon Institute

A study reported in Computer World in May 2013 by the Ponemon Institute with 577 healthcare and It professional in facilities that ranged from fewer than 100 beds to over 500 beds stated that fifty-one percent of the respondents felt HIPAA compliance requirements can be a barrier to providing effective patient care.

Specifically HIPAA reduces time available for patient care (85% of the respondents), makes access to electronic patient information difficult (79% of the respondents) and restricts the use of electronic mobile communications (56% of the respondents).

The study stated “respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. “ They also stated “they recognized the value of implementing smartphones, text messaging and other modern forms of communications, but cited overly restrictive security policies as a primary reason why these technologies were not used.”

Clinicians in the survey stated that only 45% of each workday is spent with patients; the remaining 55% is spent communicating and collaborating with other clinicians and using the electronic medical record and other clinical IT systems.

Several other statements made were:

  • Because of the need for security, hospitals and other healthcare organizations continue to use older, outdate technology such as pagers, email and facsimile machines. The use of older technology can also delay patient discharges – now taking an average of 102 minutes.
  • The Ponemon Institute estimated that the lengthy discharge process costs the U.S. hospital industry more than $3.189 billion a year in lost revenue, with another $5 billion lost through decrease doctor productivity and use of outdated technology. Secure text messaging could cut discharge time by 50 minutes.

(Source:  Computer World, “HIPAA rules, outdate tech cost U.S. hospitals $3.38 B a year”, by Lucas Mearian, May, 2013)

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smart phone mobile ME-P

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Assessment

Several suggestions offered for these preferred mobile devises are:  1) ensure encryption and access to individuals who need to have access; 2) use secure texting applications; and 3) even consider alerting employees with warnings before they send an email or share files that lets them know they are liable for the information sent

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ABOUT CAROL MILLER; BSN, MBA, PMP millerconsultgroup@gmail.com ACT IAC Executive Committee Vice Chairwoman at-Large HIMSS NCA Board Member [President – Miller Consulting Group] Phone: 703-407-4704 and Fax: 703-790-3257

Ms. Carol S. Miller has an extensive healthcare background in operations, business development and capture in both the public and private sector. Over the last 10 years she has provided management support to projects in the Department of Health and Human Services, Veterans Affairs, and Department of Defense medical programs. In most recent years, Carol has served as Vice President and Senior Account Executive for NCI Information Systems, Inc., Assistant Vice President at SAIC, and Program Manager at MITRE. She has led the successful capture of large IDIQ/GWAC programs, managed the operations of multiple government contracts, interacted with many government key executives, and increased the new account portfolios for each firm she supported. She earned her MBA from Marymount University; BS in Business from Saint Joseph’s College, and BS in Nursing from the University of Pittsburgh. She is a Certified PMI Project Management Professional (PMP) (PMI PMP) and a Certified HIPAA Professional (CHP), with Top Secret Security clearance issued by the DoD in 2006. Ms. Miller is also a HIMSS Fellow.

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How to Buy Securities On Margin

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How It Works and What Physicians’ Must Watch Out For

 Dr. David Edward Marcinko MBA CMP

“Buying on margin” is borrowing money from your stock-broker to buy a stock and using your investment as collateral. Physician-investors generally use margin to increase their purchasing power so that they can own more stock without fully paying for it. But, margin exposes all investors to the potential for higher losses.

https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

This ME-P discusses the basics of buying on margin, some of the pitfalls inherent in margin buying, whether this financial tool is for you and how you can best use it.

How Does Margin Work?

Let’s say you buy a stock for $50 and the price of the stock rises to $75. If you bought the stock in a cash account and paid for it in full, you’ll earn a 50 percent return on your investment. But, if you bought the stock on margin – paying $25 in cash and borrowing $25 from your broker – you’ll earn a 100 percent return on the money you invested. Of course, you’ll still owe your brokerage $25 plus interest.

The downside to using margin is that if the stock price decreases, substantial losses can mount quickly. For example, let’s say the stock you bought for $50 falls to $25. If you fully paid for the stock, you’ll lose 50% of your money. But if you bought on margin, you’ll lose 100%, and you still must come up with the interest you owe on the loan.

Caution: In volatile markets, investors who put up an initial margin payment for a stock may, from time to time, be required to provide additional cash if the price of the stock falls. Investors have been shocked to learn that a broker has the right to sell the securities that were bought on margin – without any notification, and at a potentially substantial loss to the investor.

Caution: If your broker sells your stock after the price has plummeted, then you’ve lost out on the chance to recoup your losses if the market bounces back.

The Risks

Margin accounts can be very risky and they are not for everyone. Before opening a margin account, be aware that:

  • You can lose more money than you have invested;
  • You may have to deposit additional cash or securities in your account on short notice to cover market losses;
  • You may be forced to sell some or all of your securities when falling stock prices reduce the value of your securities; and
  • Your brokerage firm may sell some or all of your securities without consulting you to pay off the loan it made to you.

You can protect yourself by knowing how a margin account works and what happens if the price of the stock purchased on margin declines.

Tip: Your broker charges you interest for borrowing money; take into account how that will affect the total return on your investments.

Tip: Ask your broker whether it makes sense for you to trade on margin in light of your financial resources, investment objectives, and tolerance for risk.

Read Your Margin Agreement

To open a margin account, you must sign a margin agreement. The agreement may either be part of your account agreement or separate. The margin agreement states that you must abide by the rules of the Federal Reserve Board, the New York Stock Exchange, the National Association of Securities Dealers, Inc., and the firm where you have set up your margin account.

Caution: Carefully review the agreement before signing.

As with most loans, the margin agreement explains the terms and conditions of the margin account. The agreement describes how the interest on the loan is calculated, how you are responsible for repaying the loan, and how the securities you purchase serve as collateral for the loan. Carefully review the agreement to determine what notice, if any, your firm must give you before selling your securities to collect the money you have borrowed.

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Know the Margin Rules

The Federal Reserve Board and many self-regulatory organizations (SROs), such as the NYSE and NASD, have rules that govern margin trading. Brokerage firms can establish their own requirements as long as they are at least as restrictive as the Federal Reserve Board and SRO rules.

Here are some of the key rules you should know:

Before You Trade – Minimum Margin. Before trading on margin, the NYSE and NASD, for example, require you to deposit with your brokerage firm a minimum of $2,000 or 100 percent of the purchase price, whichever is less. This is known as the “minimum margin.” Some firms may require you to deposit more than $2,000.

Amount You Can Borrow – Initial Margin. According to Regulation T of the Federal Reserve Board, you may borrow up to 50 percent of the purchase price of securities that can be purchased on margin. This is known as the “initial margin.” Some firms require you to deposit more than 50 percent of the purchase price.

Tip: Not all securities can be purchased on margin.

Amount You Need After You Trade – Maintenance Margin. After you buy stock on margin, the NYSE and NASD require you to keep a minimum amount of equity in your margin account. The equity in your account is the value of your securities less how much you owe to your brokerage firm. The rules require you to have at least 25 percent of the total market value of the securities in your margin account at all times. The 25 percent is called the “maintenance requirement.” In fact, many brokerage firms have higher maintenance requirements, typically between 30 to 40 percent and sometimes higher, depending on the type of stock purchased.

Example: You purchase $16,000 worth of securities by borrowing $8,000 from your firm and paying $8,000 in cash or securities. If the market value of the securities drops to $12,000, the equity in your account will fall to $4,000 ($12,000 – $8,000 = $4,000). If your firm has a 25 percent maintenance requirement, you must have $3,000 in equity in your account (25 percent of $12,000 = $3,000). In this case, you do have enough equity because the $4,000 in equity in your account is greater than the $3,000 maintenance requirement.

But, if your firm has a maintenance requirement of 40%, you would not have enough equity. The firm would require you to have $4,800 in equity (40% of $12,000 = $4,800). Your $4,000 in equity is less than the firm’s $4,800 maintenance requirement. As a result, the firm may issue you a “margin call,” since the equity in your account has fallen $800 below the firm’s maintenance requirement.

Margin Calls

If your account falls below the firm’s maintenance requirement, your broker generally will make a margin call to ask you to deposit more cash or securities into your account. If you are unable to meet the margin call, your firm will sell your securities to increase the equity in your account up to or above the firm’s maintenance requirement.

Tip: Your broker may not be required to make a margin call or otherwise tell you that your account has fallen below the firm’s maintenance requirement. Your broker may be able to sell your securities at any time without consulting you first. Under most margin agreements, even if your firm offers to give you time to increase the equity in your account, it can sell your securities without waiting for you to meet the margin call.

  • Margin accounts involve a great deal more risk than cash accounts, where you fully pay for the securities you purchase. You may lose more than your initial investment when buying on margin. If you cannot afford to do so, then margin buying is not for you.
  • Read the margin agreement, and ask your broker questions about how a margin account works and whether it’s appropriate for you to trade on margin. Your broker should explain the terms and conditions of the margin agreement.
  • Know how much you will be charged on money you borrow from your broker, and know how these costs affect your overall return.
  • Remember that your brokerage firm can sell your securities without notice to you when you don’t have sufficient equity in your margin account.

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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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PARTICIPATE: An Observational Research Study

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 By Patti Peeples; RPh PhD of HealthEconomics.com

SOAR

The results of this Survey will be distributed in a report to all participants in the HealthEconomics.com Newsletter, and ultimately presented in manuscript form.
Your participation is encouraged and should take no more than 15 minutes to complete.

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Link: https://www.surveymonkey.com/r/ObsResSurvey9

The Survey

In collaboration with HealthEconomics.Com, Jeff Trotter of Continuum Clinical is resuming the widely-praised series of Surveys with this all-new edition focused, once again, on the critical subject of Observational Research.

This thought-provoking Survey strives to uncover challenges associated with the design and implementation of Observational Studies, and the important organizational challenges and opportunities.

  • Who should “drive the bus” in running Observational Studies?
  • How conclusive are findings from Observational Studies?
  • What processes are optimal in support of Observational Research?

Your participation will help provide critical insights regarding this important topic, increasing clarity and shared understanding.

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Mobile-Health or Global Economy?

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Boom or Bust?

Edward Bukstel

[By Edward Bukstel]

ME-P SPECIAL REPORT

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mHealth or Global Economy, Boom or Bust?

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mobile EHR health

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UNDERSTANDING SPOUSAL DEBT

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For Doctors and Other Couples

[By Staff Reporters]

The general rule is that spouses are not responsible for each other’s debts, but there are exceptions.

Many states will hold both spouses responsible for a debt incurred by one spouse if the debt constituted a family expense (e.g., child care or groceries).

In addition, community property states will hold one spouse responsible for the other’s debts because both spouses have equal rights to each other’s income.

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Assessment

Also, you are both responsible for any debt that you have in both names (e.g., mortgage, home equity loan, credit card).

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Conclusion

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Who Does a Stock Broker Work for – Really?

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And … What’s Up at the Bank of America?

[By Ann Miller RN MHA]

http://www.CertifiedMedicalPlanner.org

According to E. Dilts, BoA is making it harder for brokers to take some of their clients with them when they leave Merrill Lynch-specifically, clients that were referred to the broker by a Bank of America branch.

Brokers in recent months have been asked to sign contracts saying that if they leave Merrill Lynch, they can’t take the names or phone numbers of those customers with them, because those clients belong to the bank.

Lawyers said this policy chips away at the decade-old truce among brokerages known as the Protocol for Broker Recruiting.

The agreement was meant to end the continual and costly legal battles between brokerages and their brokers over who had the right to keep clients, and allows departing brokers to take client information including names and phone numbers with them.

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Stocker

Stock Broker versus Brokerage House

[Courtesy Pixabay]

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Assessment

So, who does the broker [er-ah! financial advisor] really work for – the [physician] client or the brokerage house? And doesn’t this make your account just a portion of their “book of business?”

Talk about advice versus product sales?

Link: http://wealthmanagement.com/wirehouse/bank-america-chips-away-brokerage-industry-truce?NL=WM-27&Issue=WM-27_20150224_WM-27_400&sfvc4enews=42&cl=article_2&YM_RID=CPG09000002702210&YM_MID=2033

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

Un-Insured Adults in the USA

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Fall 2014

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Channel Surfing the ME-P

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A Medicare Fraud 2.0 Prediction

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More on Healthcare Fraud and Abuse with Video

Edward Bukstel

 By Edward Bukstel

ME-P SPECIAL REPORT

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Medicare Fraud 2.0 Prediction.

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fraud

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On Digital Health Investments

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258 Digital Health companies raised over $2 million in Venture Capital in 2014

By Edward Bukstel

Edward Bukstel

    ME-P SPECIAL REPORT

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$4.1 Billion in Digital Health Investments in 258 Digital Health Investments 2014.

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business

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Disease Management and Preventative Health Savings?

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On Cultural Sensitivity in Education and Medicine

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A Modern Integral Component of Healthcare Training

[By Render S. Davis MHA CHE]

[By Dr. David Edward Marcinko MBA]

[By Hope R. Hetico RN MHA]

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While America has often been called a “nation of immigrants,” it has never been more true than today. Consequently, the challenge for physicians and other health care providers, in both large cities and small communities, is meeting the health care needs of increasingly diverse and multi-cultural populations who speak different languages and have social norms, traditions, and values that may substantially differ from their own. Problems arise when clinicians expect, even demand, that patients and their families discard their cultural foundations and adhere to the health care provider’s view of the care and decision-making process.

Instead, the health care team should be more aware of and sensitive to the values and beliefs of patients who come from other cultures; working within to assure that the patient’s individual rights are supported and wishes honored to the fullest extent possible.

In her award-winning book, The Spirit Catches You and You Fall Down, Ann Fadiman chronicled this tragic clash of two cultures in medical care for a child of the traditional Hmong people of Laos, transplanted to California after the Vietnam War.

In the book, Fadiman recounts a conversation with Professor Arthur Kleinman of Harvard University, a highly regarded expert in multicultural relations and conflict, who noted that “If you cannot see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”

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anatomy-254129_640

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Former U.S. Surgeon General David Satcher, M.D., Ph.D., now Director of the Satcher Health Leadership Institute at Morehouse College of Medicine in Atlanta, Georgia, helped develop a special curriculum designed to foster greater cultural competence among physicians and health care providers.

Called the “CRASH Course,” the program emphasizes:

  1. Cultural Awareness. Acknowledging the diversity and legitimacy of the many cultures that make up the fabric of American Society;
  2. Respect. Valuing other cultural norms, even if they differ or conflict with your own;
  3. Assess and affirm. Understanding the points of both congruence and difference among cultural approaches to decision-making; learning how to achieve the best outcomes within the cultural framework of the patient and family unit;
  4. Sensitivity and self awareness. Being secure in your own values; while willing to be flexible in working through cultural differences with others;
  5. Humility. Recognizing that every culture has legitimacy and that no one is an expert in what is best for others; being willing to subordinate your values for those of another to achieve the goals of treatment.

There is little doubt that multi-cultural sensitivity will continue to grow as an increasingly integral component of medical education and risk management in health care practice.

Dr. Marcinko Teaching Philosophy

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anatomy-254120_640

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About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.  

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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Health Data Breaches Multiplying

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YET – Fines Remain Rare

By Charles Ornstein @charlesornstein

[ProPublica]

Federal health watchdogs say they are cracking down on organizations that don’t protect the privacy and security of patient records, but data suggests otherwise.

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Fines Remain Rare Even As Health Data Breaches Multiply

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data

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SUBSTANCE ABUSE AND IMPAIRED PHYSICIANS

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On Physician Health Programs [Help or Hindrance?]

[By Eric A. Dover MD]

Approximately 10-12% of physicians will develop a drug or alcohol problem at some point during their career. If physicians are impaired, they should be able to seek help from a firm but supportive and fair resource—one that demands sobriety and can determine when physicians are safe to practice.

About PHPs

Physicians with substance use disorders often seek the assistance of a state physician health program (PHP). Some physicians engage willingly with PHPs, but most are compelled to do so either by their hospital or their board of medicine.  PHPs meet with, assess, and monitor physicians who have been referred to them for substance use or other mental and behavioral health problems.

In most states, physicians who comply with any and all demands of the PHP often may continue to work, provided their sobriety is ensured through drug testing and other means. Many state boards of medicine rely completely on the PHPs for guidance about how to deal with impaired physicians.  PHPs are therefore extremely powerful.

The Problem

The problem with PHPs, though, is that despite their enormous power, they are generally barely known to most physicians and often operate with little oversight and no real means of appealing their recommendations.

To compound matters, evaluation/treatment centers and PHPs are often financially dependent on one another: Centers depend on referrals from PHPs for their viability and, reciprocally, PHP regional and national meetings are often heavily sponsored by these centers.

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Stress

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Largely Unknown Practices

Because PHP practices are largely unknown to physicians until they themselves are referred to one, physicians who do register complaints about standard PHP practice are often dismissed as bellyaching. But, some voices of concern have been heard.

For example, several years ago, a paper was published in the Journal of Addiction Medicine outlining concerns about standard PHP practice, which included the points raised above; along with others.

More recently, a group of North Carolina physicians complained about their state PHP to the state auditor. The auditor conducted an investigation and found poor oversight of the PHP by both the state medical society and the board of medicine, a lack of due process for physicians who disputed the PHP’s evaluations and/or recommendations, and multiple instances of potential conflicts of interest.

And so, some authorities suggest a national federation of PHPs to implement national standards for its members and commence routine audits of its members.

Assessment

Doctors who are unsafe to practice medicine ought to be prevented from doing so, but every doctor who enters any kind of treatment or monitoring program should be treated respectfully, and fairly, monitored appropriately, and have legitimate avenues of appealing decisions about their care.

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ABOUT

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

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Investing in State Health Innovation Plans [SHIPs]

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Top Five Investment Priorities
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SHIPS

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