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On State Tele-Health Programs

Medicaid Program Policies

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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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

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Keep Medical Directives Up to Date

On Medical Directives

By Rick Kahler CFP®

One important component of estate planning is a document, usually called a medical directive, which can include a living will, that sets out your wishes for end-of-life care and a health care power of attorney that designates someone to make medical decisions if you are unable to do so. A medical directive addresses important issues that are inevitable, but that most of us don’t want to think about or talk about. Consequently, many people leave their family members and medical providers with no guidance.

If you have not executed a medical directive, I strongly recommend doing so. If you do have a living will, I suggest you review your document periodically to be sure it still provides the best options for carrying out your wishes.

Example:

Recently I’ve encountered two situations where medical directives that had been perfectly valid and appropriate at the time they were executed had become potentially useless. In both cases, a family member designated to make end-of-life decisions had subsequently developed dementia that affected their competency to make those decisions.

This possibility is one reason why, if your medical directive designates your spouse, it’s wise to name an alternate as well. Your spouse, aging along with you, may not be the most capable person to make hard decisions when the time comes.

It’s also a good idea to communicate your specific wishes to both your primary and alternate designees. Discuss with them, as well, whether they believe they will actually be able to carry out your wishes. Unfortunately, I have seen cases where family members, with the most loving of intentions, were so hesitant to make decisions that their inaction violated their loved ones’ last wishes.

These conversations are not easy. Yet they are essential. One of my clients recently was faced with the possibility of making end-of-life decisions for her father. Several years earlier, he had executed a medical power of attorney and living will document naming her as his designated agent. At that time, the two of them had talked about his wishes, so she knew the choices he would want her to make.

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For now, my client was spared the necessity of making these difficult decisions because her father recovered. But, faced with the reality of “someday” contingencies becoming “right now” hard choices, she felt capable of doing what had to be done. She told me that what gave her the strength she needed was not the responsibility of being designated in the living will document. It was the conversations she and her father had had, both at the time he signed the document and during his recent illness.

“I made him a solemn promise that I would make the choices he needed and wanted me to make,” she said. “It felt like a vow that I couldn’t ever go back on.”

It may not be especially difficult for a family member to agree to become the designated representative in a medical directive. If the agent named in a healthcare power of attorney is in good health, the need to make hard decisions is somewhere in the future and can feel theoretical.

But at the time of a medical emergency or a draining final illness, a family member who is frightened, grieving, and exhausted may find actually making those decisions to be the hardest thing they’ve ever had to do.

Assessment

Giving your family members the clarity and direction to make end-of-life decisions for you requires more than putting their name into a document. It requires choosing someone who is willing to carry out your wishes, communicating your wishes to them through conversations, and checking periodically to make sure they are still willing and able to carry out the solemn promise that a living will entails. 

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

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™

States with Low Medicare Advantage Costs

Top Ten [10] Annually 2017

By http://www.MCOL.com

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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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

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On “Giving Tuesday”

To Give or Not to Give

By Rick Kahler CFP®

For some, the last Black Friday was a day of fun “hunting” for great deals. For others it can be a day of dread, driven by the obligation to play to the expectation of family and friends.

Ads urge us to buy everything from sweaters to screwdrivers to SUVs on the grounds that they will be perfect gifts to delight our loved ones. Charities send out solicitation letters. “Angel tree” displays in malls and bell-ringers in front of stores.  All of it can be overwhelming.

Money Scripts

We all have our own unconscious beliefs, or money scripts, when it comes to giving. In addition, we’re surrounded by beliefs our society and religions have about giving. Both the personal and the societal beliefs can range across a broad spectrum:

  • “It’s better to give than to receive.”
  • “At this time of year, good people help the needy.”
  • “If poor people weren’t so lazy, they’d provide for their kids at X-mass.”
  • “There are plenty of agencies to take care of those who need help.”
  • “You have so much that you have an obligation to share.”

Like all money scripts, all of these contain partial truths. Giving, whether to family members or to charity, is not a simple black and white issue. Some of the questions it raises might include: How do you know whether you are helping people or enabling them to avoid helping themselves? How do you give to children without encouraging them to be greedy or feel entitled to the latest and greatest of everything? How do you balance helping others and taking care of yourself?

One often overlooked factor is whether the giving is done more to help the recipient or to help the donor feel better.

For example

I remember being in a church group one evening when people were discussing giving. Two of the women there, years earlier when they were struggling single moms with young children, had experienced people from a charity coming to their doors with gift boxes of presents and food for Christmas dinner. Both of them had been humiliated and mortified rather than pleased and grateful. The well-intentioned gifts had felt like a judgment that they weren’t capable of taking care of their own families. No one had asked first whether they wanted or needed any help.

Giving can sometimes be an attempt to hold onto people, to make up to them for one’s past failings, or to be loved by them. One common example of this is divorced parents who overspend on gifts for their children. Public giving may be a way to look good or to gain acceptance or recognition in the community.

One way to respond to the complicated issue of giving is to avoid it. You can close your wallet completely, out of fear that you’ll be taken advantage of, fear that you’ll offend, or simple frustration. Another response is to try to give to every charity that asks and to spend yourself into debt buying lavish gifts for everyone you care about.

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Neither of these makes a lot of sense. Like many other of life’s decisions, the question of how to give, how much to give, and to whom is a personal, individual matter. There isn’t a formula for doing it right.

Assessment

The only suggestion I have is that you give as consciously as possible. Consider the beliefs behind your giving. Discuss giving and receiving with your spouse and your kids. Stop and think before you decide to give or not to give. Then you’re more likely to give wisely and with thoughtful compassion.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

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™

About Cyber Monday

How to Do it Like a Pro

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Need help getting the best online deals on Cyber Monday? You may with these shopping tips for our ME-P readers and subscribers, and you’ll be ready for the biggest online shopping day of the year.

Best of all, you can learn a few fun facts along the way!

Assessment

When you’ve learned everything you need to know, be sure to bookmark this Cyber Monday page and come back next year to again save on the best holiday gifts in 2019.

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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

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“Roll Out the Rollover”

More on Retirement Planning

By Rick Kahler CFP®

If your employer offers a 401(k) or other retirement plan, contributing to that plan is a foundation of your retirement savings. However, as you approach retirement age, you might consider moving some of your retirement funds out of your employer’s plan and into an IRA at a custodian like TD Ameritrade or Fidelity; etc.

Such a rollover is often done when you leave an employer, though many employers give you the option of keeping your retirement account with them. What isn’t popularly understood is that you also can do a rollover while you’re still employed, as long as you are over 59 ½.

Why Rollover?

One reason to consider leaving your employer’s plan is that most of them have higher overall fees than an IRA, especially if you choose from low-cost index mutual funds or exchange traded funds from a company like Vanguard or Dimensional Fund Advisors. It’s not uncommon to save up to 1% annually by making a rollover into these mutual funds.

However, the costs of an IRA are not always cheaper. If you have a Thrift Savings Plan (TSP) through the federal government, the total costs are .03% a year. This is far cheaper than the average equity fund that charges 1.3% or even Vanguard and DFA that charge .09% on some funds.

The disadvantage with a TSP, like most employer plans, is their very limited investment options. The TSP offers about six options. Most 401(k)s will offer several times that—still a pittance compared with the 13,000 available at most discount brokers.

Another reason for a rollover is what happens when you retire and need to withdraw funds from your account. You can withdraw money from an IRA at any time without penalty after age 59 ½, but withdrawing money from a past employer’s 401(k) plan will require jumping through a few more hoops.

One issue that surprises most people is that the required minimum distributions (RMD) rules are reversed for employer plans. A RMD is never required with a Roth IRA. However, a RMD must be taken from a Roth 401(k) when you turn 70 ½. For this reason I recommend you roll over a Roth 401(k) before you turn 70 ½. The flip side of this is that when you turn 70 ½ you do have to take RMDs from a traditional IRA, but you do not from a traditional 401(k). Only a committee could have made up these rules.

The new tax code has made charitable giving less tax advantageous. However, if you are over 70 ½, you can give to charity tax-free from your IRA via a qualified charitable distribution (QCD). Employer plans don’t allow QCDs.

Another advantage of IRAs is that you can consolidate a number of employer accounts into one IRA. You can also withdraw funds from an IRA at any age without penalty for college expenses, which you cannot do from an employer plan.

Yet, another big advantage to an IRA is the ability to do Roth conversions, which cannot be done with an employer’s plan. It’s especially important to do such conversions before turning 70 ½ when your RMDs and Social Security benefits (assuming you wait until 70) kick in and raise your taxable income and possibly your tax bracket. Taking advantage of lower tax brackets prior to age 70 to convert part of traditional IRAs to Roths can lower your RMDs, which lower your tax liability, and let some of your retirement funds grow tax free forever.

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Assessment

Done properly, a rollover from an employer’s plan to an IRA is free of any tax consequences. However, it’s important to evaluate the advantages and disadvantages carefully before you act.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

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™

Black Friday and the Physician Micro-Economy

Is it Good for Retailers … but Bad for Doctors and Consumers!

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If Black Friday 2018 is anything like 2010, retailers are going to be swimming in cash while shoppers bathe in savings. Black Friday deals drew 212 million shoppers to stores in 2010 and collectively spent $39 billion on products and services.

And, the average amount spent by a Black Friday shopper in 2010 was a whopping $365.34.

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Assessment

We predict Black Friday 2018 sales will surpass all records with a slight increase over 2010.

But, is Black Friday good for the [healthcare] economics sector? Do patients go shopping rather than to the doctor?

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

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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