35 INNOVATORS Under 35

M.I.T TECHNOLOGY IN REVIEW

The 35 Innovators Under 35 is a yearly opportunity to take a look at not just where technology is now, but where it’s going and who’s taking it there. More than 500 people are nominated every year, and from this group MIT editors pick the most promising 100 to move on to the semifinalist round.

Their work is then evaluated by a panel of judges who have expertise in such areas as artificial intelligence, biotechnology, software, energy, and materials. With the insight gained from these rankings, the MIT editors pick the final list of 35.

Global Finance Names The Innovators 2016 | Global Finance ...

READ: https://www.technologyreview.com/innovators-under-35/2021/?truid=349b552221c994e2540a304649746d7c&utm_source=the_download&utm_medium=email&utm_campaign=the_download.unpaid.engagement&utm_term=&utm_content=06-30-2021&mc_cid=478000030a&mc_eid=72aee829ad

ASSESSMENT: Your thoughts are appreciated. How many are in healthcare and fin-technology?

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HEALTHCARE POLICY: Blog and Internet Sources of Gravitas

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

REFERENCES

https://mises.org/library/mayo-clinic-and-free-market

http://www.kevinmd.com/blog/2017/08/problem-free-market-health-care.html

http://www.healthsharetv.com/content/dr-zeke-emanuel-history-healthcare-reform-us

https://www.pointnurse.com/blog/do-you-have-a-healthcare-blockchain-strategy/

http://thehealthcareblog.com/blog/2017/05/06/not-really-insurance-the-pre-existing-condition-debate/

https://specialdocs.com/learn-concierge-medicine-model

http://www.kevinmd.com/blog/2017/04/health-care-right-privilege-cant-answer.html

http://www.healthissocial.com/

http://www.msn.com/en-us/money/markets/brave-new-world-of-bitcoins-what-they-are-and-how-to-buy-them/ar-AAoWUza?li=BBnbfcN

https://www.pointnurse.com/blog/do-you-have-a-healthcare-blockchain-strategy/

http://www.kevinmd.com/blog/2017/06/golden-era-medicine-never-coming-back.html

http://mdwhistleblower.blogspot.com/2016/02/concierge-medicine-is-it-ethical-or.html

http://www.msn.com/en-us/money/healthcare/americas-health-care-crisis-is-a-gold-mine-for-crowdfunding/ar-BBCxjbU?li=BBnbfcN

http://www.msn.com/en-us/money/companies/the-company-behind-many-surprise-emergency-room-bills/ar-AAoKYCK?li=BBnbfcN

https://studymatescom.wordpress.com/

http://thehealthcareblog.com/blog/2017/04/08/is-healthcare-a-right-a-privilege-something-entirely-different/

http://www.kevinmd.com/blog/2017/07/moral-assassination-physicians-must-stop.html

http://www.kevinmd.com/blog/2017/01/emphasize-public-health-medical-education.html

http://thehealthcareblog.com/blog/2017/04/06/hobsons-wrong-answer/

http://thehealthcareblog.com/blog/2017/05/19/is-health-privacy-a-human-right/

http://www.kevinmd.com/blog/2016/12/must-temper-unregulated-free-market-philosophy-health-care.html

http://www.kevinmd.com/blog/2017/06/slow-death-private-practices.html

http://thehealthcareblog.com/blog/2017/06/23/a-primer-for-conservatives-health-insurance-is-not-really-insurance/

http://www.kevinmd.com/blog/2017/06/doctors-pr-problem.html

http://www.kevinmd.com/blog/2017/06/doctors-cops-can-fight-mistrust-way.html

http://www.msn.com/en-us/health/healthtrending/did-a-1980-letter-help-spark-the-us-opioid-crisis/ar-BBBKkM4?li=BBnb7Kz

http://alertandoriented.com/

http://www.sheknows.com/health-and-wellness/articles/1030383/crowdsourcing-health-care

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

CONTACT: Ann Miller RN MH

[Executive Director]

MarcinkoAdvisors@msn.com

***

UNICORNS: Successful Private Companies?

The Healthcare, IT AND FINANCIAL SectorS

Where Are The World's Unicorn Companies? - CITI I/O

DEFINITION: A private, non-public, company valued at more than a billion dollars.

CITE: https://www.r2library.com/Resource/Title/0826102549

Now, just five months into 2021, there were 199 new companies that reached unicorn status (a private company with a $1+ billion valuation), eclipsing the 163 companies that reached unicorn status in all of 2020, according to Crunchbase data shared with Emerging Tech Brew. And it’s not just a pandemic rebound: That figure is higher than any full-year total over the last nine years. 

Landscape lowdown 

After a 2020 full of stagnation and uncertainty, the VC scene is making up for lost time and then some. 

“Many of the concerns…that ground deal making to a halt have largely been alleviated in what many investors see as a new normal,” Joshua Chao, venture capital analyst at PitchBook told us. “We’re now seeing VCs invest in companies outside of their immediate networks and it’s just full steam ahead on deal making and fundraising.” 

Deena Shakir, partner at Lux Capital, said VCs are branching out of their traditional comfort zones to chase opportunities, leading to stiff competition and unprecedented valuations.

  • “Everyone [is] inching further upstream and downstream than their normal sweet spot,” Shakir said. “Hedge funds [are] now leading seed deals and seed funds [are] participating in growth deals.”

Why so exuberant? Blame the same Big Acceleration society underwent since Covid hit: the shift to digital. Tami Hutchinson, VP at Intel Capital, told us the pandemic-fueled digital transformation has now become “a critical must-have for all enterprises,” creating opportunities for startups to serve that need.

Health Care: Health care, financial services, and privacy and security are the most popular sectors for new $1+ billion companies, per Crunchbase. Shakir echoed that idea, saying Lux is most excited by deals at the intersections of “clinical data and AI, hardware and software, care delivery and clinical insights, [and] physical and digital security.”

More proof…

  • In Q1 2021, digital health startups amassed a record $6.7 billion in funding, on pace to eclipse the $14 billion raised in all of 2020.
  • On the fintech side, Webull, the Chinese-owned Robinhood rival, reached unicorn status in February after a $150 million funding round.
  • Israeli cybersecurity firm Wiz is an example of a fresh unicorn in the space—it was valued at $1.7 billion as of May 2021.

Looking ahead…VCs say it’s a safe bet to assume that more billion-dollar companies are on the horizon this year.

“For entrepreneurs, this is possibly one of the most founder-friendly periods we’ve seen in several years—all-time highs for valuations across the board coupled with all-time lows for deals,” Chao said.

ASSESSMENT: Your thoughts and comments are appreciated.

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***

How to THRIVE in Private Independent Medical Practice, Today?

ORDER TEXTBOOK: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PODCAST: The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays

The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays.

But Also That It Varies from 150% to 400%.

Dr. Boram (Kim) Park, MD - Dallas, TX | Internal Medicine

BY ERIC BRICKER MD

Health Insurance Companies Paid for Hospital Outpatient Services at an Even Higher Average Rate of 293% of Medicare.

A Detailed Look at the RAND Analysis Reveals that the ‘Basket’ of Services at Each Hospital Had Very Little Data.

For Example, the RAND Study’s Data for the Baylor Scott & White Hospital System in Dallas – Fort Worth Represented Only 0.4% of the Hospital’s Total Revenue.

For the Texas Health Hospital System Also in Dallas – Fort Worth, the RAND Study’s Data Only Represented 0.96% of the Hospital’s Total Revenue.

That Sample Size Is Likely Too Small to Make Accurate Comparisons from One Hospital System to Another Regarding their Commercial Insurance Prices Relative to Medicare.

ASSESSMENT: Your thoughts and comments are appreciated.

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***

Healthcare Costs Projected to Grow in 2022

Healthcare Costs Projected to Grow in 2022

Health Capital Consultants - Healthcare Valuation

A June 2021 PricewaterhouseCoopers (PwC) report found that healthcare costs have been on a steady decline for the past decade, but trailing effects from the COVID-19 pandemic could cause increases above anticipated rates over the next several years.

In 2007, the annual cost growth for healthcare spending was 11.9% and declined steadily until 2017, where it floated between 5.5% and 6.0% until 2020. However, projected healthcare cost growth for 2022 is expected to reach 6.5% due to factors such as deferred or forgone care, increased mental health issues, preparation for future pandemics, and investment in digital tools. (Read more...)

ASSESSMENT: Your thoughts are appreciated.

Citation: https://www.r2library.com/Resource/Title/0826102549

THANK YOU

***

What is PRICE’S Law of Participation?

What it is – How it works?

Derek Price, who was a British physicist, historian of science, and information scientist, discovered something about his peers in academia. He noticed that there were always a handful of people who dominated the publications within a subject.

Price found out the following:

Price's Law: Why Few People Contribute More - Learn Repeat ...

Price’s law says that 50% of the work is done by the square root of the total number of participants in the work.

Citation: https://www.r2library.com/Resource/Title/0826102549

LINK: https://expressingthegeniuswithin.com/prices-law-and-how-it-applies-to-everything/

MORE: https://getpocket.com/explore/item/price-s-law-why-only-a-few-people-generate-half-of-the-results

Your thoughts are appreciated.

THANK YOU

***

PODCAST: Direct Employer Contracting for Medical Services

Employers Can Enter Into Direct Contracts with Doctors, Hospitals and Other Healthcare Facilities for Medical Services for Members of Their Employee Health Plan.

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY ERIC BRICKER MD

Reimbursement Typically Takes the Form of a Bundled Payment or a Lower Rate of Fee-for-Service.

Employers with Greater Than 500 Employees Tend To Engage in Direct Contracting.

Mid-Market Employers with a High Concentration of Employees in One Geographic Area Tend to Engage in Direct Contracting as Well.

The Employer Frequently Uses an Independent TPA to Process the Claims for the Direct Contract.

Also, the Employee Health Plan Changes the ‘Benefit Level’ Such that Care at the Direct Contract Facility is Often at $0 Out-of-Pocket Cost for the Member.

Engaging the Plan Members with Navigation Services is Helpful to Make the Experience Integrated with the Overall Health Plan Offerings.

YOUR THOUGHTS ARE APPRECIATED.

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

THANK YOU

***

40 Years – MICROSOFT Corp.

Microsoft's biggest moments throughout the years in a chart

https://images.routledge.com/common/jackets/amazon/978148224/9781482240283.jpg

ASSESSMENT: Your thoughts are appreciated.

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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***

“HOSPITALS AND HEALTH CARE ORGANIZATIONS”

INSTITUTIONAL Foreword WITH Comprehensive Review AND FREE PREVIEW

Walmart’s Push to Create Healthcare ”SUPER CENTERS”

Walmart’s Push to Create Healthcare ”Super Centers”

Health Capital Consultants - Healthcare Valuation


Walmart, the world’s largest retailer, opened the first Walmart Health in 2019 with the main goal of helping to meet the healthcare needs of the communities they serve. After opening six locations in almost two years, Walmart is looking to operate a total of 22 standalone clinics by the end of 2021. 

This Health Capital Topics article will review Walmart Health’s approach to delivering primary care, the communities into which it is expanding, its partnerships it is developing in the healthcare sector, and the competitive landscape in which it operates. (Read more…) 

Citation: https://www.r2library.com/Resource/Title/0826102549

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

The Next-Generation of “Anti-Millionaire” Doctors

“$1 Million Mistake: Becoming a Doctor”

See the source image

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

CBS Moneywatch published an article entitled “$1 Million Mistake: Becoming a Doctor” Aside from the possibility that devoting one’s life to helping others might be considered a mistake, medical student Dan Coleman was struck by the “$1 million” figure.

Before medical school, he worked in the pharmaceutical industry and even turned down a hefty promotion to his education as soon as possible, rather than defer for a year or two. But, his financial calculations made it fairly obvious that, including benefits, bonuses, and potential promotions, his medical decision was not a $1 million mistake, but was more like a $1.3 million dollar disaster. Still; he opined:

Yet, even today, as we stare down the barrel of the Affordable Care Act, being a doctor is a very desirable job. We may not be famous, but we will be well-respected. We may not be rich, but we will certainly live comfortably. We may work a lot, but we will never be out of work. To future doctors, the young and impecunious, the anti-millionaires, tuition is a mere afterthought. All that matters is the MD.

Source: http://in-training.org/medical-students-the-anti-millionaires-4361

Millionaire Interview 81 - ESI Money

OVER HEARD IN THE MEDICAL STUDENT’S LOUNGE

“We are medical students.
We are young, proud, and righteous.
We have made the hard choice (medicine), but we have cleared the high hurdle (getting into school).


We know healthcare is a difficult, imperfect art, but we are devoted.
We arm ourselves with the weapons of knowledge and compassion, prepared to defend against the onslaught of trauma, disease, and time.
We are here to the bitter end, for our patients and ourselves.
And above all, we know the cost of our choice.

And if we’re lucky, it will stay under 6% interest through graduation”.

Daniel Coleman

[Georgetown University School of Medicine]

First-year Student

Your thoughts are appreciated,

THANK YOU

***

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

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

ODER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

***

WEALTH INCENTIVES: Temptation and Incentives

A WORKING WHITE PAPER

Orazio Attanasio

Agnes Kovacs

Patrick Moran

We propose a rich model of household behavior to study the effect of two important policies: mortgage interest tax deduction and mandatory mortgage amortization. These policies have attracted some controversy, first because they are conceived to increase overall saving, an objective that the literature does not agree they can achieve, and second because they incentivize illiquid savings and may thus increase the share of ‘wealthy hand-to-mouth’ households.

We build a life-cycle model where housing may act as a commitment device to counteract present biases arising from temptation. We show that the model matches several empirical facts, including the large share of wealthy hand-to-mouth households. We evaluate the effect of the two policies and find that they increase wealth accumulation by 7 and 10% respectively.

Our results demonstrate that these policies not only induce portfolio re-balancing, as emphasized by the previous literature, but also increase savings by making commitment more accessible.

See the source image

WHITE PAPER: https://www.nber.org/system/files/working_papers/w28938/w28938.pdf

ASSESSMENT: Your thoughts and comments are appreciated.

THANK YOU

***

SPONSOR: iMBA Inc.

INSTItute of Medical Business Advisors, Inc.

center

About the Institute of Medical Business Advisors, Inc

The Institute of Medical Business Advisors, Inc provides a team of experienced, senior level consultants led by iMBA Chief Executive Officer Dr. David Edward Marcinko MBA CMP™ MBBS [Hon] and President Hope Rachel Hetico RN MHA CMP™ to provide going contact with our clients throughout all phases of each project, with most of the communications between iMBA and the key client participants flowing through this Senior Team.  iMBA Inc., and its skilled staff of certified professionals have many years of significant experience, enjoy a national reputation in the healthcare consulting field, and are supported by an unsurpassed research and support staff of CPAs, MBAs, MPHs, PhDs, CMPs™, CFPs® and JDs to maintain a thorough and extensive knowledge of the healthcare environment. The iMBA team approach emphasizes providing superior service in a timely, cost-effective manner to our clients by working together to focus on identifying and presenting solutions for our clients’ unique, individual needs.

The iMBA Inc project team’s exclusive focus on the healthcare industry provides a unique advantage for our clients.  Over the years, our industry specialization has allowed iMBA to maintain instantaneous access to a comprehensive collection of healthcare industry-focused data comprised of both historically-significant resources as well as the most recent information available.  iMBA Inc’s specific, in-depth knowledge and understanding of the “value drivers” in various healthcare markets, in addition to the transaction marketplace for healthcare entities, will provide you with a level of confidence unsurpassed in the public health, health economics, management, administration, and financial planning and consulting fields.  iMBA Inc’s information resources and network of healthcare industry textbook resources enhanced by our professional consultants and research staff, ensure that the iMBA project team will maintain the highest level of knowledge regarding the current and future trends of the specific specialty market related to the project, as well as the healthcare industry overall, which serves as the “foundation” for each of our client engagements.

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

CONTACT: Ann Miller RN MH

[Executive Director]

MarcinkoAdvisors@msn.com

770-448-0769

***

PODCAST: Curmudgeon On “Crypto-Currency”

Curmudgeon on Crypto-currency


Vitaliy Katsenelson, CFA

Your thoughts and comments are appreciated.

THANK YOU

***

The Economic Value and Pricing of “Personalized and Precision” Medicine

PRECISION MEDICINE

By Tomas J. Philipson

DEFINITION: Personalized medicine, also referred to as precision medicine, is a medical model that separates people into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

We discuss the economic value of personalized medicine and the optimal pricing of the combination products involved. We build on previous work of Egan and Philipson (2015) who stress a link between rational adherence in health care and the value of personalized medicine. Personalized medicine converts experience goods to search goods by speeding up the learning process relative to trial and error. This explains the emergence of personalized medicine in cancer care as well as the timing of this emergence. It also predicts greater innovation-and merger incentives from Disneyland style two-part pricing of the combination products.

Personalized Medicine - Personal Medicine - Medicine ...

READ: https://www.nber.org/system/files/chapters/c13997/c13997.pdf

Your thoughts are appreciated.

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***

PODCAST: First Rules of Population Health

One of the 1st Rules of Population Health is That 5% of the Population Generates 50% of Total Healthcare Costs

Image result for eric brikker

BY ERIC BRICKER MD

However, That 5% of High-Cost Claimants is a Heterogenous Population

2.5 Percentage Points of the 5% Are Claimants That Were Either High-Cost Claimants the Previous Year with On-Going Complex Medical Situations or Generated Claims Related to Chronic Diseases Such as Diabetes or Multiple Sclerosis.

HOWEVER, the Other 2.5 Percentage Points of the 5% Are Claimants That Generated Zero or Almost-Zero Claims in the Previous 12-Months.

They Essentially ‘Blow Up’ Out of Nowhere.

This Video Describes the 4 Categories of These High-Cost Claimants:

1) Previously Known and Prolonged High Costs

2) Previously Known and Episodic High Costs (that no longer continue)

3) Previously Unknown and Prolonged High Costs

4) Previously Unknown and Episodic High Costs (that no longer continue)

Learn the Clinical Diagnoses That Make Up Each Category and the Secret of Which Groups to Target and Why.

Your thoughts are appreciated.

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***

Some Retirement Statistics and Questions for Physicians

Transitioning to the End of Your Medical Career

 BY DR. DAVID EDWARD MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

With the PP-ACA, increased compliance regulations and higher tax rates impending from the Biden administration – not to mention the corona pandemic, venture capital based healthcare corporations and telehealth – physicians are more concerned about their retirement and retirement planning than ever before; and with good reason. After payroll taxes, dividend taxes, limited itemized deductions, the new 3.8% surtax on net investment income and an extra 0.9% Medicare tax, for every dollar earned by a high earning physician, almost 50 cents can go to taxes!

Introduction

Retirement planning is not about cherry picking the best stocks, ETFs or mutual funds or how to beat the short term fluctuations in the market. It’s a disciplined long term strategy based on scientific evidence and a prudent process. You increase the probability of success by following this process and monitoring on a regular basis to make sure you are on track.

General Surveys

According to a survey from the Employee Benefit Research Institute [EBRI] and Greenwald & Associates; nearly half of workers without a retirement plan were not at all confident in their financial security, compared to 11 percent for those who participated in a plan, according to the 2014 Retirement Confidence Survey (RCS).

In addition, 35 percent of workers have not saved any money for retirement, while only 57 percent are actively saving for retirement. Thirty-six percent of workers said the total value of their savings and investments—not including the value of their home and defined benefit plan—was less than $1,000, up from 29 percent in the 2013 survey. But, when adjusted for those without a formal retirement plan, 73 percent have saved less than $1,000.

Debt is also a concern, with 20 percent of workers saying they have a major problem with debt. Thirty-eight percent indicate they have a minor problem with debt. And, only 44 percent of workers said they or their spouse have tried to calculate how much money they’ll need to save for retirement. But, those who have done the calculation tend to save more.

The biggest shift in the 24 years has been the number of workers who plan to work later in life. In 1991, 84 percent of workers indicated they plan to retire by age 65, versus only 9 percent who planned to work until at least age 70. In 2014, 50 percent plan on retiring by age 65; with 22 percent planning to work until they reach 70.

Physician Statistics

Now, compare and contrast the above to these statistics according to a 2018 survey of physicians on financial preparedness by American Medical Association [AMA] Insurance. The statistics are still alarming:

  • The top personal financial concern for all physicians is having enough money to retire.
  • Only 6% of physicians consider themselves ahead of schedule in retirement preparedness.
  • Nearly half feel they were behind
  • 41% of physicians average less than $500,000 in retirement savings.
  • Nearly 70% of physicians don’t have a long term care plan.
  • Only half of US physicians have a completed estate plan including an updated will and Medical directives.

Retired MD Doctor Retirement Gift Idea Retiring - Doctor ...

Thoughts to Ponder

And so, to help make your golden years comfortable and worry free, here are ten important retirement questions for all physicians to consider:

  1. How much money do you need to retire?
  2. What is your retirement cash flow?
  3. What is your retirement vision?
  4. How to stay on retirement track?
  5. How to maximize retirement plan contributions such as 401(k) or 403(b)?
  6. How to maximize retirement income from retirement plans?
  7. What are some other retirement plan savings options?
  8. What is your retirement plan and investing style?
  9. What is the role of social security in retirement planning?
  10. How to integrate retirement with estate planning?

The opinion of a competent Certified Medical Planner® can assist.

ASSESSMENT: Your thoughts, comments and input are appreciated.

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

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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On Finding PHYSICIAN FOCUSED Financial Advice?

OVER HEARD IN THE DOCTOR’S LOUNGE

Michigan Association of Osteopathic Family Physicians ...

The financial planner is a like juggler, trying to keep a variety of balls simultaneously in the air.  Each aspect of practice becomes critical, just as action is needed. 

Some of the activities of operating a successful financial planning practice generally attract more attention than others, such as marketing and advertising, closing engagements, and office administration.  Because product review, selection and implementation are often related to advisor compensation, they attract a great deal of the financial juggler’s concentration. 

But, the heart of financial planning, niche advice, often receives little attention.  Not because it is unimportant, it just doesn’t seem immediately and predictably urgent.  Here, that ball does not seem to be dropping so rapidly. 

However, retaining clients and receiving referrals from other professionals is very dependent on the quality of the advice delivered.  And, the first line of protection from practitioner liability exposure is to not deliver incorrect or incomplete advice. 

But, where does the financial advisor turn for ideas and organized research in the healthcare sector? 

Edwin P. Morrow; CFPTM, CLU, ChFC, RFC

edwin

[Middletown, Ohio, USA]

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

THANK YOU

***

PODCAST: Hospital Employee Roles [Nurses, Med Techs, Clerks and More]

So You, Your Family and Friends Can Have a Practical Understanding Should You or They Ever Be Hospitalized

***

BY ERIC BRICKER MD

***

Learn the Roles of 1) Nurses, 2) Charge Nurses, 3) Shift Coordinators, 4) Techs and 5) Clerks in a Hospital So You, Your Family and Friends Can Have a Practical Understanding Should You or They Ever Be Hospitalized

***

Nurses on General Medical and Surgical Floors Typically Have a 4:1 Patient to Nurse Ratio During the Day and an 8:1 Patient to Nurse Ratio Overnight.

Nurses in the ICU Typically Have a 2:1 or 1:1 Patient to Nurse Ratio.

Nurses on a Floor or Unit Have a ‘Charge Nurse‘ Who is the Head Nurse for the Floor for That Specific Shift.

Those Charge Nurses Then Collaborate with the Shift Coordinator Who is a Very Senior and Experience Nurse Who Coordinates All the Patient Beds for a Particular Division at a Large Hospital (e.g. All Medicine Patients vs. All Surgical Patients) or for the Entire Hospital If It Is a Smaller Hospital.

Medical Techs Provide Support Roles in Patient Rooms Such as Checking Vitals, Blood Glucose Finger-Sticks, Etc.

The Clerk Sits at the Nurses Station for the Floor and Typically Answers the Call-Button for Each of the Patient Rooms During the Day in Addition To Their Administrative Responsibilities.

Your thoughts are appreciated.

THANK YOU

***

SIMPLE: The “50-30-20” Budget Rule of Thumb

Try the 50/30/20 rule OF WANTS, NEEDS AND SAVINGS

By Dr. David Edward Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

There are varying opinions on how much of your total income should go toward savings and retirement goals each month. Moreover, the answer is likely to vary, depending on your full financial profile.

But if you’re looking for some basic KISS guidelines, consider applying the 50-30-20 rule, a budgeting method that allocates 50% of your income to essentials, like rent and bills, 30% to discretionary spending and 20% to savings.

Citation: https://www.r2library.com/Resource/Title/0826102549

Image shows a pie chart broken up into 50%, 30%, and 20%. Title reads: "The 50/30/20 Budgeting Rule." Under 50% says "Needs: groceries, housing, utilities, health insurance, car payment." Under 30% reads: "Wants: shopping dining out, hobbies." Under 20% says "Savings"

Your thoughts are appreciated.

THE RULE: https://www.thebalance.com/the-50-30-20-rule-of-thumb-453922

THANK YOU

ZERO BASED BUDGET: https://medicalexecutivepost.com/2021/05/24/the-zero-based-budget-for-physicians/https://medicalexecutivepost.com/2015/07/02/can-doctors-achieve-financial-independence-without-budgeting/

EPI BUDGET FACTS: https://www.epi.org/resources/budget/budget-factsheets/

NO BUDGETS: https://medicalexecutivepost.com/2015/07/02/can-doctors-achieve-financial-independence-without-budgeting/

HOUSEHOLD BUDGET: https://medicalexecutivepost.com/2013/10/07/on-setting-your-household-budget-ugh/

***

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

ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

***

MEDICAL ERRORS: Incidence and Prevelance

Robert James Cimasi

Todd A. Zigrang

Health Capital Consultants - Healthcare Valuation

“Knowing is not enough; we must apply. Willing is not enough; we must do. Goethe [1]

As developments in research and technology have advanced medical practice, the improved ability to diagnose and treat patients has led to an increased volume of medical assessments and procedures performed. However, these increases in the volume of procedures performed by physicians have led to an increase in both the risk of harm to patients and the exposure to liability for physicians.[2] Today, most healthcare services are delivered not by individual Marcus Welby type of physicians,[3] but through a group practice, healthcare organization, or hospital system. While there are numerous advantages to physicians providing care as employees of a healthcare enterprise, some of the unintended consequences exhibited under physician employment arrangements (e.g., diminishing physician autonomy, patient quotas, and limited time to spend with patients) have led to an increase in the potential for patient harm and subsequent physician liability.[4]  Additionally, as the overlap between the scope of practice for physicians and non-physicians continues to increase, the complexities of malpractice liability, which may jeopardize the licenses of both the supervising physician and the non-physician professional, may similarly increase.[5] The result of these increased risks, medical errors, disgruntled patients, and changing scopes of practice has produced an environment that is ripe for malpractice litigation.[6] 

Numerous studies and examinations of the reality of medical errors demonstrate the varied nature and causes contributing to these errors, and the need for the medical malpractice system.  The 2000 Institute of Medicine’s (IOM) landmark report, entitled, “To Err is Human: Building a Safer Health System,” conservatively estimated that in 1997, “at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors.”[7] Moreover, the IOM report noted that out of 30,000 discharges at 51 randomly selected New York hospitals in 1984, adverse events occurred in 3.7% of all hospitalizations or (1,110 hospitalizations), with 58% of adverse events (approximately 644 hospitalizations) caused by preventable medical errors, and 27.6% of adverse events (approximately 306 hospitalizations) caused by negligence.[8]  In addition to medical errors, more than one million serious medication errors occur every year in U.S.[9] As observed in The Leapfrog Group’s study, one adverse drug effect (ADE) adds, on average, $2,000 to the cost of a hospitalization, which totals over $7.5 billion per year nationwide.[10]

Other studies have updated the figures relied upon in the IOM report. In 2010, the Office of Inspector General (OIG) estimated that approximately 13.5% of hospitalized Medicare beneficiaries experienced adverse events during their hospitalizations, 44% of which were deemed preventable by independent physician reviewers.[11] Within this estimate, the OIG subdivided the adverse events into four clinical categories:

  • Events related to medication – 31%;
  • Events related to ongoing patient care – 28%;
  • Events related to surgery or other procedures – 26%; and,
  • Events related to infection – 15%.[12]

A 2013 study published in Journal of Patient Safety combined the OIG’s estimate with the estimates of three other studies[13] relating to the prevalence of medical errors to conclude that over “210,000 preventable adverse events per year…contribute to the death of hospitalized patients,” with numerous additional errors shortening patients’ lifespans and causing other harms.[14]

The debate surrounding medical errors focuses not only on the number of adverse events in hospitals and deaths due to these adverse events, but also the causes of these adverse events.  Although the 2000 IOM report is widely cited for its estimate of deaths due to medical errors,[15] the report also provided one of the first arguments that many medical errors “could likely have been avoided had better systems of care been in place,” framing the medical error debate not solely on “incompetent or impaired providers” but also on the process of care delivery.[16] These process improvements can center on infrastructure as well as policies and procedures regarding the provision of medical care. The same IOM committee that published the 2000 report released a second report in 2001 entitled, “Crossing the Quality Chasm: A New Health System for the 21st Century,” which advocated for widespread change in overall structures and processes in the healthcare environment as a means to preventing medical errors and improving quality, and listed six “aims” for high quality care: safety; effectiveness; efficiency; equity; timeliness; and, patient-centeredness.[17]  However, a 2013 IOM report entitled, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” noted that, 12 years later, these six aims still had not been achieved, and attributed the “fragmented, uncoordinated, and diffusely organized” infrastructure of the U.S. healthcare delivery system to the lack of systemic processes in place.[18] Specifically addressing outpatient enterprise structures, a 2011 study on adverse drug events (ADEs) in ambulatory care settings noted the potential for infrastructure improvements to support the reduction of medical errors, stating that “as health information technology becomes more widespread in ambulatory health care delivery… automated surveillance for (adverse drug events) will become more feasible.”[19]

The OIG has provided similar guidance to healthcare providers regarding the relationship between structure and quality. In its revised guidance to nursing homes, the OIG recommended that nursing facilities can “promote compliance by having in place proper medication management processes,” such as utilizing a consultant pharmacist and continually training staff in proper medication management.[20]  Nevertheless, criticism still exists regarding the processes utilized by healthcare providers to reduce medical errors. In its 2010 report on adverse events suffered by Medicare beneficiaries, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) “influence hospitals to reduce adverse events through enforcement of the conditions of participation” in Medicare, which includes sanctioning physicians through the peer review process.[21] Other studies have advanced the OIG’s claim a step further, arguing that “the hospital peer-review system has widespread failures that permit negligent care by physicians.”[22]

In an attempt “to improve patient safety by encouraging voluntary and confidential reporting of events that adversely affect patients,”[23] The Patient Safety and Quality Improvement Act (PSQIA) of 2005, effective January 19, 2009, established a voluntary reporting system for medical errors.[24] Under PSQIA, to address provider fear that “patient safety event reports could be used against them in medical malpractice cases or in disciplinary proceedings,”[25] confidentiality provisions regarding the protection of “patient safety work product” were established.[26]Patient safety work product” includes any information that is collected while reporting and analyzing a patient safety event,[27] i.e., “a process or act of omission or commissions that resulted in hazardous health care conditions and/or unintended harm to the patient.[28] Under PSQIA, Patient Safety Organizations (PSOs) are charged with collecting and analyzing data under the supervision of the Agency for Healthcare Research and Quality (AHRQ).[29]

Despite the numerous attempts and strategies to curtail the prevalence of medical errors, no definitive answer exists as to whether medical errors are properly attributable to process or physician errors on a large scale. If it were determined that most medical errors are mistakes from breakdowns in processes of care rather than the negligence of physicians, improving and implementing new and effective process controls may best reduce medical errors – and the resulting incidence of medical malpractice cases.[30] However, to date, the healthcare industry and the U.S. tort system are far from reaching this conclusion, leaving the tort system – as well as malpractice insurers and their physician insureds – to continue to grapple with this uncertainty.

https://media3.s-nbcnews.com/j/newscms/2016_18/1524261/errors_fd53fca207ac4622017a0b55e1dcb951.nbcnews-ux-2880-1000.png

[1]       “Crossing the Quality Chasm: A New Health System for the 21st Century,” Institute of Medicine, National Academy of Sciences, 2001, front matter.

[2]       “Overview of Medical Errors and Adverse Events,” By Maité Garrouste-Orgeas, et al., Annals of Intensive Care, Vol. 2, No. 2 (2012), p. 6.

[3]       “Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Vol. 1, By Robert James Cimasi, MHA, ASA, FRICS, CVA, CM&AA, Hoboken, NJ: John Wiley & Sons, 2014, p. xiii.

[4]       “Health Law: Cases, Materials, and Problems, 7th Edition,” By Barry R. Furrow, Thomas L. Greaney, Sandra H. Johnson, Timothy Stoltzfus Jost, and Robert L. Schwartz, St. Paul, MN: West Publishing Company, 2013, p. 507.

[5]       “Licensure of Health Care Professionals,” In “Health Care Law: A Practical Guide, Second Edition” By Scott Becker, Matthew Bender Co., 1998, § 16.02[4], p. 16-23.

[6]       “Health Law: Cases, Materials, and Problems, 7th Edition,” By Barry R. Furrow, Thomas L. Greaney, Sandra H. Johnson, Timothy Stoltzfus Jost, and Robert L. Schwartz, St. Paul, MN: West Publishing Company, 2013, p. 506-507.

[7]       “To Err is Human: Building a Safer Health System,” Institute of Medicine, National Academy of Sciences, 2000, p. 26. The IOM study extrapolated data from the 1984 New York study, as well as a 1992 study from Colorado and Utah to the number of hospitalizations in 1997 to estimate the number of deaths due to medical errors in 1997. The report authors note that these extrapolations may be low because the studies:

  1. Considered only those patients whose injuries resulted in a specified level of harm;”
  2. Imposed a high threshold to determine whether an adverse event was preventable or negligent;” and,
  3. Included only errors that are documented in patient records.”

“To Err is Human: Building a Safer Health System,” Institute of Medicine, National Academy of Sciences, 2000, p. 31.

[8]       “To Err is Human: Building a Safer Health System,” Institute of Medicine, National Academy of Sciences, 2000, p. 30.

[9]     “Fact Sheet: Computerized Physician Order Entry,” The Leapfrog Group, March 3, 2009; “To Err is Human: Building a Safer Health System,” By Institute of Medicine, 2000, p.1.

[10]     “Leapfrog Hospital Survey Results,” The Leapfrog Group, 2008, p. 3.

[11]     “Adverse Events in Hospitals: National Incidence among Medicare Beneficiaries,” Office of Inspector General, November 2010, p. 15, 22.

[12]     “Adverse Events in Hospitals: National Incidence among Medicare Beneficiaries,” Office of Inspector General, November 2010, p. 15.

[13]     “‘Global Trigger Tool’ Shows That Adverse Events in Hospitals May be Ten Times Greater Than Previously Measured,” By David C. Classen et al., Health Affairs, Vol. 30, No. 4 (2011); “Adverse Events in Hospitals: Case Study of Incidence Among Medicare Beneficiaries in Two Selected Counties,” Office of Inspector General, December 2008, http://oig.hhs.gov/oei/reports/OEI-06-08-00220.pdf (Accessed 2/17/15); “Temporal Trends in Rates of Patient Harm Resulting from Medical Care” By Christopher P. Landrigan, MD, MPH, et al., New England Journal of Medicine, Vol. 363, No. 22 (November 24, 2010).

[14]     “A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care” By John T. James, PhD, Journal of Patient Safety, Vol. 9. No. 3 (September 2013), p. 125.

[15]     “How Many Die From Medical Mistakes in U.S. Hospitals?” By Marshall Allen, National Public Radio, September 20, 2013, http://www.npr.org/blogs/health/2013/09/20/224507654/howmanydiefrommedicalmistakesinushospitals (Accessed 12/3/14).

[16]     “To Err is Human: Building a Safer Health System,” Institute of Medicine, National Academy of Sciences, 2000, p. 30.

[17]     “Crossing the Quality Chasm: A New Health System for the 21st Century,” Institute of Medicine, National Academy of Sciences, 2001, p. ix, 25.

[18]     “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” Institute of Medicine, National Academy of Sciences, 2009, p. 134.

[19]     “Adverse Drug Events in U.S. Adult Ambulatory Medical Care,” By Urmimala Sarkar et al., Health Services Research, Vol. 46, No. 5 (October 2011), p. 1527.

[20]     “OIG Supplemental Compliance Program Guidance for Nursing Facilities,” Federal Register Vol. 73, No. 190 (September 30, 2008), p. 56837.

[21]     “Adverse Events in Hospitals: National Incidence among Medicare Beneficiaries,” Office of Inspector General, November 2010, p. 32.

[22]     “A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care”, By John T. James, PhD, Journal of Patient Safety, Vol. 9. No. 3 (September 2013), p. 127.

[23]     “Patient Safety and Quality Improvement Act of 2005,” Agency for Healthcare Research and Quality, http://archive.ahrq.gov/news/newsroom/press-releases/2008/psoact.html (Accessed 3/5/15).

[24]     “Health Information Privacy: Understanding Patient Safety Confidentiality,” U.S. Department of Health and Human Services, http://www.hhs.gov/ocr/privacy/psa/understanding/index.html (Accessed 3/5/15); “Patient Safety and Quality Improvement; Final Rule,” Federal Register, Vol. 73, No. 226 (November 21, 2008), p. 70732.

[25]     “Patient Safety and Quality Improvement Act of 2005,” Agency for Healthcare Research and Quality, http://archive.ahrq.gov/news/newsroom/press-releases/2008/psoact.html (Accessed 3/5/15).

[26]     “Patient Safety and Quality Improvement: Final Rule” Federal Register, Vol. 73, No. 226 (November 21, 2008), p. 70734.

[27]     “Patient Safety and Quality Improvement: Final Rule” Federal Register, Vol. 73, No. 226 (November 21, 2008), p. 70739.

[28]     “Patient Safety and Quality Improvement: Final Rule” Federal Register, Vol. 73, No. 226 (November 21, 2008), referring to footnote 7 in “Patient Safety and Quality Improvement: Proposed Rule” Federal Register, Vol. 73, No. 29 (February 12, 2008), p. 8113.

[29]     “Understanding Patient Safety Confidentiality” U.S. Department of Health and Human Services, http://www.hhs.gov/ocr/privacy/psa/understanding/index.html (Accessed 3/5/15).

[30]     “To Err is Human: Building a Safer Health System,” Institute of Medicine, National Academy of Sciences, 2000, p. 30.

Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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***

TAX DEDUCTIONS: Home Ownership Simplified

Take Full Advantage Of These Tax Deductions

DR. DAVID EWARD MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

The housing market is HOT right now. Lumbar and wood is expensive. Inflation is emerging. So, owning a home can be very lucrative. Seriously, owning a home can not only give you a cheaper monthly payment than renting but in many cases, the tax benefits make the decision a no-brainer.

Citation: https://www.r2library.com/Resource/Title/0826102549

Home ownership falls for first time in a century - Telegraph

Here are a few of the larger deductions that you need to be sure to take:

Interest you pay on your mortgage: If you own a home and don’t have a mortgage greater than $750,000, you can deduct the interest you pay on the loan. This is one of the biggest benefits to owning a home versus renting–as you could get massive deductions at tax time. The limit used to be $1 million, but the Tax Cuts and Jobs Act of 2017 (TCJA) reduced the limit and made some clarifications on deducting interest from a home equity line of credit.

Property taxes: Another awesome benefit to owning a home is the ability to deduct your property taxes. Before TCJA, the rules were a little more flexible and you were able to deduct the entirety of your property taxes. Now things have a changed a bit. Under the new law, you can deduct up to $10,000. The deduction for state and local income taxes was combined with the deduction for state and local property taxes, too.

Tax incentives for energy-efficient upgrades: While most of the tax incentives for making energy-efficient upgrades to your home have gone away, there are still a couple worth noting. You can still claim tax deductions on solar energy–both for electric and water heating equipment, through 2021. The longer you wait, though, the less money you’ll get back. Here’s the percentage of equipment you can deduct, based on time of installation:

Between January 1, 2017, and December 31, 2019 – 30% of the expenditures are eligible for the credit
Between January 1, 2020, and December 31, 2020 – 26%
Between January 1, 2021, and December 31, 2021 – 22%

ASSESSMENT: But, is now the best time to buy a home? Your thoughts are appreciated.

Rent V. Buy: https://medicalexecutivepost.com/2017/03/14/the-apartment-rent-vs-home-buy-decision/

MDs: https://medicalexecutivepost.com/2012/02/15/is-home-renting-for-chumps/

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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PODCAST: “Inelastic” Demand in Healthcare

Economic Implications of Pain Suffering and Imminent Death?

Inelastic Demand in Healthcare: Economic Implications of Pain, Suffering and Imminent Death.

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By Eric Bricker, MD

Inelastic Demand Occurs When the Quantity Demanded for a Good or Service Does NOT Change When the Price Changes.

Citation: https://www.r2library.com/Resource/Title/0826102549

Consequently, When the Supply of a Healthcare Service is Limited, then the Price Goes Up … Way Up, Since the Quantity Demanded Does Not Change.

Examples of Inelastic Demand with Limited Supply in Healthcare Are:

1) Emergencies

2) Patented Medications for Diseases That Have No Other Alternatives

3) Doctor Specialties Where the Patient Has No Choice in the Services Such As Radiologists, Anesthesiologists and Pathologists

The High-Cost Claimants with Inelastic Demand Drive the Majority of Healthcare Costs for a Group.  They Generally Fall into 3 Diagnosis Categories: 1) Orthopedics, 2) Cardiovascular and 3) Cancer.

Orthopedics Should Be the 1st Priority for Lowering Healthcare Costs for a Population … While Demand May be Inelastic, Usually There is Choice and Not a Limited Supply of Orthopedic Services.

Efforts in Orthopedics Should Focus on Increasing Choice, Such as Free Travel to Centers-of-Excellence with Bundled Pricing.

Cardiovascular Care and Cancer Care Tend to Have Inelastic Demand AND Limited Supply. Therefore, the Best Way to Lower Healthcare Costs in These Areas is Through Prevention.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

Doctors “Pay Up” OR ELSE “Don’t Work”

Physicians Suspected of Mental Health Issues

J. Wesley Boyd M.D., Ph.D.

I used to be an Associate Director in a state physician health program (PHP) and I served as a consultant when the state of North Carolina audited its PHP. Now, roughly twice a month I am contacted by a physician somewhere in the U.S. who is, effectively, being extorted.

How are they being extorted? These physicians are forced to either pay tens of thousands of dollars to for-profit evaluation/treatment centers or else lose their ability to practice medicine.

LINK: https://www.psychologytoday.com/us/blog/almost-addicted/201912/doctors-pay-or-else-dont-work#=

MD Mental CARE: https://www.psychologytoday.com/us/blog/almost-addicted/201904/why-physicians-who-need-psychiatric-care-go-kansas

MEDICAL BOARDS: https://medicalexecutivepost.com/2016/07/14/a-brief-history-of-medical-boards/

EDITOR’S NOTE: Colleague J. Wesley Boyd, M.D., Ph.D., is a professor of psychiatry and medical ethics at Baylor College of Medicine. He is also a lecturer on global health and social medicine at Harvard Medical School. He writes on issues of social justice, human rights, immigration and asylum, access to care, and substance use disorders. And, he is the author of the book, Almost Addicted, which won the Will Solemine Award for Excellence in Medical Writing from the New England American Medical Writer’s Association. Dr. Boyd also contributed to our major textbook on Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors. We appreciate his work and contributions.

Dr. David E. Marcinko MBA

***

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

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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HOSPITALS and Health Care Organizations

Management Strategies, Operational Techniques, Tools, Templates and Case Studies

Tex Book Review

Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today’s increasingly competitive health care market.

Offering practical experience and applied operating vision, the authors integrate Lean managerial applications, and regulatory perspectives with real-world case studies, models, reports, charts, tables, diagrams, and sample contracts. The result is an integration of post PP-ACA market competition insight with Lean management and operational strategies vital to all health care administrators, comptrollers, and physician executives. The text is divided into three sections:

  1. Managerial Fundamentals
  2. Policy and Procedures
  3. Strategies and Execution

Using an engaging style, the book is filled with authoritative guidance, practical health care–centered discussions, templates, checklists, and clinical examples to provide you with the tools to build a clinically efficient system. Its wide-ranging coverage includes hard-to-find topics such as hospital inventory management, capital formation, and revenue cycle enhancement. Health care leadership, governance, and compliance practices like OSHA, HIPAA, Sarbanes–Oxley, and emerging ACO model policies are included. Health 2.0 information technologies, EMRs, CPOEs, and social media collaboration are also covered, as are 5S, Six Sigma, and other logistical enhancing flow-through principles. The result is a must-have, “how-to” book for all industry participants.

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

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What is EISOPTROPHOBIA?

NOW YOU SEE ME – NOW I DON’T WANT TO SEE MYSELF

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By Dr. David Edward Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

DEFINITION: Eisoptrophobia  is the fear of mirrors or, more specifically, of seeing your own reflection in a mirror. Looking into a mirror can cause people with eisoptrophobia shame or distress.

The term is derived from the Greek “eis” and “optikos”. Even though the sufferers know their fear is irrational, they experience excessive anxiety when they look into the mirror.

ASSESSMENT: Your thoughts are appreciated.

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ORDER DICTIONARY: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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***

HISTORY: Medical Education and Practice in the USA

Domestic Medical SCHOOL Education

Robert James Cimasi

Todd A. Zigrang

Health Capital Consultants - Healthcare Valuation

U.S. medical education began in the late eighteenth century as an apprenticeship program in which physicians taught their trade to a few pupils, a pedagogical learning style which relied heavily upon the capacity, skills, and knowledge of the individual physician.[1] However, as learning newly discovered information and utilizing new technologies became more necessary to the industry’s practice, many physicians found the apprenticeship system no longer adequate as a manner of educating the next generation of physicians.[2] As a result, the conventional concept of medical education that originated in the U.S. in the 1750s was manifested through informal courses and demonstrations by private individuals or for-profit institutions. Those individuals who were not satisfied with a typical U.S. medical education, consisting of two identical 16-week lecture terms, might venture to Europe for a more formalized and detailed manner of learning.[3]

One of these students who studied in Europe was William Shippen, who began teaching an informal course on midwifery when he returned to the American colonies in 1762.[4] He later addressed the limitations of what might be taught in one informal course when he began teaching a lecture series on anatomy to help educate those who wished to be a physician, but could not travel abroad. John Morgan, a classmate of Shippen, noticed the potential of his friend’s endeavor and proposed the idea to create a professorship for the practice of medicine to the board of trustees of the College of Philadelphia.[5] Just across town, Thomas Bond, who conceived the idea of, and successfully established, the Pennsylvania Hospital with Benjamin Franklin, recognized the value to allowing medical students to participate in bedside training.[6] When Bond agreed to a partnership with the College of Philadelphia, the University of Pennsylvania became home to America’s first medical school.[7]

In 1893, Johns Hopkins University also made history by housing the first medical school that was able to operate out of a university-owned hospital.[8] The medical school not only encouraged clinical research to be performed by every member of their faculty, but the program also included a clinical research clerkship for every student during their rotation.[9] This program quickly became the model to which schools aspired and set the foundation for national medical education by connecting science and medical research with clinical medicine.[10]

With these early examples of medical schools, America’s field of medical education and clinical medicine made monumental strides. However, the societal pressures, caused by the U.S.’s population growth and demand for educated physicians,[11] did not allow many other universities to build on Johns Hopkins’ or the University of Pennsylvania’s foundation model, and led to the development of medical schools that had their own unique set of entrance and graduation requirements. While some focused entirely on medicine, other schools (termed Studia Generalia) also incorporated law, theology, and philosophy in their curricula.[12] In an attempt to both understand and make uniform the field of medical education, the American Medical Association (AMA) founded the Council on Medical Education (CME) in 1904.[13] The CME created minimum national educational standards for training physicians, and subsequently found that many schools did not meet these established standards.[14] However, the CME did not share the ratings of any of these medical schools “outside the medical fraternity.”[15]

In 1910, the AMA commissioned the Carnegie Foundation for Advancement of Teaching to conduct a study of medical education and schools.[16] Abraham Flexner conducted the inquiry and detailed his findings in what became known as The Flexner Report.[17] In his review of the U.S. medical education system, Flexner found that many of the proprietary medical schools met the AMA’s educational goals, but an imbalance existed between the pursuit of science and medical education.[18]  Professors were focused solely on student throughput, and did not ensure a high level of medical training that reflected the developments in the medical industry.[19] As aptly noted by Dr. John Roberts in his book entitled The Doctor’s Duty to the State, “[m]any of you remember the struggle to wrest from medical teachers the power to create medical practitioners with almost no real knowledge of medicine. The medical schools of that day were, in many instances, conducted merely as money-makers for the professors.”[20] As the AMA gained more influence over the provision of healthcare in the U.S., the value and power of medical education also gained recognition. Notably, teaching hospitals had the power to influence the development of their disciplines through their research initiatives, the quality of care they provided, and their ability to operate as an economy of scale, allowing them to dictate the evolution of medical education.[21]

Since the establishment of the first medical school in the U.S., medical education has been the foundation for shaping standards of care in the practice of medicine and defining medical errors as deviations from the norms of clinical care.[22] When Thomas Bond helped establish the University of Pennsylvania medical school, he envisioned a normal day where the physician:

…meets his pupils at stated times in the Hospital, and when a case presents adapted to his purpose, he asks all those Questions which lead to a certain knowledge of the Disease and parts affected; and if the Disease baffles the power of Art and the Patient falls a Sacrifice to it, he then brings his Knowledge to the Test, and fixes Honour [sic] or discredit on his Reputation by exposing all the Morbid parts to View, and Demonstrates by what means it produced Death, and if perchance he finds something unexpected, which Betrays an Error in Judgement [sic], he like a great and good man immediately acknowledges the mistake, and, for the benefit of survivors, points out other methods by which it might have been more happily treated.[23]

Originally, students were to study and learn from medical errors and adverse events through medical education as a means of improving the quality of care. However, it is difficult to effectively implement any significant advancement learned through the research and investigation of prior errors in a timely and cost-effective manner. Additionally, physician supply shortages have only increased the amount of patients that a physician must see daily, while simultaneously decreasing the amount of time they can spend with each patient. Although medical education continues to be one of the central underpinnings to the development of the medical industry, outside pressures that shape the clinical practice of physicians continue to limit physician effectiveness in providing quality care to patients.[24]

While improving the quality and rigor of medical education has been a constant focus throughout the history of U.S. medical education, the challenges of replicating it on a scale that produces enough qualified physicians to meet the growing demands of the U.S. population, with constantly changing technologies, has consistently been a central issue. Notably, in the 13 years preceding 1980, the ratio of actively practicing physicians to patients increased by 50%.[25] This increased physician-to-patient ratio led to concerns over quality of care and cost-effectiveness, which in turn caused the creation of a government committee to evaluate physician manpower allocation and distribution. The Graduate Medical Education National Advisory Committee (GMENAC) was first chartered in April 1976, and later extended through September 1980.[26] Its purpose was to “analyze the distribution among specialties of physicians and medical students and to evaluate alternative approaches to ensure an appropriate balance,”as well as to“encourage bodies controlling the number, types, and geographic location of graduate training positions to provide leadership in achieving the recommended balance.”[27] GMENAC produced seven volumes of recommendations regarding physician manpower supply,[28]  through the development of several models by which to determine the projected number of physicians that would be needed in the future by different subspecialties to achieve “a better balance of physicians.”[29] Ignoring critics of the report, U.S. medical schools adjusted their enrollment numbers in response to the GMENAC’s recommendations, causing a significant decrease in the supply of new physicians going into the 21st century.

***

History of Conventional Medicine - 24 Hour Translation ...

[1]       “Healthcare Valuation: The Four Pillars of Healthcare Value,” Volume 1, Robert James Cimasi, MHA, ASA, FRRICS, MCBA, CVA, CM&AA, John Wiley & Sons, Hoboken, NJ: 2014, p. 22-23.RR

[2]       “Before There Was Flexner,” American Medical Student Association, 2014,

         http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Before.aspx (Accessed 1/7/15).

[3]       “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:

          Oxford University Press, 1999, p. 4.

[4]       “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 3-5.

[5]       “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 3-5.

[6]       “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 3-5.

[7]       “Before There Was Flexner,” American Medical Student Association, 2014,

         http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Before.aspx (Accessed 1/7/15).

[8]       “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:

          Oxford University Press, 1999, p. 18-19.

[9]       “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:

          Oxford University Press, 1999, p. 18-19.

[10]     “Science and Social Work:  A Critical Appraisal,” By Stuart A. Kirk, and William James Reid, New York, NY: Columbia University Press, 2002, Chapter 1, p. 2-3.

[11]     “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

          Publications, Inc., p. 6-7.

[12]     “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.

[13]     “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.

[14]     “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.

[15]     “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.

[16]     “U.S. Health Policy and Politics: A Documentary History,” By Kevin Hillstrom, Thousand Oaks, CA: CQ Press, 2012, p. 141.

[17]     “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 3-19.

[18]     “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 3-19.

[19]     “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 3-19.

[20]     “The Doctor’s Duty to the State: Essays on The Public Relations of Physicians,” By John B. Roberts, AM, MD, Chicago, IL: American Medical Association Press, 1908, p. 23.

[21]     “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:

          Oxford University Press, 1999, p. 19.

[22]     “Science and Social Work:  A Critical Appraisal,” By Stuart A. Kirk, and William James Reid, New York: Columbia University Press, 2002, Chapter 1, p. 2-3.

[23]     “Dr. Thomas Bond’s Essay on the Utility of Clinical Lectures,” By Carl Bridenbaugh, Journal of the History of Medicine (Winter 1947), p. 14; “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health

         Publications, Inc., p. 4.

[24]     “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:

          Oxford University Press, 1999, p. xxi.

[25]     “How many doctors are enough?” By J.E. Harris, Health Affairs, Vol. 5, No. 4 (1986), p.74.

[26]   “Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services – Volume VII,” Graduate Medical Education National Advisory Committee, Washington, DC: U.S. Government Printing Office, 1981, p. 5, 16.

[27]     “Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services – Volume VII,” Graduate Medical Education National Advisory Committee, Washington, DC: U.S. Government Printing Office, 1981, p. 73.

[28]     “Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services – Volume VII,” Graduate Medical Education National Advisory Committee, Washington, DC: U.S. Government Printing Office, 1981, p. 5-6.

[29]     “GMENAC: Its Manpower Forecasting Framework,” By D.R. McNutt, American Journal of Public Health, Vol. 71, No. 10 (October 1981), p. 1119.

[30]     “Crossing the Quality Chasm: A New Health System for the 21st Century,” Institute of Medicine, National Academy of Sciences, 2001, front matter.

[31]     “Overview of Medical Errors and Adverse Events,” By Maité Garrouste-Orgeas, et al., Annals of Intensive Care, Vol. 2, No. 2 (2012), p. 6.

Your thoughts are appreciated.

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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***

PODCAST: Fundamentals of Healthcare Finance

Today’s Video is a Fundamental of Healthcare Finance That Every Professional Must Understand… and that Most Consumers DO NOT.

***

2021 Medical Captive Forum | Roundstone Insurance

BY ERIC BRICKER MD

The Formulary is the List of Medications That Are Covered by Health Insurance.  Not All Medications Are Covered. The Doctor Does Not Know What Medications Are or Are Not on Their Patients’ Formularies. However, the Pharmacy Does Via Computer Software That They Use.

Citation: https://www.r2library.com/Resource/Title/0826102549

***

Formularies Have Many Rules Associated With Them:

1) Prior Authorization – Approval Must Be Given by the Health Insurance Company/PBM Before They Agree to Pay for a Medication.

2) Step Therapy – Certain Less Expensive Generic Medications Have to Be ‘Tried’ First and Fail Before a Doctor Can Prescribe a More Expensive Brand-Name Medication.

3) Mandatory Generics – If a Brand Name Medication Has A Direct Generic Equivalent, Then the Insurance May Only Agree to Pay for the Generic and Not the Brand.

4) Mandatory Mail Order – Certain Chronic Medications That Are Filled for 90 Day Supplies Must Be Filled via Mail Order and Not at the Retail Pharmacy.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

What is the “5-100” Insurance Rule?

THE 5 -100 “Policy” Rule 

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

With any universal life insurance policy (and certainly all variable life policies), fluctuating rates of return, the actual timing of the premium payments, and potential internal policy changes by the insurance company, all contribute to results that will probably differ substantially from the original illustration. 

See the source image

RULE: The 5 – 100 Rule states that as a result of accounting for these elements, all initial projections of cash value beyond 5 years, will necessarily be 100 percent incorrect when compared to actuality. 

A prudent policy owner should therefore keep on top of any changes and react accordingly.  If a policy owner ignores his/her policy for even 5 years, any adverse changes could be so drastic as to make rectifying them very costly.

Citation: https://www.r2library.com/Resource/Title/0826102549

Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

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***

DICTIONARY: Health Insurance and Managed Care

GLOSSARY OF TERMS

ORDER HERE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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***

MEDICARE: Safe Harbor Regulations

Medicare “Safe Harbor” Regulations

Invite Dr. Marcinko | The Leading Business Education ...

The Medicare Safe Harbor rules were passed in an effort to identify areas of practice that would not lead to a conviction under the anti-fraud statute.  The Safe Harbor regulations provide for eleven areas where providers may practice without violating the anti-fraud statute. 

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

Areas of safe practice under these regulations are briefly highlighted below:

  • Large Entity Investments – Investment in entities with assets over $50 million. The entity must be registered and traded on national exchanges.
  • Small Entity Investments – Small entity investment entities must abide by the 40-40 rule.  No more than 40% of the investment interests may be held by investors in a position to make referrals. Additionally, no more than 40% of revenues can come through referrals by these investors.
  • Space and Equipment Rentals – Such lease agreements must be in writing and must be for at least a one year term. Furthermore, the terms must be at fair market value.
  • Personal Services and Management Contracts – These contracts are allowable as long as certain rules are followed. Like lease agreements, these personal service and management contracts must be in writing for at least a one-year term, and the services must be valued at fair market value.
  • Sale of a medical practice – There are restrictions if the selling practitioner is in a position to refer patients to the purchasing practitioner.
  • Referral services– Referral services (such as hospital referral services) are allowed. However, such referral services may not discriminate between practitioners who do or do not refer patients.
  • Warranties – There is certain requirements if any item of value is received under a warranty.
  • Discounts – Certain requirements must be met if a buyer receives a discount on the purchase of goods or services that are to be paid for by Medicare or Medicaid.
  • Payments to Bona Fide Employees – Payments made to bona fide employees do not constitute fraud under the Safe Harbor Regulations.
  • Group Purchasing Organizations – Organizations that purchase goods and services for a group of entities or individuals are allowed; provided certain requirements are met.
  • Waiver of Beneficiary Co-Insurance and Deductible – Routine waiver would not come under the safe harbor.

A physician’s actions that come under the Safe Harbor Regulations will not violate the Medicare Fraud and Abuse Statutes.  However, the provider must still abide by the Stark amendments and must also abide by applicable state law.

STARK UPDATE: https://medicalexecutivepost.com/2018/08/03/cms-to-review-stark-law-relevance-once-again/

Your thoughts are appreciated.

THANK YOU

***

ORDER TEXTBOOK [3rd]: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

***

PODCAST: The Income and Substitution Effects in Healthcare Finance

Important Economic Concepts to UNDERSTAND

Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY ERIC BRICKER MD

One of Their Applications Pertains to the Impact on Time Spent Working Vs. Time Spend on Leisure if a Healthcare Worker’s Pay is Changed.

DEFINITION: The INCOME EFFECT States That If a Worker’s Pay is Decreased, They Will Work More Hours to Maintain the Same Income. Conversely, If a Worker’s Pay is Increased, They Will Work Fewer Hours and Still Maintain the Same Income.

Citation: https://www.r2library.com/Resource/Title/0826102549

A Real-World Example of the Income Effect is When Medicare Decreased Reimbursement for Echocardiograms and as a Result, Decreased Cardiologists’ Pay. Accordingly, Cardiology Practices Increased the Number of Patients They Saw Per Day to Make Up for the Lost Pay and Maintain Their Income.

The SUBSTITUTION EFFECT States That Work and Leisure Time Have OPPORTUNITY COSTS for Each Other.

If a Worker’s Pay Goes Up, then the Opportunity Cost for Leisure (i.e. Not Working) Also Goes Up and the Worker Will Work MORE, Not LESS. Conversely, If a Worker’s Pay Goes Down, then the Opportunity Cost for Leisure Goes Down and the Worker Will Work LESS, Not MORE.

Whether the Income or Substitution Effect Dominates Depends on the Person and the Situation.

THE POINT: In the World of Fee-for-Service Reimbursement, a Decrease in Doctor Pay Per Service May Result in Doctors Providing More Services In Order to Maintain Their Income… Nullifying Any Cost-Savings.

PODCAST: The Income and Substitution Effects Are Important Economic Concepts to Understand in Healthcare Finance.

Your thoughts appreciated.

THANK YOU

***

ME-P Speaking Invitations

Dr. David E. Marcinko is at your Service

thumbnail_IMG_1663.edit1

Dr. David Edward Marcinko MBA CMP® enjoys personal coaching and public speaking and gives as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.

These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.

His talks tend to be engaging, iconoclastic, and humorous. His most popular presentations include a diverse variety of topics and typically include those in all iMBA, Inc’s textbooks, handbooks, white-papers and most topics covered on this blog.

CONTACT: Ann Miller RN MHA

MarcinkoAdvisors@msn.com

Ph: 770-448-0769

Abbreviated Topic List: https://healthcarefinancials.files.wordpress.com/2009/02/imba-inc-firm-services.pdf

Second Opinions: https://medicalexecutivepost.com/schedule-a-consultation/

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

THANK YOU

***

NEWS ALERT: SCOTUS Rules to Leave ACA in Place

BREAKING NEWS!

On June 17, 2021, the Supreme Court of the United States (SCOTUS) released its long-awaited ruling on the fate of the Patient Protection and Affordable Care Act (ACA). In a 7-2 ruling, the majority (written by Justice Stephen Breyer) found that the two individual and 18 state plaintiffs did not have standing, stating

the plaintiffs…failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional. They have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.” 

By ruling on the question of standing, the Court did not have to proceed to, and rule on, the issue of the constitutionality of the Individual Mandate.

The Court reversed the Fifth Circuit’s ruling with respect the standing issue, vacated the ruling, and remanded the case with instructions to dismiss.

***

***
A more robust discussion of the majority’s opinion and the procedural history of this case will be included in the June 2021 issue of Health Capital Topics.
(Read the ruling here)

ASSESSMENT: Your comments are appreciated.

THANK YOU

***

PODCAST: Physician WEDDING Costs

 The Economics of Weddings for Medical Professionals

The average wedding costs about $ 25,525 and medical professionals often spend much more.

Destination Weddings - Dynamic Roadshow

QUERY: Do you want a big wedding party for your family and friends, or an earlier retirement for yourself?

PODCAST: https://www.youtube.com/watch?v=XQBRHJ7aGbM

Your thoughts are appreciated.

THANK YOU

***

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

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

***

HOSPITAL EMPLOYER PROVIDED TRANSPORTATION BENEFITS

By Dr. David Edward Marcinko MBA CMP©

SPONSOR: http://www.CertifiedMedicalPlanner.org

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COST COMPARISONS

Example 1: Dr. Kurt purchases an automobile for $15,000.

His hospital business use is 80% and he drives 20,000 total miles per year.  Operating costs for the year, including gasoline, oil, insurance, maintenance, repairs, and license fees, are $4,000. If Kurt owns the car for five years, ownership will cost $35,000 ($4,000 x 5 = $20,000, $20,000 + $15,000 = $35,000), or $7,000 per year. For, each personal use mile costs $1.75 (100% -80% = 20%, 20% x 20,000 miles = 4,000 miles, $7,000/4,000 miles = $1.75). Kurt’s employer reimburses him 34.5 cents per mile for the business-related miles. As a result, the business use of the car is only partially reimbursed (16,000 business miles x 34.5 cents = $5,520).  

However, the business usage costs Kurt $5,600(80% of $7,000). Kurt subsidizes the employer 9.25 cents per mile ($7,000 – $5,520 = $1,480, $1,480 /16,000 = 9.25 cents). Kurt’s total cost of ownership is $1.84 per mile, or $36,850 ($1.88 x 20,000 personal miles over the five-year life).

1

Example 2: Dr. Ben uses a hospital employer-provided vehicle 4,000 miles per year in 2003.

He reimburses the employer 34.5 cents per mile. His cost for five years is $6,900 (5y x 4,000 = 20,000 miles, 20,000 miles x 34.5 = $6,900).

Beginning on January 1st 2013, the standard mileage rates for the use of a car (also vans, pickups or panel trucks) were:

  • 56.5 cents per mile for business miles driven
  • 24 cents per mile driven for medical or moving purposes
  • 14 cents per mile driven in service of charitable organizations

Note the dramatic contrast, from the employee’s perspective, between the above two examples, of the company reimbursing the employee for business use of his personal car, versus the employee reimbursing the company for personal use of the vehicle.

The business, medical, and moving expense rates decrease one-half cent from the 2013 rates.  The charitable rate is based on statute.

Source: http://www.irs.gov

2

ASSESSMENT: Your updated thoughts in modernity are appreciated.

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

THANK YOU

***

PODCAST: Tele-Health Benefits Everyone!

State of Telehealth in USA vs EU 2015 - Intersog eHealth

DEFINITION: Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.

Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

CITE: https://medicalexecutivepost.com/2021/06/03/dictionary-of-health-information-technology-and-security-2/

****

Telehealth Benefits Everyone!




Rich talks with veteran Telehealth executive, C.J. Mark about the growth of Telehealth in the last decade. They discuss the issues surrounding Telehealth, and how Covid has accelerated the importance of remote medical care.

PODCAST: https://richardhelppie.com/cj_mark/

ASSESSMENT: Your thoughts and comments are appreciated.

THANK YOU

***

Asset Protection Issues For [Physicians] and Crypto Investors

Ike Z. Devji J.D. - Tempe, Arizona - Lawyer | Lawyer Directory

By Ike Devji, J.D.

Crypto currency is all the rage and continues to make some coin investors small fortunes even as prices swing widely and scams emerge. These are some basic defensive measures to keep your digital wallet safe.

READ MORE: https://www.proassetprotection.com/asset-protection-for-crypto-investors/

EDITOR’S NOTE: Ike Devji contributed to our textbook on Risk Management for Doctors and Advisors. We appreciated his important chapter contribution.

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

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

Your comments are appreciated.

THANK YOU

***

SAMPLE: New Physician Letter of Employment Contract

ABOUT | DAVID EDWARD MARCINKO

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

SAMPLE NEW PHYSICIAN LETTER OF EMPLOYMENT INTENT

Dear Dr. [Name of Physician]

On behalf of [Name of medical practice or clinic] (hereinafter called the “practice”), this letter sets out a proposed agreement for your initial employment in Dr. [Name of physician]’s medical practice. After both you and Dr. [Name of physician] have agreed upon all issues related to your employment, a formal physician employment agreement will be prepared for your review and signature.

1.   Term: You will be an employee of the practice for an initial [Duration]-month period starting [Month, Date, Year]. Should you and the practice want to proceed past this initial employment period, an offer of co-ownership may be made to you as described in item nine below.

      Your employment with the practice will essentially be “at will,” since you or the practice may voluntarily terminate it at any time upon 30 days’ written notice to the other. However, the following are conditions under which the practice may terminate your em­ployment immediately: (a) upon your death or disability for three (3) consecutive months; (b) upon the suspension, revocation, or cancellation of your right to practice medicine in the State of [State]; (c) if you should lose privileges at any hospital at which the practice regularly maintains admission privileges; (d) should you fail or refuse to follow reasonable policies and directives es­tablished by the practice; (e) should you commit an act amounting to gross negligence or willful misconduct to the detriment of the practice or its patients; (f) if you are convicted of a crime involving moral turpitude, including fraud, theft, or embezzlement; and (g) if you breach any of the terms of your employment contract.

2.   Compensation: Your salary for the initial 12-month period will be $[dollar value] and $[dollar value] in the second 12-month period, each year payable in monthly installments. You will also be enti­tled to an incentive bonus calculated as follows: [Percentage] % of your collected production when such collections exceeds $[dollar value] in the first year and $[dollar value] in the second year. The bonus each year will be calculated and paid on a semiannual basis. You will also be entitled to receive a one-time signing bonus of $[dollar value] if you sign your employment contract before [Month, Date, Year].

      A portion of your compensation may be paid for by proceeds received from [Name of hospital] under the terms and conditions of a hospital recruitment agreement. The parties to this agreement will be the hospital and the practice only. However, forgiveness of any advances made by the hospital will be directly contingent upon the length of time you remain with the practice. Therefore, should your employment terminate for any reason, the practice will re­quire you to repay to it any amounts the practice repays the hospi­tal, in no matter what form, per the terms and conditions in the hospital recruitment agreement. [Note: Use this if the practice signs a hospital recruitment agreement with the hospital.]

3.   Benefits: In addition to your base compensation and incentive bo­nus, the practice will pay for the following: (a) health insurance, (b) malpractice insurance, (c) continuing medical education (CME) costs, (d) medical license fee, (e) board certification exam fee, (f) reasonable cellular phone costs, and (g) a pager. You will also be entitled to a moving cost allowance for relocating to [Location.] You will be entitled to two weeks of paid vacation, 10 working days as paid sick leave, and four days paid time off for CME or the board certification exam.

4.   Disability Leave: In case of absence because of your illness or injury, your base salary will continue for a period not exceeding 30 days per calendar year, plus any unused vacation time and sick leave. You will be entitled to any incentive bonus payments that may be due to you as collections are received on your prior production. Absence in excess of 30 days would be without pay. Unused sick leave cannot be carried over to succeeding years, nor will it be paid for at any time.

5.   Exclusive Employment: As an employee, you will be involved full-time in the practice and you may not take any outside employ­ment during the term of your employment agreement without the practice’s written approval. However, you will be entitled to keep compensation from honorariums, royalties, and copyrights if ap­proved by the practice in writing. If the practice does not give approval, then the income from such activities shall remain the property of the practice.

6.   Termination Compensation:  Should your employment terminate for any reason, you will be entitled to accrued but unpaid base compensation, earned but unpaid incentive bonus, and unused va­cation leave.

7.   Non-Solicitation: During the course of your employment, the prac­tice will introduce and make available to you its contacts and refer­ring physician relationships, ongoing patient flow, general hospital sources, business and professional relationships, and the like. Since you have not been in private practice in the area previously, you acknowledge that you currently have no established patients following you. If there should be a termination, the practice will not restrict your ability to practice medicine in the area; however, it will require you to enter into a nonsolicitation agreement in which you agree not to solicit the employees of the practice nor its patients to follow you into your new medical practice. [Note: Insert Covenant Not to Compete here, if applicable.]

8.   Employee-Only Status: During the term of your employment, you will not be required to contribute any money toward the practice’s equipment or operations, but likewise your work will give you no financial interest in the assets of the practice. However, the prac­tice intends to offer you the opportunity to buy into the ownership of the practice as set forth in item 9 below.

9.   Ownership Opportunity: At the end of your employment period, the practice will evaluate your relationship and may offer you the opportunity to become a co-owner in the practice (or enter into an office-sharing relationship). This offer is not mandatory and is at the total discretion of the practice. Should an offer not be tendered for some reason, the practice will wait until the end of your next 12-month employment period to decide whether to tender an offer of co-ownership.        If an offer of co-ownership is made, Dr. [Name of physician] will discuss with you the following: (a) what percentage of the practice you will be allowed to acquire, (b) how best to value such interest, and (c) how you will pay for the acquisition of such interest. The practice hopes to achieve mutually agreeable solutions to these ownership issues.

We hope this offer meets with your approval. If so, please contact Dr. [Name of physician] as soon as possible. This letter is not intended to be a legally binding agreement; it is, rather, a tool to be used to prepare your formal physician employment agreement. If you should have any questions, please do not hesitate to contact myself or Dr. [Name of physician] at your convenience.

Sincerely,

Atlantic Physicians Group

MEDICAL GROUP PRACTICE, LLC

Lantana FLA

ASSESSMENT: Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

PODCAST: How New Technologies Are Predictably Spread and How it Applies to Healthcare

BY ERIC BRICKER MD

[Book Review]

***

The Technology Adoption Lifecycle Was Explained in Geoffrey Moore’s Famous Book ‘Crossing the Chasm.

If You Are a Healthcare Entrepreneur or Innovator Your MUST Understand and Apply the Technology Adoption Lifecycle.

It States that Disruptive Innovation (i.e. Innovations that Require Behavior Change) Is Not Evenly Adopted Across a Population.

Rather, People Segment Themselves into Sub-Groups That Adopt the New Innovation Differently. To Whit:

**************

Early Adopters Love Tinker and Like New Innovations Just Because They Are New. Early Adopters Tend to Not Be Price-Sensitive.

Pragmatists Have a Specific Problem that the New Innovation Will Solve and If They See Other People Using It, They Will Use It Too. Pragmatists Are Somewhat Price-Sensitive.

Conservatives Would Rather Not Adopt the New Innovation, but if it is Already Built-in to Something They Already Buy, Then They Will Be More Likely to Use It. Conservatives are Very Price Sensitive.

Skeptics Will Never Adopt the New Innovation.

**************

To Spread a New Innovation, One Must Cross the Chasm Between the Early Adopters and Pragmatists With a ‘Niche‘ and ‘Bowling Pin‘ Strategy.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

New “MEDICAL SPECIALTIES” 2.0

BY DR. DAVID E. MARCINKO MBA CMP®

Image result for dasvid marcinko
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SPONSOR: http://www.CertifiedMedicalPlanner.org

GLOSSARY OF PRACTITIONER TERMS?

Each generation of doctors and medical professionals is extraordinarily complex, bringing various skills, expertise and expectations to the modern medical work environment. Determining the best method to unite such diverse thinking is one of the many challenges faced by physician executives and healthcare leaders today.

And, as linguistic evolution occurs, the nomenclature of hospitalist was followed by that of intensivist, proceduralist and nocturnalist, etc [www.MedInnovationBlog.com and Personal communication Richard L. Reece MD].

Is it any wonder that many medical leaders and executive in the Baby Boomer generation find themselves at a loss? The days of functional leadership are gone and suddenly, no one cares about the expertise of the Baby Boomers or how they climbed the corporate ladder, in medicine or elsewhere. Leadership in the new era is no longer about command-control or dictating with intense focus on the bottom line; it is about collaboration, empowerment and communication. And, it is not about titles and nomenclature; it is about lifestyle choice.

What else drives these new-wave specialists?

The answer, of course, is the next-generation of physicians and their emerging new medical business and practice models, which include:

  • “Ambulists” are doctors that travel locally, have no, or only a sparse physical office presence of their own. They sporadically provide services that are additive to traditional practice models [i.e., endocrinologist in a large family medical office with many diabetics]. 
  • “In-Situ” physicians regularly provide services that are complimentary to existing traditional practice models [i.e., dentists or podiatrists in a medical practice].
  • “Laborists” are obstetricians that do not wish to be on-call. First begun in Cape Cod and other Massachusetts hospitals, such obstetricians work regular shifts for the sole purpose of delivering babies.
  • “Locum Tenens” doctors travel around the country as itinerants [i.e., cruise ships] as temporary substitutes for another the same specialty.
  • “Officists” remain in their own physical practice, and rarely see patients in the hospital, nursing home, patient home, out-patient facility, etc.
  • Finally, “dayhawk physicians” mimic the “nighthawk physician” model where radiologists in remote locations read films in the middle of the night as cash-strapped hospitals often find it cheaper to outsource with better services and more timely interpretations in many cases.

Your thoughts are appreciated.

THANK YOU

***

OVERHEARD IN THE FINANCIAL ADVISOR’S LOUNGE

On Asset Protection FOR PHYSICIANS

From my perspective, asset protection is a team sport, and lawyers rely on financial advisers all the time to spot issues for clients. We do not all share the opinion that non-lawyers are incapable of giving good advice.

J. Chris Miller JD

Alpharetta, GA

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

THANK YOU

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PODCAST: Soap-Box Opera of Healthcare Reform?

By Carolyn McClanahan MD CFP

Your thoughts are appreciated.

THANK YOU

***

SPONSOR: http://www.CertifiedMedicalPlanner.org

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

ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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HUMANITARIAN WISDOM IN PATIENT CARE AS AN ETHICAL AND MORAL IMPERATIVE!

AND … RISK MANAGEMENT TOOL?

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BY DR. DAVID EDWARD MARCINKIO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

To start, let us all recall the Canadian physician Sir William Osler MD, one of the founders of Johns Hopkins Hospital in my hometown of Baltimore Maryland, and where I played stickball in the parking lot as a kid. He left a sizeable body of wisdom that has guided many physicians in the practice of medicine. So, allow me to share with you some of that accumulated wisdom and the quotes that have served me well over the years.

From Dr. Osler, I learned the art of putting myself in the patient’s shoes. “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’ Realize, so far as you can, the mental state of the patient, enter into his feelings.” Osler further stresses that we should “scan gently (the patient’s) faults” and offer the “kindly word, the cheerful greeting, the sympathetic look.”1

“In some of us, the ceaseless panorama of suffering tends to dull that fine edge of sympathy with which we started,” writes Osler in his famous essay “Aequanimitas.”2 “Against this benumbing influence, we physicians and nurses, the immediate agents of the Trust, have but one enduring corrective — the practice towards patients of the Golden Rule of Humanity as announced by Confucius: ‘What you do not like when done to yourself, do not do to others.’”

Medicine can be both art and science as many physicians have discovered. As Osler tells us, “Errors in judgment must occur in the practice of an art which consists largely of balancing probabilities.”2 Osler notes that “Medicine is a science of uncertainty and an art of probability” and also weighs in with the idea that “The practice of medicine is an art, based on science.”3,4

Osler emphasized that excellence in medicine is not an inheritance and is more fully realized with the seasoning of experience. “The art of the practice of medicine is to be learned only by experience,” says Osler. “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”5

Finally, some timeless wisdom on patient care came from Osler in an address to St. Mary’s Hospital Medical School in London in 1907: “Gain the confidence of a patient and inspire him with hope, and the battle is half won.”6

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Osler has also imparted plenty of advice on the business of medicine. In “Aequanimitas,” Osler says there are only two types of doctors: “those who practice with their brains, and those who practice with their tongues.”7

In a valedictory address to medical school graduates at McGill University, Osler suggested treating money as a side consideration in a medical career.8 “You have of course entered the profession of medicine with a view of obtaining a livelihood; but in dealing with your patients let this always be a secondary consideration.”

“You are in this profession as a calling, not as a business: as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man,” explains Osler in the address to St. Mary’s Hospital Medical School.6 “Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.”

It is not easy for doctors to combine a passion for patient care, a knowledge of science and the maintenance of business, according to Osler in the British Medical Journal.9 “In the three great professions, the lawyer has to consider only his head and pocket, the parson the head and heart, while with us the head, heart, and pocket are all engaged.”

While some aspects of practice may fall short or be devoid of appropriate financial remuneration, the giving of one’s time, expertise and experience in improving patient outcomes and the quality of their lives may be the greatest gift. “The ‘good debts’ of practice, as I prefer to call them … amount to a generous sum by the end of each year,” says Osler.9

And so, as you practice medicine and reflect on your career, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.

References

1. Penfield W. Neurology in Canada and the Osler centennial. Can Med Assoc J. 1949; 61(1): 69-73

2. Osler W. Aequanimitas. Chapter 9, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 159

3. Bean WB. William Osler: Aphorisms, CC Thomas, Springfield, IL, p. 129.

4. Osler W. Aequanimitas. Chapter 3, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 34

5. Thayer WS. Osler the teacher. In: Osler and Other Papers. Johns Hopkins Press, Baltimore, 1931, p. 1.

6. Osler W. The reserves of life. St. Mary’s Hosp Gaz. 1907;13 (1):95-8.

7. Osler W. Aequanimitas. Chapter 7, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 124

8. Osler W. Valedictory address to the graduates in medicine and surgery, McGill University. Can Med Surg J. 1874; 3:433-42.

9. Osler W. Remarks on organization in the profession. Brit Med J. 1911; 1(2614):237-9.

10. Jacobs. AM: PMNews, April, 2015.

ASSESSMENT: Your thoughts are appreciated.

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

ODER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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On DISPOSABLE and Other “Next-Gen” Credit Cards

Touring with Marcinko | The Leading Business Education ...

BY DR. DAVID EDWARD MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

‘Chip & Pin’ Technology

Disposable credit cards are the newest innovation to help reduce fraud and assumed identity scams on e-commerce based websites. As with traditional credit cards, these cards are numbered, but used only once. Then, electronically they are erased so that there is nothing left in the merchant’s database for hackers to steal.

But, in 2014, Congress began looking at new ways to keep personal credit card information safe after several high-profile security breaches at some of America’s top retailers.

WHY? Current credit cards use easy to hack magnetic strip technology from the 1960s. Many consumers want more secure “pin & chip” cards which have been in use in Europe for years. Even though micro-chip technology costs billions to implement, merchants are moving in that direction as they issue new cards to consumers. Most modern polls show nearly half of all people surveyed are extremely concerned about the safety of their personal credit card information.

Burner Cards: Similar to a burner phone or “throwaway” social media account, burner credit cards are temporary, virtual credit cards that are not your “main” credit card. The bank or burner card app will give you a temporary number that links back to your main credit card which you can use for online purchases.

An ANonymous Credit Card provides an extreme degree of privacy and prevents the tracking of your expenses by a spouse, people with bad intentions or government monitoring agencies. It is important to realize that there are plenty of legitimate reasons for wanting to buy something discreetly through an Anonymous Credit Card.

Credit Card Mistakes to Avoid

No number has as far-reaching an impact on your money as your credit scores.

Here are some obstacles, physicians and all of us, should dodge on the road to financial security:

  • Don’t pay for a credit card repair service.
  • Don’t miss a payment.
  • Don’t max out your card.
  • Don’t take a cash-advance.
  • Don’t skip using your cards.
  • Don’t chase interest rates.
  • Don’t apply for several credit cards all at once.
  • Don’t co-sign a loan.
  • Don’t spread our car or mortgage payments.

Citation: https://www.r2library.com/Resource/Title/0826102549

Denied Credit

If you are denied a credit card, you have the right to obtain a credit report free from the agency which denied you. Your request must be made in writing and within thirty-sixty days. Consumer credit is governed by the Fair Credit Reporting Act (FCRA).  The regulations are issued by and enforced by the Federal Trade Commission. Certain states offer consumers additional rights.  Credit reporting agencies are referred to as a “consumer reporting agency”.

ASSESSMENT: Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

HEDGE FUNDS: History in Brief

ABOUT | DAVID EDWARD MARCINKO

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

The investment profession has come a long way since the door-to-door stock salesmen of the 1920s sold a willing public on worthless stock certificates. The stock market crash of 1929 and ensuing Great Depression of the 1930s forever changed the way investment operations are run. A bewildering array of laws and regulations sprung up, all geared to protecting the individual investor from fraud. These laws also set out specific guidelines on what types of investment can be marketed to the general public – and allowed for the creation of a set of investment products specifically not marketed to the general public. These early-mid 20th century lawmakers specifically exempted from the definition of “general public,” for all practical purposes, those investors that meet certain minimum net worth guidelines.

The lawmakers decided that wealth brings the sophistication required to evaluate, either independently or together with wise counsel, investment options that fall outside the mainstream. Not surprisingly, an investment industry catering to such wealthy individuals, such as doctors and healthcare professionals, and qualifying institutions has sprung up.

EARLY DAYS

The original hedge fund was an investment partnership started by A.W. Jones in 1949. A financial writer prior to starting his investment management career, Mr. Jones is widely credited as being the prototypical hedge fund manager. His style of investment in fact gave the hedge fund its name – although Mr. Jones himself called his fund a “hedged fund.” Mr. Jones attempted to “hedge,” or protect, his investment partnership against market swings by selling short overvalued securities while at the same time buying undervalued securities. Leverage was an integral part of the strategy. Other managers followed in Mr. Jones’ footsteps, and the hedge fund industry was born.

In those early days, the hedge fund industry was defined by the types of investment operations undertaken – selling short securities, making liberal use of leverage, engaging in arbitrage and otherwise attempting to limit one’s exposure to market swings. Today, the hedge fund industry is defined more by the structure of the investment fund and the type of manager compensation employed.

The changing definition is largely a sign of the times. In 1949, the United States was in a unique state. With the memory of Great Depression still massively influencing common wisdom on stocks, the post-war euphoria sparked an interest in the securities markets not seen in several decades. Perhaps it is not so surprising that at such a time a particularly reflective financial writer such as A.W. Jones would start an investment operation featuring most prominently the protection against market swings rather than participation in them. 

Citation: https://www.r2library.com/Resource/Title/0826102549

Apart from a few significant hiccups – 1972-73, 1987 and 2006-07 being most prominent – the U.S. stock markets have been on quite a roll for quite a long time now. So today, hedge funds come in all flavors – many not hedged at all. Instead, the concept of a private investment fund structured as a partnership, with performance incentive compensation for the manager, has come to dominate the mindscape when hedge funds are discussed. Hence, we now have a term in “hedge fund” that is not always accurate in its description of the underlying activity. In fact, several recent events have contributed to an even more distorted general understanding of hedge funds.

During 1998, the high profile Long Term Capital Management crisis and the spectacular currency losses experienced by the George Soros organization both contributed to a drastic reversal of fortune in the court of public opinion for hedge funds. Most hedge fund managers, who spend much of their time attempting to limit risk in one way or another, were appalled at the manner with which the press used the highest profile cases to vilify the industry as dangerous risk-takers. At one point during late 1998, hedge funds were even blamed in the lay press for the currency collapses of several developing nations; whether this was even possible got short thrift in the press.

Needless to say, more than a few managers have decided they did not much appreciate being painted with the same “hedge fund” brush. Alternative investment fund, private investment fund, and several other terms have been promoted but inadequately adopted. As the memory of 1998 and 2007 fades, “hedge fund” may once again become a term embraced by all private investment managers.

See the source image

ASSESSMENT: Physicians, and all investors, should be aware, however, that several different terms defining the same basic structure might be used. Investors should therefore become familiar with the structure of such funds, independent of the label. The Securities Exchange Commission calls such funds “privately offered investment companies” and the Internal Revenue Service calls them “securities partnerships.”

Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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THANK YOU

***

PODCAST: The Future of Healthcare Looks to Medicare’s Past?

See the Future of Healthcare By Looking to Medicare’s Past

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY DR. ERIC BRICKER MD

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Desire for a Healthcare ‘Safety Net’ Goes Back Almost 100 years to President F.D.R. and His “New Deal

FDR Was Able to Pass Social Security, but He Also Wanted a Healthcare Safety Net Too.

Presidents Truman and Kennedy Also Wanted a Federally-Funded Healthcare Safety Net.

LBJ Carried the Torch of the Healthcare Safety Net. He Was Able to Have Medicare Legislation Passed in 1965 by Combining 3 Separate Proposals and Acts:

1) Hospital Insurance

2) Doctor Insurance That Was Voluntary

3) the State-Administered Kerr-Mills Act 

Hospital Insurance Became Medicare Part A. Doctor Insurance Became Medicare Part B. The Kerr-Mills Act Became Medicaid.

Presidents Carter and Clinton Also Wanted to Expand the Healthcare Safety Net. President Obama Expanded the Healthcare Safety Net with Passage of Obamacare. President Biden is Seeking to Expand the Healthcare Safety Net Too.

The Arc of Government-Funded Healthcare Stretches Back Almost 100 Years and Will Inevitably Result in the Full Government Payment for Healthcare in America.

It’s Not a Question of If, But When.

Implication: United Health Group is Making Many Acquisitions to Become a Vertically Integrated Healthcare Company to Position Itself as a Major Government Contractor for the Eventual Federal Takeover.

PODCAST: https://www.youtube.com/watch?v=OAh7Rl7w1wM

Your thoughts are appreciated.

THANK YOU

***

What is a CONTENT DELIVERY NETWORK, Doctor?

CDNs and What They Mean to Physicians

BY J.M.

[Anonymous IT Expert]

DOCTOR – Do you like the internet? Do you use EMRs/EHRs? Do you like fast internet? Of course you do.

But, without a strong infrastructure of content delivery networks (CDNs), website loading times would be too slow to stream tele-health/tele-medicine visits or tela-radiology services; not to mention Netflix, or argue with Reddit strangers or your patients; etc.

CDNs are geographically distributed networks of servers that handle processing and speed up internet delivery. In practice, CDNs make website content like HTML pages, JavaScript files, style-sheets, images, and videos load faster. They also reduce bandwidth costs, handle more traffic, and provide a little security protection. 

  • CDNs don’t actually host web content, but instead keep cached versions of it at the ready in edge servers. 

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How CDN Works? How to Find the Cheapest CDN Provider?

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Fastly is one of a number of significant CDN providers that help form the infrastructure of the internet. And while the outage shows the breadth of its reach, it’s far from the biggest player—Akami, Cloudflare, and Amazon CloudFront take up 75% of revenue in CDN space, per Intricately.

But Fastly, one of the world’s largest cloud computing companies itself, just had an outage that shut down its CDN service, affecting major websites including the New York Times, HBO Max, and the British government’s homepage. 

ASSESSMENT: Were you or your clinic or hospital affected? Your thoughts and comments are appreciated.

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ASK A FINANCIAL ADVISOR? About Company “Vesting”

A YOUNG PHYSICIAN INQUIRES ABOUT NON-PUBLIC COMPANY SHARES AND VESTING?

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QUESTION: I am a physician and work for a startup healthcare IT company with shares in a non-public company that vests over time. What does that mean, and will the shares only be worth something if we go public or are acquired?

Shelly from Boston, MA

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ANSWER: In most cases, startups dangle equity compensation over employees like a just-out-of-reach cupcake in front of a treadmill. Vesting means some condition needs to be met before you fully own your shares, whether it’s staying at the company for a period of time, reaching a target valuation, or both.

Once your shares have fully vested, you’d think you can finally cash in. But that’s not always the case. It’s a hassle to sell private company shares because there are far fewer buyers compared to selling shares in a publicly traded company. 

If you want to sell your stake before the company goes public, you can ask the execs at your company to buy back your shares. If they say no—and they might, because once they let one employee sell, it’s hard to turn down others—you need another buyer, like an outside investor.

There are eBay-like marketplaces for selling private company shares, but it’s not like posting a picture of your old iPod and offering free shipping. You can only sell to accredited investors (aka hedge funds and other rich folks), and your company needs to authorize the sale. 

It’s way easier to sell your shares if and when your company goes public or is acquired by another company.

Thanks for the query.

Citation: https://www.r2library.com/Resource/Title/0826102549

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ASSESSMENT: Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

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