CONTROLLED SUBSTANCES RISKS IN MEDICINE

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CONTROLLED SUBSTANCES RISKS for MDs

[By staff reporters] http://www.CertifiedMedicalPlanner.org

The Drug Enforcement Agency (DEA) controls the issuance of DEA numbers that permit the physician to prescribe controlled substances to their patients. The use of controlled substances is important to almost all medical specialties. Family practitioners use codeine to treat coughs and surgeons use narcotics to manage pain. The spectrum-of-use is wide. 

Rogue physicians

Unfortunately, there will always be a rogue physician willing to sell narcotic prescriptions. These physicians cause the DEA to cast a jaundiced eye towards all physicians.

However, the dilemma may be that there are simply too many stories of physicians who “over-use” controlled substances in a practice designed to ease the suffering of their patients; or not? And, how do we differentiate among them all? The physician never knows when a patient coming into the office complaining of pain and asking for pain medication – whether that patient is truly in pain or not – is an undercover agent for the DEA.

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Has it come to prescriber beware?  

This peril and paranoia (combined with the risk of a malpractice claim of “hooking” the patient) causes some physicians to actually under prescribe pain medication. The U.S. Department of Veterans Affairs may be at particular risk.

[SOURCE: Chicago Tribune, January 9th, 2015].

Conclusion

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 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

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Apology Programs in Medicine

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By staff reporters http://www.CertifiedMedicalPlanner.org

APOLOGY PROGRAMS?

[What they are – How they work]

To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.”

The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why.  It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation.  These programs are promoted as humanitarian, and, at least in terms of providing an emotional outlet for patients, they are.

The evidence also suggests that they are about something else: money.  Every aspect of how they operate – from who risk managers involve, to what those involved are told to say – suggests a key goal is to dissuade patients from seeking compensation by creating an emotional connection with them.

A Study

The data establishes that it works, too.

A 2010 study found that at one major facility, apology programs resulted in fewer injured patients making claims and, among those that did, they accepted a fraction of the amount in settlement compared to patients who made claims before the program was instituted.

For minor injuries, no real harm is done by this; but the outcome can be cataclysmic for seriously injured patients who accept an apology in lieu of compensation.

Doug Wojcieszak, owner of the advocacy group Sorry Works, [http://sorryworkssite.bondwaresite.com] often receives requests to teach doctors how to communicate after a problem. He became interested in the topic when his older brother died at age 39 from a medical error. While losing his brother was awful, the experience was compounded by a total lack of communication and accountability afterward.

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Curiously, when an attorney suspects that he has committed legal malpractice, he must disclose it to the client and recommend that the client seek outside counsel to get objective legal advice on how to proceed. By contrast, when a doctor suspects that he has committed medical malpractice, at many facilities he is expected to employ a set of protocols that discourage the injured patient from considering the need for compensation. Yet, while an attorney could be disbarred for this sort of behavior, medical apology programs widely receive praise.

Source: Gabriel H. Teninbaum JD: Suffolk University Law School-Chapman Law Review Research Paper 11-30.

Conclusion

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Yale University

HEALTH PLAN BEHIND NEW HOSPITAL RANSOM-WARE INCIDENTS

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HEALTH PLAN BEHIND NEW HOSPITAL RANSOM-WARE INCIDENTS

by Derrick Smithsonian for HealthTurnup

Hospitals downloaded ransomware with their electronic payment from a plan that demanded discounts for out of network services
ON THE HEELS OF a highly-publicized ransomware attack experienced by a southern California hospital, HealthTurnup has learned a number of additional hospitals have been victims of a “copycat” hospital ransomware campaign that has been orchestrated by a health plan seeking reductions in their out-of-network payments.

According to sources, the new hospital ransomware incidents all involve malware downloaded when accepting electronic payment from the plan for out of network services, that locks the hospital’s information system by encrypting virtually all files, until a ransom is returned equal to a percentage discount of the previously paid out of network charges.

Sources indicate that the FBI cut short an investigation of the incidents after determining there was proper disclosure provided in the health plan’s electronic payment page, that accepting download of payment of full charges for the out of network services would also provide “download of a suite of complimentary payment adjustment software.”

“Who reads the legal fine print in the tiny font that accompanies those electronic payment download pages provided by the plans?” a representative for one of the impacted hospitals complained. “And the galling thing is, the health plan demanded their discount refund in bitcoins. We’re still issuing refunds with paper checks. Do you know what a pain it is to manually adjust one transaction to bitcoins?”

 

e6030530904385_56389b1f258f2

Assessment

http://www.BusinessofMedicalPractice.com

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Disruptive Behavior and Bullies in Medicine

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“Micro-Aggressors” in Healthcare

[By staff reporters] http://www.CertifiedMedicalPlanner.org

Every workplace has “micro-aggressors” or/or bullies that exhibit disruptive behavior.

But, when the workplace is a hospital, it’s not just an employee problem.

Definition

Microaggression is a term coined by psychiatrist and Harvard University professor Chester M. Pierce in 1970 to describe insults and dismissals he said he had regularly witnessed non-black Americans inflict on African Americans.

In 1973, MIT economist Mary Rowe extended the term to include similar aggressions directed at women; eventually, the term came to encompass the casual degradation of any socially marginalized group, such as the poor and the disabled.

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Case Report

In one reported case, the worker, felt threatened: His superior came at him “with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing.” He thought he was about to be hit. Instead, his angry co-worker stormed out of the room.

But, it wasn’t just any room: It was in a hospital, adjacent to a surgical area. The screamer was a cardiac surgeon, and the threatened employee was a perfusionist, a person who operates a heart/lung machine during open heart surgery. In 2008, the Indiana Supreme Court ruling in Raess v. Doescherupheld a $325,000 settlement for the perfusionist, who said he was traumatized.

Conclusion

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Yale University

DIRECT PAY MEDICAL PROVIDER RISKS

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[By staff reporters] http://www.CertifiedMedicalPlanner.org

The Three Basic Duties

A cash-based medical practice or direct care provider has these basic duties:

  1. * to comply with statutory duties such as the drug laws
  2. * to obtain proper consent for medical care
  3. * to render care that is not substantially inferior to that offered by like providers

A breach of any of these duties that causes harm to a patient can result in a malpractice suit. While the first two duties are important, it is the duty to render good quality medical care that is the basis for most malpractice lawsuits. The breach of this duty is most likely to result in a serious patient injury. The prevention of such negligent injuries is the responsibility of the individual provider, but it also basic to the institution’s quality control program.

From the individual provider’s point of view, quality control involves continuing education, attention to detail, and retrospective review of the course of the provider’s patients. The process is only loosely structured and is usually poorly documented. This lack of formal structure is less important for the individual provider because the provider’s actions are judged only within the context of the injured patient in question (although previous actions may be used to negate claims of accidental injury).

Assessment

And so, the legal questions is whether the care rendered the injured patient was negligent. It is not relevant to the case if the provider carried out an effective personal quality control program.

Conclusion

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Yale University

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Ethnic Disparities in Dementia Risk

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By http://www.MCOL.com

One-in-Four Expected to be Diagnosed

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Understanding Your Real Rate of Return [RROR]

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Some Modern ROR versus RORR Musings

Rick Kahler MS CFPBy Rick Kahler MS CFP®

http://www.KahlerFinancial.com

Is there anything more important than the overall rate of return you earn on your investment portfolio?

Yes, there is. It’s the real rate of return.

Past Half Decade

Over the past five years, even diversified portfolios have earned relatively low returns. Many investors are fearful that this has significantly reduced the income they can expect to receive upon retirement.

To see whether that fear is justified, let’s look at some numbers. Based on a model portfolio I follow that holds nine different asset classes, the average return for the past three years (after all fees and expenses) was 2.45%. The five-year return was a little better at 2.67%. However, the seven-year return was 5.62%.

If an expected long-term (10 years or more) overall return on the same portfolio was 5.00%, at first glance it appears the portfolio slightly exceeded its expectation for seven years, but fell considerably short the last three and five years.

Now – Take a Second Glance

But, if there is a first glance, you know there is a second glance coming. And that second glance highlights a seemingly obscure fact that changes the picture considerably. In every future return expectation, there is also another estimate that rarely is mentioned, but which is as important as the rate of return. This is the rate of inflation.

While the long-term expected overall return was 5.00%, the long-term expected rate of inflation was 3.00%. That means there was an expectation the investments would earn 2.00% above the rate of inflation.

This is known as the real rate of return (RROR) and it’s far more important than the overall rate of return.

For example, if the projected inflation rate was 4%, the expected real rate of return would have been 1%. At a projected inflation rate of 6%, the real rate of return would have actually been negative.

Most financial planners base their projections of a client’s retirement income on the real rate of return. A real rate of return of 2% is very common.

The Real Rate of Return

Taking into account the real rate of return, what has actually happened over the past three, five, and seven years? Overall expected returns have definitely been lower over the past three and five years. So has the rate of inflation. While the estimated inflation rate was 3.00%, the actual inflation rate was significantly lower, at 0.78% for the past three years and 1.03% for the past five. Subtracting these numbers from the overall rate of return (2.45% for three years and 2.67 for five years) gives us the real rates of return: 1.68% and 1.64% for the last three and five years. Compared with the estimated real return of 2.00%, this is slightly lower but still close to hitting the target.

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stock market

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Looking at the seven-year real rate of return, things go from “ok” to “phenomenal.” While the overall rate of return of 5.62% was higher than the expected return of 5.00%, the inflation rate was 1.03% instead of the expected 3.00%. This resulted in a real rate of return of 4.59%, more than double the expected real rate of return.

Bottom Line

The bottom line is that those investors who have been in the market for seven years will have more to spend in retirement than previously projected. In investment circles, this is called a home run.

For physician investors discouraged by recent overall return numbers, a second look might give you cause to cheer up. If you’ve invested in a diversified portfolio, rebalanced, and stayed the course during market crashes, things may be better than they seem.

Assessment

Thanks to one of the lowest inflation rates in modern history, you could be further ahead than you thought.

Conclusion

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On “Negative” Interest Rates

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ArtBy Arthur Chalekian GEPC

[Financial Consultant]

Are markets suffering from excessive worry?

Last week, markets headed south because investors were concerned about the possibility of negative interest rates in the United States – even though the U.S. Federal Reserve has been tightening monetary policy (i.e., they’ve been raising interest rates).

The worries appear to have taken root after the House Financial Services Committee asked Fed Chair Janet Yellen whether the Federal Reserve was opposed to reducing its target rate below zero should economic conditions warrant it (e.g., if the U.S. economy deteriorated in a significant way). Barron’s reported on the confab between the House and the Fed:

“Another, equally remote scenario also gave markets the willies last week: that the Federal Reserve could potentially push its key interest-rate targets below zero, as its central-bank counterparts in Europe and Japan already have. Not that anybody imagined it was on the agenda of the U.S. central bank, which, after all, had just embarked on raising short-term interest rates in December and marching to a different drummer than virtually all other central banks, which are in rate-cutting mode.”

Worried investors may want to consider insights offered by the Financial Times, which published an article in January titled, “Why global economic disaster is an unlikely event.” It discussed global risks, including inflation shocks, financial crises, and geopolitical upheaval and conflict while pointing out:

“The innovation-driven economy that emerged in the late 18th and 19th centuries and spread across the globe in the 20th and 21st just grows. That is the most important fact about it. It does not grow across the world at all evenly – far from it. It does not share its benefits among people at all equally – again, far from it. But it grows. It grew last year. Much the most plausible assumption is that it will grow again this year. The world economy will not grow forever. But it will only stop when…resource constraints offset innovation. We are certainly not there yet.”

Assessment

Markets bounced at the end of the week when the Organization of Petroleum Exporting Countries (OPEC) indicated its members were ready to cut production. The news pushed oil prices about 12 percent higher and alleviated one worry – for now.

NY Fed Reserve Bank

Conclusion

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Are We Still in a Sideways Stock Market?”

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Are we there YET!

vitaly[By Vitaliy Katsenelson CFA]

In 1976 the Eagles came out with their most successful album, Hotel California, featuring the eponymous single. That song became their claim to fame. Over the next almost four decades the Eagles performed thousands of concerts and they wrote a lot of new songs, but you can’t see yourself going to an Eagle’s concert and not hearing “Hotel California.”  They performed “Hotel California” at every concert and maybe more than once at some. I don’t have the fame the Eagles do, nor do I entertain for a living (unless you call this entertainment).

But, I do feel a little bit like the Eagles when I talk about sideways markets. Let me explain.  I wrote Active Value Investing in 2007, and I followed up with a simplified version, The Little Book Of Sideways Markets, in 2010. Since the books came out, I have given hundreds of interviews and presentations all over the world on the subject.  And just as the Eagles grew sick of playing “Hotel California,” I am sick of sideways markets. When I do interviews now, I politely ask the interviewer to stay away from the topic of sideways markets, as it really bores me.

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Bull markets

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Now, recently I’ve received emails form loyal readers and reporters asking“I am attaching an article I wrote for Institutional Investor magazine in April 2013 that answers this question.  And if you want to peer deep into the entrails of sideways markets, read this very lengthy article I wrote for John Mauldin’s (must-read) Outside the Box newsletter.  IMAGE Very little has changed since I wrote this article (or the books).

Okay, the Donald and a Democratic Socialist are the lead contenders for the presidency of the US, but otherwise the framework I discussed in the article is much the same.  I could have written the article today, since the data points I used haven’t fundamentally changed – they’ve only gotten more extreme (despite the recent sell-off). The law of mean reversion (i.e., high valuations lead to lower valuations and high profit margins lead to lower profit margins) is still intact.

P.S. Lately I’ve been travelling more than usual.  I just came back from a two-day trip to San Diego, where I attended the Qualcomm analyst investor day.  I could have watched it online (I usually do), but Qualcomm is one of our largest positions and I wanted to be physically present to get a visceral feel for the management.  I’m glad I went.  I will be spending this week in Miami, attending one of my favorite investment conferences (and this time I have a hotel reservation).

Assessment

In late February a small group of my very close value investor friends is getting together in Denver.  First we’ll visit a few companies, then we’ll ski a few days in Vail and, most importantly, share and debate investment ideas until the wee hours.  We had a similar gathering in Atlanta a few months ago – it was absolutely amazing.

Conclusion

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Rationality and Emotions in Financial Decisions [Video]

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Rationality and Emotions in Financial Decisions

By Professor Eyal Winter [SFI Seminars]

Conclusion

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How to Invest the Dale Carnegie Way

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How to Win Friends and Influence People

vitaly

By Vitaliy Katsenelson CFA

My History

The first time I read Dale Carnegie’s How to Win Friends and Influence People was in 1990. I was living in Russia; the Cold War had just ended. Capitalist American books suddenly became very popular. Carnegie’s was one of the first to be translated into Russian and was “the book to read.” Everyone wanted to be a capitalist, and this book was supposed to make me a better one. I decided, however, that it was stuffed with disingenuous fluff — that it taught the reader how to not be authentic; it turned you into a fake.

Thinking back, at the time I read it, that book had no chance of getting through to me. I was a product of the Soviet system. We were Seinfeld’s Soup Nazi “No soup for you” nation. Teachers who were kind and inspired students were considered weak. I remember two teachers in my school who were considered virtuosos. Neither one smiled. They rarely praised and were never afraid to insult their students for getting an answer wrong. But they were highly regarded because they knew their subjects well and thoroughly subjugated their students.

Here is how Carnegie puts it:

“When dealing with people, let us remember we are not dealing with creatures of logic. We are dealing with creatures of emotion, creatures bristling with prejudices and motivated by pride and vanity.”

If we were computers and had no emotions, then my Soviet teachers would have been right that knowledge is the only thing that matters. Then teaching (communicating) would be just data transfer from teacher to student.

But, if you have something you think is worth uploading to others, they have to be willing to download it. This is where the wisdom of Carnegie comes in. If we were computers, the way data was packaged would be irrelevant — the content would be all that mattered. However, because we are human, the way we package our content is paramount if the other side is to be willing to receive it.

Criticism is futile because it puts a person on the defensive and usually makes him strive to justify himself. Criticism is dangerous because it wounds a person’s precious pride, hurts his sense of importance and arouses resentment.

There is a person I work with (she is probably reading this, so I have to tread lightly). She has a task she does for me on a regular basis. She is a very diligent and hardworking person, but occasionally she makes a mistake. Pre–Dale Carnegie, I would criticize her. Not anymore. Now I start with praise — how she does a great job, how sometimes I wish I could match her attention to detail — and only then do I lightly mention her mistake. Everything I say about her work is absolutely true — she’d detect a lie. The data upload is the same — she made a mistake — but I package it differently. The result is that she has been making a lot fewer mistakes and the quality of our working environment has improved.

As an investor, I am constantly involved in arguing and debating with others. I debate ideas with my partner, Mike, and with my value investor friends. Mike and I often disagree — which is awesome, because if we always agreed, one of us would be extraneous. But this quote from Carnegie’s book changed how I debate: “You can’t win an argument. You can’t because if you lose it, you lose it; and if you win it, you lose it. Why? Well, suppose you triumph over the other man and shoot his argument full of holes and prove that he is non compos mentis. Then what? You will feel fine. But what about him? You have made him feel inferior. You have hurt his pride. He will resent your triumph.”

Carnegie provides this advice: “Our first natural reaction in a disagreeable situation is to be defensive. Be careful. Keep calm and watch out for your first reaction. It may be you at your worst, not your best. Control your temper. Remember, you can measure the size of a person by what makes him or her angry. Listen first. Give your opponents a chance to talk… Look for areas of agreement. When you have heard your opponents out, dwell first on the points and areas on which you agree.”

I used to feel I had to win every argument. I patted myself on the back when I did. Now I wish I hadn’t.

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df6e2218796363_562d230ca763b

[Influence Meter]

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Twenty-five years later I wish I could turn to my 17-year-old self and say, “Read this book slowly; pay attention; this is the most important thing you’ll ever read. It will change your life if you let it.” Unfortunately, due to the lack of a time machine, I can’t do that, but I can encourage everyone around me, including my kids, to read this very important book.

Carnegie’s book will turn anyone into a better businessperson or capitalist because it will help you to understand other people better. But more important, this book will make you a better spouse and a better parent.

P.S. I wish I’d reread Dale Carnegie’s book before my oldest child was born. I would have made fewer mistakes as a parent. I’ve been very good at trying not to criticize him and emphasizing his achievements. But I have not been careful enough in selecting his teachers. When Jonah was younger he liked to play chess, and we played together at least once a day. We got him a bona fide Russian chess teacher. He was a 70-something-year-old engineer, a brilliant chess player, Moscow champion. But he was tough. Rarely smiled. Emphasized the negatives (when Jonah made a wrong move) and underemphasized the positives (when Jonah made the right move). He was actually a genuinely good person, and he probably would be a good teacher for an adult – like me. But Jonah required a teacher that inspired, that poured water on the small seed of interest he had in chess. Instead, after a year, Jonah lost interest and quit playing chess.

Here is another example

My daughter Hannah had a Russian language teacher (the wife of Jonah’s chess teacher). The wife was not much different from the husband – emotionless and tough. Hannah studied Russian for a year and made little progress. She was scared, intimidated. Dissatisfied with her lack of progress, we changed teachers. Hannah’s new teacher is a beam of light and excitement. When she comes to our house she brings joy (and candy). After every lesson Hannah gets candy. Hannah’s Russian leaped forward. She got to the point where she started to read and memorize poems in Russian. She participated in her first “Russian poetry jam.” She looks forward to every lesson, not just because of the candy but because her new Russian teacher figured out a way to make Hannah feel good about herself when studies Russian – that is Dale Carnegie 101 

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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USA State Well Being Rankings

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By http://www.MCOL.com

Highest Well-Being Scores

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Conclusion

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Physician Characteristics Prone to Malpractice Claims

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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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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DOES THE STOCK MARKET OVER-REACT?

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Some say it does!

ArtBy Arthur Chalekian GEPC

[Financial Consultant]

Some experts say it does. In 1985, Werner DeBondt, currently a professor of finance at DePaul University, and Richard Thaler, currently a professor of behavioral science and economics at the University of Chicago, published an article titled, Does The Stock Market Overreact? 

Professor Speak

The professors were among the first economists to study behavioral finance, which explores the ways in which psychology explains investors’ behavior. Classic economic theory assumes all people make rational decisions all the time and always act in ways that optimize their benefits. Behavioral finance recognizes people don’t always act in rational ways, and it tries to explain how irrational behavior affects markets.

Research 

DeBondt and Thaler’s research, which has been explored and disputed over the years, supported the idea that markets tend to overreact to “unexpected and dramatic news and events.” The pair found people tend to give too much weight to new information. As a result, stock markets often are buffeted by bouts of optimism and bouts of pessimism, which push stock prices higher or lower than they deserve to be.

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ambulance

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In a recent memo, Oaktree Capital’s Howard Marks reiterated his long-held opinion, “…In order to be successful, an investor has to understand not just finance, accounting, and economics, but also psychology.” He makes a good point.

Assessment 

When markets become volatile, it’s a good idea to remember the words of Benjamin Graham, author of The Intelligent Investor, who wrote, “By developing your discipline and courage, you can refuse to let other people’s mood swings govern your financial destiny. In the end, how your investments behave is much less important than how you behave.”

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:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Video on The Current State Of The Stock Market

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Earnings Crisis!

By Chapwood Investments, LLC   

          ***             

MARKETS CLOSED TODAY!   

A Message From Ed Butowsky On The Current State Of The Stock Market

[2/11/2016]

ImageProxy

Click on this link to view video message

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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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“Sell Everything!”

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Rick Kahler MS CFP

[By Rick Kahler MS CFP]

“Sell Everything!”

That’s the advice to investors from RBS, a large investment bank based in Scotland, which issued the dire recommendation to its customers on January 8th, 2016.

The warning urged investors to sell everything except high-quality bonds, predicting the global economy was in for a “fairly cataclysmic year ahead …. similar to 2008.” They said this is a year to focus on the return of capital rather a return on capital.

Stunning

I was first stunned that a respectable investment bank would issue such a radical recommendation. Then I was amused at my own surprise. I had momentarily forgotten this is logical behavior for a company whose profits depend on its customers actively buying and selling. It is not legally required to look out for customers’ best interests and has no incentive to do so.

Clearly, the time-honored way of earning market returns over the long haul is to diversify among asset classes, rebalance religiously, and always stay in the markets. The research is overwhelming that shows those who attempt to time the markets have significantly lower returns over the long haul than those who don’t.

Example:

For example, according to a study by Dalbar, Inc., over the last twenty years the average underperformance of investors and advisors that timed the market was 7.12% a year.

What’s so bad about trying to minimize loses and selling out when things begin looking scary?

Nothing. Who wouldn’t want to exit markets just in time to watch them fall so low that you could sweep up bargains by buying back in? Therein lies the problem: not only do you need to get out on time (not too early and not too late), but you must then know when to get back in.

The Crystal Ball

The only way I know to do this is to own a crystal ball, which the economists at RBS apparently possess.

Here are a few of the things they say to expect:

  • Oil could fall as low as $16 a barrel.
  • The world has far too much debt to be able to grow well.
  • Advances in technology and automation will wipe out up to half of all jobs.
  • Global disinflation is turning to global deflation as China and the US sharply devalue their currencies.
  • Stocks could fall 10% to 20%.

Prediction

The last prediction was the one that grabbed my attention. Given the comparison of the coming year to 2008, I expected a forecast of a significantly greater drop in stocks, say 40% to 60%. Comparatively, their forecast of 10% to 20% seems almost rosy.

While RBS is particularly gloomy, bearish forecasts have also been issued by other investment brokerage firms, including JP Morgan, Morgan Stanley, Bank of America Merrill Lynch, Barclays, Deutsche Bank, Societe Generale, and Macquarie.

Just for perspective, here’s a look as reported by The Spectator at previous predictions from Andrew Roberts, the RBS analyst who issued the recent dire warning. In June 2010, he warned,

“We cannot stress enough how strongly we believe that a cliff-edge may be around the corner, for the global banking system (particularly in Europe) and for the global economy. Think the unthinkable.” In July 2012, he said, “People talk about recovery, but to me we are in a much worse shape than the Great Depression.”

Incidentally, one thing Roberts did not predict was the meltdown of 2008.

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“Sell Everything?”

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Assessment

The inaccuracy of earlier dire predictions should encourage physicians and all investors to stay the course.

As usual, chances are that those who diversify their investments among five or more asset classes and periodically rebalance their portfolios will come out on top. The odds greatly favor consumers who ignore doom-and-gloom warnings, especially from those whose companies may profit from investor panic.

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:

 

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

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Healthcare Technology Purchasing in 2015

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By Peer 60 and eVisit

Amount of Dollars Invested

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hitn_marketshare_infographic

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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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A STEP-WISE APPROACH TO THE DIVORCE MEDIATION PROCESS FOR MDs

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And … their Financial Advisors

[An Appendix Styled Special ME-P Report]

Anju D. Jessani, MBA, APM

Accredited Professional Mediator & Arbitrator

Divorce with Dignity

223 Bloomfield Street, Suite #104

Hoboken, New Jersey 07030

201-217-1090 (voice)

201-217-1220 (fax)

www.MedicalBusinessAdvisors.com

As opposed to therapy with is often open-ended, mediation should be approached in a structured manner so as to minimize mediation fees, maximize the productivity of sessions by keeping clients focused, and expedite a fair resolution before the conflict is allowed to escalate. The reality of divorce is that most clients have similar issues they need to address such as the house, the pension, and college education for the children.  Nevertheless, the process should also be flexible to properly address the uniqueness of each clients’ situation such as different religious requirements, or the needs of a gifted child.

In this ME-P, I describe an approach to the divorce mediation process with the caveat that each mediator has their own style, hat there are many right approaches to this process, and the process can take more or less sessions and time than described below depending on the complexity of the issues, the availability of documentation and third-party appraisals, and preparedness of the parties, and the parties readiness to proceed. I have found that on average, I meet with client from three to eight 90 minute sessions over a two-three month time frame.  However, I have had clients who literally take years to work through the issues, and also clients who have completed the mediation process over two weekends.

My objective is to provide information that demystifies what happens behind closed doors during the divorce mediation process. Although I have outlined an approach that assumes the couple has children, I use the same approach in a more contracted fashion, for couples without children.

The mediator helps the separating couple address the custody and parenting time issues, distribution of assets and liabilities, child and spousal support amounts, insurance, income tax and other decisions needed to restructure their family into two units.

The mediator’s role is to help the couple explore options and their consequences, and bring knowledge and experience that provides a context for decision-making.   Mediation is guided by the concept of self-determination – decision-making authority in the mediation process rests with the parties. When necessary, the mediator will refer the couple to experts for services such as appraisals.

At the end of the mediation process, the mediator prepares a Memorandum of Understanding that summarizes the agreements reached. Although attorneys generally do not participate in the mediation sessions, the two spouses are advised to have their attorneys review the memorandum.  They may also use the services of an attorney or attorneys to prepare their separation or divorce agreement, based on the decisions in the memorandum.

The success rate for divorce mediation, which I define as the parties coming to agreement, is higher than in other civil mediation cases. Additionally, the success rate for couples voluntarily seeking divorce mediation is significantly higher than for court-mandated mediation.  From my experience, 90% of separating clients who voluntarily come to mediation, complete the process.

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Scheduling The First Mediation Session

A client may phone or e-mail to either learn more about mediation or to make an appointment. In his book The Fundamentals of Family Mediation, John Haynes, the Founding President of the Academy of Family Mediators, states that “the mediator is presented with a classic dilemma: how to provide sufficient information so she can make can intelligent decision about the suitability of mediation while at the same time not developing a relationship with the client.”1

During this initial inquiry, the mediator will try and ascertain the following:

  1. How the prospect received their name.
  2. The names of the parties and their attorneys.
  3. Where the parties are in the divorce process with their attorneys.
  4. Whether there are any domestic violence issues that would preclude the couple form mediating.
  5. The length of the marriage and the ages of the children, if any.

The mediator will provide the following information during the conversation:

  1. Description of the mediation process and the role of the mediator.
  2. The role of mediator versus role of the attorney in the divorce process.
  3. Typical number of sessions, fee structure, and available times for the first session.
  4. Information on my background, training and experience.

Mediation Session #1

The first session serves as an introduction and overview of the mediation process. The agenda for the first session will usually encompass the following:

  1. Description of mediation, the mediator’s role, number of sessions and fees.
  2. Parties’ objectives for today and for the mediation process.
  3. Review the mediation agreement (not to be signed that day).
  4. Grounds for filing for divorce/separation, and a summary of the legal process of divorce.
  5. Issues that must be addressed today.
  6. Description of issues to be addressed in the mediation process.
  7. Develop list of documents for clients to bring in for the next session.

This session is usually highly emotionally charged. There may be great anxiety about the session, anger between the parties, and apprehension about the mediator and the mediation process.  A number of things help to put the clients at ease during this session.  Mediators may remind clients that the purpose of the first session is to provide them with information, and that they are under no pressure to make any decision until they are comfortable.

The most helpful information obtained during this session is each of the party’s objectives for the mediation. What mediators hear most frequently is that the parties don’t want to spend unnecessary money, don’t have the intestinal fortitude for a court battle, want to keep their conflict private, and want to remain friendly with each other for the sake of the children.

The mediation agreement includes the following:

  1. The parties have entered mediation voluntarily, and it is understood that they may discontinue the mediation process at any time.
  2. They have not waived the right to consult with and/or retain their own attorney.
  3. The mediation process is confidential with the exception of information regarding abuse, neglect, abandonment, or exploitation of a child.
  4. Neither the mediator nor his/her records shall be subject to subpoena.
  5. Good faith disclosure requires full disclosure of information and production of documents; if documents requested are not provided, the mediator reserves the right to terminate the mediation.
  6. If the services of other experts are required such as appraisers, the parties will retain neutral experts and will pay their fees directly to them.
  7. The hourly fee for the mediation and the payment schedule (usually pay-as-you go).
  8. That the Memorandum of Understanding (MOU) is not a legal document; their attorney(s) will include information from the MOU in the Property Settlement Agreement/Divorce Agreement.
  9. That the parties are urged to consult with attorneys prior to signing the Property Settlement Agreement/ Divorce Agreement.

The mediator may provide legal information, but should not provide legal advice. They may cover the grounds for filing for divorce for their state, who may file for divorce, any residence requirements, as well as a time-line of the legal process.

Towards the end of the first session, the mediator will provide a list of documents needed for the next session. If either party has a defined benefit pension plan, the mediator will provide forms so that they can request a valuation of the pensions. If there is a business or professional practice, the mediator will suggest that the parties need a business valuation by a neutral business appraiser, and may provide a list of professionals they recommend.  Other documents that are usually requested include:

  1. The children’s school schedules with holidays.
  2. Pay stubs.
  3. Last year’s W-2 Forms for each party (summarizing annual earnings).
  4. Most recent federal tax return.
  5. Copies of all bank, brokerage, and 401(k)/403(b) statements.
  6. Most recent mortgage statement showing outstanding loan balances
  7. A summary of all insurance policies and coverage.
  8. A market assessment of real estate if property values are in dispute.
  9. A list of household items to be divided, if the parties cannot agree among themselves how to divide these items.
  10. A credit report for each party.

With the exception of business appraisals which can be very time consuming, it usually takes two or three weeks for clients to collect the other requested documentation and deal with getting a market assessment on the house. Therefore, scheduling the second session for three weeks later makes sense.  The time lapse is also helpful in allowing client to process what happened in mediation and their emotional issues regarding their impending separation and divorce.

Picture by Ryan McGuire

Mediation Session #2

The focus of this session is on developing the parenting plan and on data collection. The agenda for the second session will usually encompass the following:

  1. Sign the mediation agreement.
  2. Develop the parenting plan and address related issues.
  3. Meet with each party alone (caucus).
  4. Collect requested documentation.
  5. Provide budget worksheets for completion by the next session.

Many states require parents in divorce proceeding to file parenting plans, with the hope that the parties will be encouraged to fulfill their parenting responsibilities through their agreements rather than rely on judiciary intervention. The parenting plan typically encompasses non-financial parenting issues, including:

  1. The type of custody chosen and reasons for selecting it (usually either sole custody to one parent with parenting time to the other, joint legal custody with one parent having primary residential care, or joint physical custody).
  2. A specific schedule for parenting time for each party including weeknights, weekends, vacations, religious holidays, school vacations, birthdays, and special occasions, and including procedures for transferring the child.
  3. Access to various records including educational and medical records.
  4. Provisions or restrictions on domestic or international travel.
  5. The impact if there is a contemplated change of residence by a parent; and
  6. Participation in making decisions regarding the child included decisions about religious upbringing, health care and education.During this session, the mediator may meet with each party alone (caucus) for approximately ten minutes with the idea of providing equal time to each participant. Different mediators have different views on whether the caucus is confidential; they should share this information, so you can proceed accordingly. Most clients appreciate the time in caucus, as it allows them to share the emotional details of their personal situation without worrying about their spouse’s reactions.
  7. If the case appears appropriate for spousal support because of a large difference in the parties incomes, or if one party is a supported spouse, budgeting is a necessity. However, even for clients who have similar incomes, preparing a budget can help reduce the level of anxiety about separating.   The mediator may provide budget work sheets for clients to complete outlining current and projected expenses. As time is needed to go through the documents provided by clients, for them to collect budget information, and for the return of the business appraisal, it is good to schedule the next session at least two weeks out.
  8. In some other states, child support is based on a number of factors including the number of overnights each parent has with the child/children. By first developing the parenting plan, the mediator has an essential building block to assist the clients in structuring their financial settlement.

Product DetailsProduct Details

Mediation Session #3

The focus of this session is on data analysis for child support and distribution of assets and liabilities. The agenda for the third session will usually encompass the following:

  1. Review child support based on child support guidelines.
  2. Discuss other financial issues related to the children.
  3. Review inventory of assets and liabilities.
  4. Decide how to divide assets and liabilities.
  5. Collect budgeting information.

By the third session, most clients feel comfortable with mediation process and the routine of going through the agenda. This session will be pivotal, and requires that clients be ready to make key financial decisions.  However, because the clients have provided the necessary documentation that has allowed the mediator to conduct data analysis, they will now be in a position to make decisions based on information.

Each state has its own child support guidelines and formulas, and many of the courts will require proof that parties have been provided with information regarding what child support would be by the state’s child support guidelines. Therefore the mediator should be able to perform these calculations.  Clients may choose to adjust the child support — that is also something the mediator should work through with clients.  Additionally, if spousal support is also warranted, child support may be revised upward or downward depending on the amount of spousal support agreed to in Session Four.

There are frequent and recurring child expenses that must also addressed during this session including:

  1. Work-related childcare.

·         Child’s share of health insurance premiums.

  1. Out-of-pocket health care expenses of the child such as for orthodontia.

·         Other extraordinary, but forcasted expenses such at SAT preparation classes.

Some child-related costs cannot be anticipated at the time of the divorce such as fees for summer camps or karate lessons.   Parents often choose to share these costs, or pay them in percentage to their incomes.  The mediator may also bring up the following issues:

  1. Frequency and/or events that should trigger a child support modification.
  2. Age of emancipation for the children as related to the child support obligation.
  3. Any religious rights of passage and how they will be funded such as Bar Mitzvahs.
  4. The parties’ desires regarding the child’s college education and costs.

The first area discussed with respect to assets and liabilities is personal property. If the parties can decide how to divide their personal property on their own such as furniture, stereo equipment, television, computer equipment, antiques, photographs, the mediator will usually stay out of that process.  If they cannot, the mediator may suggest they make an inventory of household items, place a fire sale price next to each item, and then take turns picking which items they desire.  If one person ends up with significantly less, they can ask for reimbursement from the other party.

The parties have provided documentation including copies of bank statements, business valuations, brokerage statements, and pensions statements. Once all the information has been collected, one methodology for dividing assets and liabilities it to prepare a three column spreadsheet program such as Excel.  The total estate would be in Column One.  Columns Two would be reserved for assets and liabilities the wife is receiving, and Column Three would be reserved for assets and liabilities for husband is receiving.  As an example, if the parties have a car worth $10,000 with a $5,000 loan, a house worth $250,000 with a $125,000 mortgage, and a bank account with $130,000, the total value of their entire estate as indicated in Column One would be $260,000.  If the parties decide the wife is keeping the car, the car loan, the house and the mortgage, those values go in Column One, it is clear that she is getting 50% of the total assets.  Please note that this is a simple illustration and does not adjust for potential taxes, sales commissions and closing costs that may or not be considered in the mediation process.

During the mediation session, the mediator may go through numerous alternatives on how they could divide up the marital assets and liabilities, and may look for ways to balance the division through vehicles such as Qualified Domestic Relations Orders that allow the transfer of part of a pension of deferred savings plan to the other party.

As time is needed to analyze budget information provided by the clients, it is wise to schedule the next session for two weeks later.

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

Mediation Session #4

The focus of this session is on budgets, spousal support and other outstanding. The agenda for the fourth session will usually encompass the following:

  1. Review parties current and forecasted budgets.
  2. Discuss what is needed if there are shortfalls including spousal support.
  3. Review other outstanding issues including incomes taxes, religious issues, cost of the divorce, etc.
  4. Provide agenda for next session.

As with the balance sheet, the mediator will take data provided by the clients and create a spreadsheet with the parties’ marital budget, and the projected budgets for each of the parties after the separation and divorce. There are many issues that influence the ease or difficulty of this task.  It is usually easier if the parties are already living in separate residences, and if both parties are employed and working at their full earning capacity.  It is harder if the parties are self-employed, and also if they have a lot of cash expenditures that are hard to track.  The parties’ capacity for record keeping will influence the accuracy of the budget.  For most clients the goal is to capture the 20% of expenses that account for 80% of their budget.

During the session, the mediator will review the current and forecasted budgets with the clients, and try and help them jog their memories for expenditures and well as income sources we may have missed. The budgets either provide reassurance that both parties will be self-sustaining and relatively comfortable, or help identify shortfalls.  The budgeting exercise provides for a more rational discussion regarding spousal support be it some type of interim support, support for a number of years, or in longer-term marriages, permanent alimony.  Because establishing both the amount and the term of spousal support is highly subjective, it is advisable that that clients see advise from counsel, and even get a second opinion, if they are not comfortable

Outstanding issues usually addressed in this session include:

  1. Income taxes including exemptions for the children, and filing status during the separation.
  2. Religious issues such as possibly religious annulments for Catholic clients, and Gets for Jewish clients.
  3. Whether the wife plans to change her name following the divorce.
  4. Social Security issues, including a process for equalizing social security benefits for long-term marriages.
  5. How the parties plan to pay the legal costs and fees for the divorce.

Once the mediator has gathered the remaining information so that he/she will be in a position to write a draft version of the Memorandum of Understanding. As I now need time to draft this document, the next session will be scheduled for at least for two weeks later.

couple

Mediation Session #5

The focus of the fifth, and usually the last session is on reviewing the Draft Memorandum of Understanding and amending/correcting it.

The Draft MOU summarizes everything the parties have agreed to in the mediation process. The MOU   is not intended as a legal document and will remain unsigned by the parties.  It serves the purpose of putting in writing the goals, intentions and attitudes of the couple.  The mediator will each client with a drafts copy of the MOU, and then should go through it in as great detail as is needed, to ensure that the document reflects the intentions of the clients.   The Final MOU will be mailed to clients shortly after the session.

Generally, the text of the MOU does not come as a surprise to client. However, seeing the document itself can be upsetting to some clients, as it reminds them that they are moving along in the process.  If any of the issues appear to be creating conflict, the mediator may caucus with the parties to try and bring it to closure.  If it appears that the clients could benefit from another mediation session, the mediator will suggest it.  However, this is the exception rather than the rule.

If clients have not secured legal counsel, most mediators will supply a list of mediation friendly attorneys, and will encourage their clients to make contact with a few attorneys so that they can inquire about fees, availability and approach.

Frequently, mediators will suggest that clients also review the MOU with their accountant, tax accountant, and financial planner. This review often helps identify or confirm strategies that may be mutually advantageous.  As an example, there may be a tax benefit to waiting until the next-year for the divorce to be finalized.  In that situation, the parties can instruct their attorneys accordingly.

The last part of this session will be spent answering questions and addressing concerns. Most clients are comfortable with the MOU, but apprehensive about moving forward.  They should be assured that the hardest part of the process is done – the decision making. Their attorneys will review the MOU and help them implement the agreement.  For some clients, there is a sadness in moving on.  The mediator will assure them that if any conflicts arise during the filing process, during the divorce, or after the divorce, they are free to come back to mediation to address those issues.

[THE END]

Note 1 John M. Haynes, The Fundamental of Mediation, 31 (State University of New York Press, 1994).

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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divorce

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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

On Income Inequality

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A Passionate Discussion

Rick Kahler MS CFP

By Rick Kahler MS CFP®

Income inequality is a topic of passionate discussion today in many of the circles I move in. The discussion typically starts with a foregone conclusion that income inequality is a huge problem in the US. Some solutions I hear include increasing the top income tax bracket to 90%, initiating an annual wealth tax, or increasing the estate tax to 100%.

While leveling the playing field will certainly solve income inequality, it won’t solve the real problem. When I say that, I often get stares of bewilderment and disdain. It isn’t unusual for people to slowly distance themselves as if I had shapeshifted into Donald Trump.

How bad is it?

First, how bad is income inequality in the US? It’s certainly no worse today than it’s been in the last 80 years. The CIA World Factbook 2015 Gini Index, a rating where 0 is equal income and 100 is completely unequal income, finds the US rates a 45.0, exactly what it was in 1929. That puts us in 38th place, slightly above the global median, which is 39.4. The worst 30 countries have ratings of 46.8 to 63.2.

Regardless of the fact that it has not increased over the last 80 years, what is the real problem with income inequality? A common assumption is that it has created an America where most people don’t have enough to afford a minimal quality of life.

But is that true?

In a column from October 2015, George Will cites a new book, On Equality, by Harry G. Frankfurt, a Princeton emeritus professor of philosophy. Frankfurt drives home a main contention that economic inequality is not inherently morally objectionable and that “doing worse than others does not entail doing badly.” His alternative to economic egalitarianism is the “doctrine of sufficiency,” which is that the moral imperative should be that everyone have enough.

Now, consider this

If you are a US citizen with an income of over $32,400, you are in the world’s top 1%. Globally, you are considered “rich.” Indeed, the poorest 1% of US citizens have more wealth than two-thirds of the world’s people. Clearly, income inequality in the US doesn’t inherently mean everyone in society doesn’t have enough. This would suggest that complaints about US income inequality may be in response to something other than having enough.

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Perhaps the real problem is more of a “discontent of those who are comfortable but envious,” as George Will suggests. Consider this: to be in the top 1% in income in the US you need to earn over $380,000 a year. Someone earning $32,400 a year, even though they are in the global top 1%, may easily lose that perspective when viewing someone earning over $380,000. The comparison could foster discontent by stirring up feelings of envy, jealousy, unworthiness, shame, and guilt. Rather than taking responsibility for and exploring these difficult emotions, instead we often shove them deep within and demonize others.

Will suggests that the biggest underlying producer of income inequality is freedom. Freedom includes the power to choose careers, such as opting to be a teacher rather than an engineer with full knowledge that teachers generally earn substantially less than engineers. The economic and non-economic benefits of each profession are dictated by market forces, rather than those in government deciding the winners and losers.

Assessment

Envy of the rich is almost timeless and universal. Properly reframed, it also can be motivating. Contrary to common perception, 85% of the top 1% did not inherit wealth but are first-generation millionaires or billionaires. Perhaps envy didn’t drive them to try to tear down what others had achieved. Instead, it motivated them to build their own success. 

Conclusion

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EMR Security Risk [No protocol for physical emergencies]

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BEWARE “OLD-FASHIONED” CYBER SECURITY PHYSICAL RISKS

By Shahid N. Shah MS]

Shahid N. Shah MS

In the event of an emergency [likes now storm Jonas last week], a well defined contingency plan helps the team to allow for data restoration in addition to providing physical security. A contingency plan is usually used when there is an emergency, for example when there is an outage. During the crisis it is important that the doctors still have access to EMRs/ePHI so that the quality of care is not compromised.

Major Mitigation:

Based on the size of the physician’s practice, the contingency plans in place may vary. For small doctor’s offices, the whole staff may need to be involved in restoration. In the case of large physician practices, authorized personnel may need to be accompanied into the buildings by guards.

A contingency plan should be in place that ensures the right people have access to where the PHI is physically housed. This would mean that there needs to be procedures and processes that are well established so that in the case of an emergency, authorized people that have access can retrieve the PHI or even make a back up copy of the PHI data.

For example, this can mean bringing up the application in another data center if the primary data center housing the application becomes inaccessible. This should be done so that the physician’s have uninterrupted access to their patient’s PHI even in the event of an emergency.

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Assessment

Periodic third party audits of contingency plans and mock emergency drills can help ensure that this risk has been taken care of and mitigated.

Conclusion

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Why are we tolerating the use of junk science against those in the medical profession?

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A direct question that begs for a direct answer

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Why are we tolerating the use of junk science against those in the medical profession? A direct question that begs for a direct answer.

Conclusion

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How the Super Bowl could be bad for your health

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How the Super Bowl could be bad for your health

The following originally appeared on The Upshot (copyright 2016, The New York Times Company). It also appeared on page A3 of The New York Times print edition on February 2, 2016.

NOTE: Nothing else today; we are all busy watching Super Bowl 50!

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Mobile HIPAA Solutions for Hospital & Health Systems

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New-Wave Health Information Technology

Carol S. Miller[By Carol Miller RN MBA] 

To help hospitals and health systems comply with Health Insurance Portability and Accountability Act regulations, best practices are emerging for securing all electronic communication – cloud, wireless, and texting – of protected health information.

These new technologies will continually be evolving with hospitals, providers and patients move to new means of communication.

Below is a description of how mobility solutions are impacted by HIPAA

The recent launches of Apple Health and Google Fit have stirred a lot of interest in health application development.  It is important that hospitals and providers understand the laws around PHI and HIPAA compliance for any healthcare-focused mobile application or software.  While not all healthcare applications fall under HIPAA rules, those that collect, store, or share personally identifiable health information with covered entities (such as hospitals and providers) must be HIPAA-compliant.

Enter PCs in the Examination Room

For years, hospitals have wanted to bring computers into exam rooms, waiting rooms, and treatment rooms to eliminate hard-to-read patient charts, making sure everyone treating the patient was seeing the same information, assuring that everything was recorded as it occurred, and enabling doctors, nurses, and technicians to stay connected to vital information and services wherever they were throughout the hospital.

Many hospitals have adopted Computer on Wheels (COWs) or tablets but many of these were hard to use, had poor touch-screen interface and did not last long on a battery.  Ipads seem to be the logical replacement as long as the iPad can comply with HIPAA rules.

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HIPAA Not Aging Well?

HIPAA was written nearly 20 years ago, before mobile health applications were ever envisioned. Because of this, some areas of the law make it hard to determine which applications must be HIPAA- compliant and which are exempt.  Considering the numerous ways security breaches can occur with a mobile device, it is no wonder that HHS is very leery about how PHI is handled on smartphones, wearables, and portable devices.

Compliance

If the applications are going to send or share health data to a hospital, doctor or other covered entity, it MUST be HIPAA-compliant.  Adhering to the Privacy and Security Rules of HIPAA is essential, especially considering the dangers that come with handling protected health data on a device.

Examples include:

  • Phones, tablets, and wearables can be easily stolen and lost, meaning PHI could be compromised
  • Social media and email are easily accessible by the device, making it easy for users to post information that breaches HIPAA privacy laws.
  • Push notifications and other user communications can violate HIPAA laws if they contain PHI
  • Users may intentionally or unintentionally share personally identifiable information, even if the application’s intended use doesn’t account for it
  • Not all users take advanage of the password-protected screen-lock feature, making data visible and accessible to anyone who comes in contact with the device
  • Devices like the iPhone do not include physical keyboards, so users are more likely to use basic passwords that are not as safe as complex options.
  • This protected health information can include everything from medical records and images to scheduled appointment dates.

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The-Psychology-of-Analytics-When-Working-is-Not-Working

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Assessment

Regardless of the device, it is important to take all the steps possible to comply with HIPAA guidelines.

More: http://www.BusinessofMedicalPractice.com

Conclusion

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

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Update on HIPAA Cloud Solutions for Hospitals and Health Systems

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New-Wave Technology and PHI

Carol S. Miller

[By Carol Miller RN MBA]

To help hospitals and health systems comply with Health Insurance Portability and Accountability Act regulations, best practices are emerging for securing all electronic cloud communication of protected health information.

These new technologies will continually be evolving with hospitals, providers and patients move to new means of communication.

Cloud Solutions

Cloud solutions are becoming a needed commodity in treating patients today but also present a risk to privacy and security violation. Despite the advantages of cloud computing, organizations are often hesitant to use it because of concerns about security and compliance.

Specifically, they fear potential unauthorized access to patient data and the accompanying liability and reputation damage resulting from the need to report HIPAA breaches. While these concerns are understandable, a review of data on HIPAA breaches published by the HHS shows that these concerns are misplaced.

In fact, by using a cloud-based service with an appropriate security and compliance infrastructure, a facility can significantly reduce its compliance risk.

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But, because HIPAA compliance involves stringent privacy and security protections for electronic protected health information (PHI), many cloud providers are balking at signing new Business-Associate Agreements.

Most cloud-technology providers, such as Box and Dropbox, do not include the built-in privacy protections that guarantee HIPAA compliance. Because many cloud storage companies store plain-text data on their servers, PHI is especially vulnerable to breaches and compliance violations.

HIPAA Not Aging Well

HIPAA was written nearly 20 years ago, before cloud health applications were even envisioned. Because of this, some areas of the law make it hard to determine which applications must be HIPAA- compliant and which are exempt.  Considering the numerous ways security breaches can occur with a cloud solution, it is no wonder that HHS is very leery about how PHI is handled on server farms in the cloud.

Assessment

Regardless of the storage modality – it is important to take all the steps possible to comply with HIPAA guidelines.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

 

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

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Value Based Care [VBC] and Physician Performance?

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Prevalence and Metrics within Physician Compensation Plans 

By http://www.MCOL.com

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ImageProxy

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Conclusion

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Is Glaxo Looking To Replace Andrew Witty As CEO?

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Is Glaxo Looking To Replace Andrew Witty As CEO?

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Conclusion

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Investment Lessons Learned from the Poker Table

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“I don’t know”

vitaly

               By Vitaliy Katsenelson CFA                   

These three words don’t inspire a lot of confidence in the messenger and probably will not get me invited onto CNBC, but that is exactly what I think about the topic I am about to discuss. I received a few e-mails from people who had a problem with a phrase in one of my blog posts this fall.

In that article I examined various risks that other investors and I are concerned about. The phrase was “the prospect of higher, maybe even much higher, interest rates.” These readers were convinced that higher interest rates and inflation are not a risk because we are not going to have them for a long, long time, that we are heading into deflation. These readers basically told me that I should worry about the things that will come next, not things that may or may not happen years and years down the road. I am pretty sure that if that phrase had addressed the risk of deflation and lower interest rates ahead, I’d have gotten as many e-mails arguing that I was wrong — that we’ll soon have inflation and skyrocketing interest rates, and deflation is not going to happen. I don’t know whether we are going to have inflation or deflation in the near future.

More important, I’d be very careful about trusting my money to anyone holding very strong convictions on this topic and positioning my portfolio on the basis of them. Any poker player knows that the worst thing that can happen is to have the second-best hand. If you have a weak hand, you are going to play defensively or fold (unless you are bluffing) and likely won’t lose much.

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But, if you’re pretty confident in your hand, you may bet aggressively (god forbid you go all-in) — after all, you could easily have the winning cards. Four of a kind is a great poker hand unless your opponent has a straight flush. Generally, the more confident you are in an investment, the larger portion of your portfolio will be placed in that position.

Therefore superconvinced inflationists will load up on gold, and superconvinced deflationists will be swimming in long-term bonds. If their predictions are right, they’ll make a boatload of money. If they’re wrong, however, they will have the second-best-hand problem — and lose a lot of money. The complexity of the global economy has been increased by monetary and fiscal government interventions everywhere. There is no historical example to which you can point and say, “That is what happened in the past, and this time looks just like that.” When was the last time every major global economy was this overlevered and overstimulated? I think never. (Okay almost never, but you have to go back to World War II.) What is going to happen when the Fed unwinds its $4 trillion balance sheet? I don’t know.

Also the transmission mechanism of problems in our new global economy is so much more dynamic now than it was even a decade ago. Just think about the importance of China to the global economy today versus 2004. That year U.S. imports from China stood at $196 billion. Just in the first eight months of 2014, they were $293 billion. China was single-handedly responsible for the appreciation of hard commodities (oil, iron ore, steel) over the past decade as it gobbled up the bulk of incremental demand.

Now, I don’t want to sink to the level of the one-armed economist — but conversation about inflation and deflation is just that, an “on one hand . . . but on the other hand” discussion. Just like in poker, second-best hands may be tolerable if, when you went all-in, you did not leverage your house, empty your kid’s college fund or pawn your mother-in-law’s cat. Even if you lost your money, you will live to play another hand — maybe just not today.

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In the “I don’t know” world, second-best hands when you bet on inflation or deflation are acceptable on an individual position level (you can survive them) but are extremely dangerous, maybe fatal, on an overall portfolio level.

Investing in the current environment requires a lot of humility and an acceptance of the fact that we know very little of what the future holds. I’d want the person who manages my money to have some discomfort with his or her economic crystal ball and to construct my portfolio for the “I don’t know” world.

Assessment

As a writer, you know you are in trouble when you have to quote both Albert Einstein and Mahatma Gandhi in the same paragraph, but when I ask readers to do something as difficult as I am in this column, I need all the help I can get. “It is unwise to be too sure of one’s own wisdom,” Gandhi said. “It is healthy to be reminded that the strongest might weaken and the wisest might err.” Einstein took the idea a step further: “A true genius admits that he/she knows nothing.” Smarter and humbler people than me were willing to say, “I don’t know,” and it is okay for us mortals to say it too.

Repeat after me . . . 

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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