Medicare Spending on EpiPens

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Part D

By  http://www.MCOL.com

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

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Prescription Drug Bitterness

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By Ben’s Bitter Blog

I just read the other day that there are only two countries in the world that allow prescription drugs to be advertised on television and one of those is the Good Ole USA.

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I have to say that I feel bad for the rest of the world because you guys are missing out on something […]

Prescription Drug BitternessBen’s Bitter Blog

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Texas VA medical center accused of falsifying veteran wait times

By Dr. Eowyn

Another VA scandal for Obama’s record. From Fox News: A Houston VA hospital altered records to hide lengthy patient waiting lists even as a national scandal regarding treatment of veterans was unfolding, a federal watchdog charged in a scathing report released this week. Officials at the Michael E. DeBakey VA Medical Center in Houston and […]

 Texas VA medical center accused of falsifying veteran wait times — Fellowship of the Minds

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Doctor Bitterness

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By Ben Gardner [Ben’s Bitter Blog]

Most people would be surprised to know this about me, but I am neither invincible or indestructible. Because of this, from time to time, I get sick.

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Sometimes I even have pain. I am very bitter about this, but it is something even I have to deal with. When my drug of choice, Aleve, isn’t […]

Doctor BitternessBen’s Bitter Blog

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On the Future of Healthcare [video]

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By NIHCM Foundation

This briefing brought together leading health care experts with diverse backgrounds to discuss the future of health care, including potential policy reforms and new ways of thinking about long-term care, the consumer experience and the concept of value in health care.

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cenergistic

Watch Now

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The mHealth app Market is getting CROWDED

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There are 259,000 mHealth apps now

ralfBy Ralf-Gordon Jahns

ralf.jahns@research2guidance.com

Almost 100,000 mHealth apps have been added since the beginning of last year, amounting to 259,000 currently available on major app stores. In addition, 13,000 mHealth publishers have entered the market since the beginning of 2015, totaling 58,000. The largest global study on mHealth app publishing reveals a massive increase in competition in the mHealth app market.

The results of this year’s mHealth App Developer Economics 2016 study show a steep increase in competition level among mHealth app publishers. The supply side of mHealth apps is measured in the number of available apps and publishers. They are growing significantly faster than the demand side which is quantified by the number of mHealth app downloads. The number of mHealth apps and active mHealth app publishers has seen strong growth since 2015. This year, the total number of mHealth apps listed on major app stores across the globe grew by 57% to 259,000 apps.

“This impressive growth is based on three main developments; the growing number of mHealth app publishers, the increased importance of multi-platform app publishing and the expansion of existing mHealth app portfolios”

The number of mHealth app publishers grew in line with the number of apps. There are currently 58,000 mHealth app publishers app on major app stores, 28% more since the beginning of 2015. There appears to be no immediate end to the number of companies rushing into the market to launch their first mHealth app. Multi-platform publishing also contributes to the growth on the supply side of the mHealth app market.

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it-is-getting-crowded

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Currently 75% of mHealth publishers are developing their mHealth apps both on iOS and Android platforms. Multi-platform publishing is even more significant for HTML5 and Windows Phone developers, however these platforms are still niche and don’t contribute a lot to the overall number of mHealth apps yet.

In contrast, growth rates of mHealth app store downloads are estimated to be only +7% in 2016, having been +35% the previous year, reaching a total of 3.2B in 2016. This is in line with other app market categories and reflects the fact that growth of capable devices that can download apps has slowed down in most western countries. As a consequence of this increased competition, it will be even more difficult to stand out and gain significant downloads. Only 14% of mHealth app publishers generated more than 100,000 downloads with their mHealth app portfolio in one year. This share increased only marginally by 3pp since 2014.

“Consumers are still downloading mHealth apps because they have heard about them or found them in the app store” explains Audrone Skardziute, Analyst at research2guidance. “The next push on the demand side will come from recommendations of traditional healthcare companies that are pushing apps to their employees or members.”

With hundreds of new mHealth apps released daily, companies have to consider their app launch as if it were a familiar product in a saturated market. The mHealth Developer Economics 2016 research program is the largest research program about mHealth app publishing. This year more than 2,600 mHealth app developers and decision makers participated and shared their experiences and views about the mHealth app market. There is much more and we will continue to write about the results of the study. Read the full report to see all results.

MORE: Download the free 28 page report here.

About

research2guidance is a Berlin-based mobile app economy specialist. The company’s service offerings include app strategy consulting, market studies and research.

Link to the report:

http://research2guidance.com/product/mhealth-app-developer-economics-2016/

Link to the blog post: http://research2guidance.com/2016/10/11/mhealth-app-market-getting-crowded-259000-mhealth-apps-now/ Link to the image: http://research2guidance.com/wp-content/uploads/2016/10/It-is-getting-crowded.png

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Presidential Politics & Wall Street

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and ….. Doctors!

Rick Kahler MS CFP

By Rick Kahler MS CFP®

Recently, I reported on a survey that found most investment advisors are expecting the presidential election to result in rough seas for both their businesses and their client’s long-term retirement portfolios.

As it turns out, I am in the minority of advisors that disagree with that belief.

Presidential Power?

This is why. Even though the U.S. President is often called the most powerful person in the world, our presidents don’t run the economy any more than they run the Congress or the Supreme Court. While they may have some influence over all three, that influence goes only so far.

Certainly the president, as head of the executive branch, has authority over enforcing or not enforcing the laws passed by Congress. We’ve witnessed this most notably with President Bush, who didn’t enforce some environmental laws, and President Obama, who has vigorously enforced them. This gives the president a lot of influence on enforcing regulations which impact business and consumers.

Enforcing or not enforcing regulations dealing with commerce and Wall Street can have some influence on the economy.

Executive Branch Powers

Still, Executive Branch powers include foreign affairs, ordering military actions, and making appointments to the courts. Congress enacts all laws and controls the spending. The Supreme Court decides if both the Executive Branch and the Congress comply with the Constitution. Presidents can certainly influence Congress, but they remain one cog of many cogs in the wheel of government.

While the president has an influence on the economy, it isn’t the major influence that the media or either political party make it out to be. People think a president has great power to fix an economy. Even presidential candidates believe their own rhetoric around what they can accomplish until they take up residence in the Oval Office and discover there are a plethora of constraints that mute their power. This is how the founding fathers designed our government, which is actually a good thing, especially in this election cycle.

Long Term Portfolios

That is why, viewed in the context of your long-term retirement portfolio, you need not worry about who becomes president. Could there be some short-term swings in the stock market? Certainly.

Will who is elected president in November make a difference in the long run … No?

Of More Concern

Of slightly more concern, and potentially more economically impactful, is if one party gains control of both the Executive Branch and Congress. The last time we saw that was in 2008-2010 when the Democrats controlled both houses of Congress and the Presidency. One of the biggest outcomes of that two-year run was the passing of the Affordable Health Care Act, which certainly had a large economic impact. Whether that impact was positive or negative depended on your economic status. For many of the uninsured working poor, it was a godsend. For anyone not qualifying for a subsidy on the exchanges, it was a massive increase in health premiums.

That said, I won’t be doing anything differently with my investments even if we have a Democratic or Republican sweep of the Congress and Presidency. If you have a globally diversified portfolio of many different asset classes, you have no need to make any adjustments.

And now … Doctors and Political Parties

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Your Surgeon Is Probably a Republican, Your Psychiatrist

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Assessment

While I am neutral as to the impact of the presidential election on my investment portfolio, that certainly does not mean I don’t care about the election or the person who represents our country in its highest office. I am going to vote, because elections do matter. The choices we make as voters, not only for president, but for Congress and state and local officials, do have an impact on the direction of our country.

MORE: President Trump vs. President Clinton: The impact on physicians

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Navigating Health Care Integrated Delivery Networks

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It’s Complicated

http://www.MCOL.com

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Competent, Ethical and Fair Legal Representation for Doctors

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 —A Possible New Niche Area for Lawyers?

Langan MD

By Michael Lawrence Langan, M.D.

Wretched creatures are compelled by the severity of the torture to confess things they have never done and so by cruel butchery innocent lives are taken; and by new alchemy, gold and silver are coi…

Competent, Ethical and Fair Legal Representation for Doctors —A Possible New Niche area for Lawyers.

*** 

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The Financial Instability “Hypothesis”

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By David Shahrestani

On January 13, 2010, the chief executives of four top Wall Street institutions gathered together in Washington to testify on what went wrong in the years leading up to the great recession …

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journalism_grants_image

 Financial Instability Hypothesis

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The PRIME Act

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Preventing and Reducing Improper Medicare and Medicaid Expenditures Act

demBy Dr. David Edward Marcinko MBA

http://www.CertifiedMedicalPlanner.org

This Act was introduced into congress in 2013 and contains a number of provisions that would increase rewards and incentives for those who uncover healthcare fraud, as well as heighten penalties for those who commit it.

The PRIME Act

The PRIME Act would enact stronger penalties for Medicare and Medicaid fraud; curb improper or mistaken payments made by Medicare and Medicaid; establish stronger fraud and waste prevention strategies with Medicare and Medicaid to help phase out the practice of “pay and chase” (i.e., recouping monies already erroneously paid to providers instead of detecting problems on the front end); curb the theft of physician identities; expand the fraud identification and reporting work of the Senior Medicare patrol; take steps to help states identify and prevent Medicaid overpayments; and improve the sharing of fraud data across state and federal agencies and programs.

fraud

Assessment

The law directs the Secretary to develop a plan to revise the incentive program under HIPAA for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse.

And, it also requires the plan to include certain recommendations for ways to enhance rewards for individuals reporting and an extension of the incentive program to the Medicaid program.

MORE: Ten Ways to Prevent Fraud [Consumer]

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The Massacre of Hedge Fund Business

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By Michael Zhuang

Michael Zhuang

The Massacre of Hedge Fund Business

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I took the sensationalist title from a CNBC article I read recently. The articles talks about,  and I quote,
” … hedge funds, as a category, is experiencing the worst quarter of outflows since the bottom of the financial crisis … there were an avalanche of stories about the industry’s nearly systematic underperforming.”
Readers of my newsletter and blog, The Investment Scientist,  can thank me later for warning them years ago.
Examples
On April 28, 2011, I published “A Balanced Portfolio to Avoid (II): Hedge Funds Don’t Deliver Outstanding Returns.” Let me quote my former self:
“Hedge funds are often peddled as an unique asset class that are uncorrelated with the market. In reality, hedge funds are as much an asset class as Las Vegas is.”
The unspoken message is: you should expect to lose money.
On August 15, 2012, I published “Why You should Avoid Hedge Funds.
” I wrote that article after I read the book by former hedge fund industry insider Simon Lack, “The Hedge Fund Mirage.”  I summarized the book in one sentence for my readers: “Between 1998 and 2010, hedge fund fees totaled $440 billion vs. $9 billion profits for investors.”
Note: Hedge fund performance reporting is voluntary – unprofitable hedge funds need not report – so even the $9 billion profit figure should be taken with a grain of salt.
On June 13, 2013, I was aghast at SEC Chairwoman Mary Jo White’s proposal to allow hedge funds to market to the public. That day, I wrote a sarcastic piece “Why Allowing Hedge Funds to Market to The Public is Such A Good Idea.”
In the concluding paragraph I wrote:
“What’s unfair about the existing hedge fund rule is that only the top 1% get that bragging right. The rest of us don’t even know such a wonderful opportunity exists to transfer our puny wealth to the hedge fund managers who are really the top 0.1%.”
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dollar-1029742_640
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Assessment
I hope somewhere out there a reader or two did not buy into the hedge fund hype because of my writings. That would make all the midnight oil I have burned worth it!

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Understanding Capital Investment Risks for Hospitals

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Capital Investment Risks for Hospitals

By Calvin Weise CPA and Dr. David E. Marcinko MBA CMP®

www.CertifiedMedicalPlanner.org

Capital investments create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What is unknown are the benefits to be realized by those capital investments.

Capital Investments

For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low. Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs.

Capital Assets

When capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Manager Tasks

Hospital managers need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

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Hospital with paper MRs

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Modern Portfolio Theory

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different.

Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio.

Risk Measure

Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them. Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition. Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics.

In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk.

Conclusion

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The Stock Market Doesn’t Care About Clinton or Trump

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By

Yep! 

We have only a month to go before voters settle on either Hillary Clinton or Donald Trump.

Guess what?

The stock market doesn’t care a whit.

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stock-exchange

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The Stock Market Doesn’t Care About Clinton or Trump | Rebalance-IRA.com

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Health Plan Marketing Costs

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By http://www.MCOL.com

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graphoid092116

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More

How Much Money Should a Medical Practice Spend on a Marketing Campaign?

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Mental Health Coding and Billing

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Dr. David E. Marcinko MBA

By Dr. David Marcinko MBA

http://www.CertifiedMedicalPlanner.org

Coding Classification

The classification and coding systems used by mental health insurers, both diagnosis-related groups (DRGs) through revenue codes for facility and program services and current procedural terminology (CPT) for in and out patient professional services and consultations, are still being defined through historical methodologies and are vague compared to the medical classification coding structure.

Example:

As an example, mental health insurers classify Tourette Syndrome (TS) as a “mental disorder.” In fact, TS is an inherited, neurobiological disorder, and both neurologists and psychiatrists treat TS with the same medications. If TS were reclassified under the medical coding structure, TS would not only receive potentially a better reimbursement but public perception of TS as a “mental disorder” would be changed.

DSM-IV-TR

The Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision), also known as the DSM-IV-TR, is a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. The coding system utilized by the DSM-IV is designed to correspond with codes from the International Classification of Diseases, commonly referred to as the ICD. Since early versions of the DSM did not correspond with ICD codes and updates of the publications for the ICD and the DSM are not simultaneous, some distinctions in the coding systems may still be present.

For this reason, it is recommended that users of these manuals consult the appropriate reference when accessing diagnostic codes. In addition, DSM5 was last updated in May 2013.  For more information, contact the APA at (800) 368-5777.

Assessment

Besides the above coding manual, the International Statistical Classification of Diseases and Related Health Problems” produced by the World Health Organization (WHO) is another commonly used manual which includes criteria for mental health disorders.

Conclusion

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On a NEW economic hybrid medical reimbursement system

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Enter Hybrid Reimbursement!

dem-2By Dr. David Edward Marcinko MBA CMP®

http://www.CertifiedMedicalPlanner.org

As we know – not withstanding ACOs or bundled care reimbursement models – current medical reimbursement structures involve the submission and payment of medical CPT® coded claims.

Still, some doctors feel they need to “up-code” to maximize revenue or even “down-code” for fear of having a claim denied.

The Outcome

The upshot is that contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

Enter Hybrid Reimbursement Models

This hybrid reimbursement system might use a two-payment structure.

  1. For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.
  2. The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.

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Flag MOney

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Assessment

Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar. 

Conclusion

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Health Coverage and the Un-Insured

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For 2016

By http://www.MCOL.com

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infographic0916

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Key Hospital Employee Benefits

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For KEY Hospital Employees

By PERRY D’ALESSIO; CPA

[D’Alessio Tocci & Pell LLP]

Dr. David E. Marcinko; MBA CMP®

http://www.CertifiedMedicalPlanner.org

Effective January 1st 2014, the limitation on the annual benefit under a defined benefit plan under Section 415(b)(1)(A) was increased from $205,000 to $210,000.

For a participant who separated from service before January 1st 2014, the limitation for defined benefit plans under Section 415(b)(1)(B) is computed by multiplying the participant’s compensation limitation, as adjusted through 2013, by 1.0155.

The limitation for defined contribution plans under Section 415(c)(1)(A) is increased in 2014 from $51,000 to $52,000.

The Code provides that various other dollar amounts are to be adjusted at the same time and in the same manner as the dollar limitation of Section 415(b)(1)(A). These dollar amounts and the adjusted amounts are as follows:

  • The limitation under Section 402(g)(1) on the exclusion for elective deferrals described in Section 402(g)(3) is increased to $17,500.
  • The annual compensation limit under Sections 401(a)(17), 404(l), 408(k)(3)(C), and 408(k)(6)(D)(ii) is increased from $255,000 to $260,000.
  • The dollar limitation under Section 416(i)(1)(A)(i) concerning the definition of key employee in a top-heavy plan is increased from $165,000 to $170,000.
  • The dollar amount under Section 409(o)(1)(C)(ii) for determining the maximum account balance in an employee stock ownership plan subject to a 5‑year distribution period is increased from $1,035,000 to $1,050,000, while the dollar amount used to determine the lengthening of the 5‑year distribution period is increased from $205,000 to $210,000.
  • The limitation used in the definition of highly compensated employee under Section 414(q)(1)(B) is increased from to $115,000.
  • The dollar limitation under Section 414(v)(2)(B)(i) for catch-up contributions to an applicable employer plan other than a plan described in Section 401(k)(11) or Section 408(p) for individuals aged 50 or over is increased from $5,000 to $5,500. The dollar limitation under Section 414(v)(2)(B)(ii) for catch-up contributions to an applicable employer plan described in Section 401(k)(11) or Section 408(p) for individuals aged 50 or over remains unchanged at $2,500.
  • The annual compensation limitation under Section 401(a)(17) for eligible participants in certain governmental plans that, under the plan as in effect on July 1, 1993, allowed cost‑of‑living adjustments to the compensation limitation under the plan under Section 401(a)(17) to be taken into account, is increased from $380,000 to $385,000.
  • The compensation amount under Section 408(k)(2)(C) regarding simplified employee pensions (SEPs) is increased from $500 to $550.
  • The limitation under Section 408(p)(2)(E) regarding SIMPLE retirement accounts is increased from to $12,000.
  • The limitation on deferrals under Section 457(e)(15) concerning deferred compensation plans of state and local governments and tax-exempt organizations is increased to $17,500.
  • The compensation amounts under Section 1.61‑21(f)(5)(i) of the Income Tax Regulations concerning the definition of “control employee” for fringe benefit valuation purposes is increased from $100,000 to $105,000.  The compensation amount under Section 1.61‑21(f)(5)(iii) is increased from $205,000 to $210,000.
  • The Code also provides that several pension-related amounts are to be adjusted using the cost-of-living adjustment under Section 1(f)(3). These dollar amounts and the adjustments are as follows:
  • The adjusted gross income limitation under Section 25B(b)(1)(A) for determining the retirement savings contribution credit for married taxpayers filing a joint return is increased from $35,500 to $36,000; the limitation under Section 25B(b)(1)(B) is increased from $38,500 to $39,000; and the limitation under Sections 25B(b)(1)(C) and 25B(b)(1)(D), from $59,000 to $60,000.
  • The adjusted gross income limitation under Section 25B(b)(1)(A) for determining the retirement savings contribution credit for taxpayers filing as head of household is increased from $26,6250 to $27,000; the limitation under Section 25B(b)(1)(B) is increased from $28,875 to $29,250; and the limitation under Sections 25B(b)(1)(C) and 25B(b)(1)(D), from $44,250 to $45,000.
  • The adjusted gross income limitation under Section 25B(b)(1)(A) for determining the retirement savings contribution credit for all other taxpayers is increased from $17,750 to $18,000; the limitation under Section 25B(b)(1)(B) is increased from $19,250 to $19,500; and the limitation under Sections 25B(b)(1)(C) and 25B(b)(1)(D), from $29,500 to $30,000.
  • The applicable dollar amount under Section 219(g)(3)(B)(i) for determining the deductible amount of an IRA contribution for taxpayers who are active participants filing a joint return or as a qualifying widow(er) is increased from $95,000 to $96,000. The applicable dollar amount under Section 219(g)(3)(B)(ii) for all other taxpayers (other than married taxpayers filing separate returns) is increased from $59,000 to $60,000. The applicable dollar amount under Section 219(g)(7)(A) for a taxpayer who is not an active participant but whose spouse is an active participant is increased from $178,000 to $181,000.
  • The adjusted gross income limitation under Section 408A(c)(3)(C)(ii)(I) for determining the maximum Roth IRA contribution for married taxpayers filing a joint return or for taxpayers filing as a qualifying widow(er) is increased from $178,000 to $181,000. The adjusted gross income limitation under Section 408A(c)(3)(C)(ii)(II) for all other taxpayers (other than married taxpayers filing separate returns) is increased from $112,000 to $114,000.

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IRS

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Assessment

Administrators of defined benefit or defined contribution plans that have received favorable determination letters should not request new determination letters solely because of yearly amendments to adjust maximum limitations in the plans.

Source: http://www.irs.gov/newsroom/article/0,,id=187833,00.html

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Medicaid’s Most Costly Drugs

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The 5 Most Common RX’s

By http://www.MCOL.com

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More on Childhood Obesity Trends

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obesity-chart

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50 Things Every Gentleman Should Know

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Practical Psychology

54f358d389279a6e9f0b59d95f51461a

By Gus

A gentleman is one who puts more into the world than he takes out.

-George Bernard Shaw

According to a recent article in Salon, the “radical” act of paying attention to each other.…

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50 Things Every Gentleman Should Know, presented by Practical Psychology

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Reasons to Remember Death, by the School of Life

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Daily Dose

By Gus-

https://www.wisedrugged.com

Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.

-Steve Jobs [In the spirit of Halloween being …]

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Daily Dose: Reasons to Remember Death, by the School of Life

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More on Private LTCI

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On The Unpredictability of The Market

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On Brexit

Michael Zhuang

By Michael Zhuang,

[Principal of MZ Capital Management]

At the end of June this year, UK citizens voted in a referendum for the nation to withdraw from the European Union. The result, which defied the expectations of many, led to market volatility as participants weighed possible consequences.

Journalists

Journalists responded by using the results to craft dramatic headlines and stories. The Washington Post said the vote had “escalated the risk of global recession, plunged financial markets into free fall, and tested the strength of safeguards since the last downturn seven years ago.” The Financial Times said “Brexit” had the makings of a global crisis. “[This] represents a wider threat to the global economy and the broader international political system,” the paper said. “The consequences will be felt across the world.”

What about those self-proclaimed financial gurus? Motley Fool wrote: “Sell Everything! How Brexit Can Shatter Share Market” and Jim Cramer wrote: “Don’t Buy! Why the Mass Brexit Sell Off is Worth Riding Out.”

It turned out there was no “mass brexit sell off”

It’s true UK got a new Prime Minister, and the Pound Sterling fell to 35 years low. But within a few weeks of the UK vote, Britain’s top share index, the FTSE 100, hit 11-month highs. By mid-July, the US S&P 500 and Dow Jones Industrial Average had risen to record highs. Shares in Europe and Asia also strengthened after dipping initially following the vote.

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Assessment

Before Brexit faded away in our memory, what can we learn from this experience? I don’t know about you, here is what I learn. We don’t know what gonna happen in the future, and we don’t know how the market gonna react. And those pundits on TV and newsletter don’t know either. Prudent investing aka wealth preservation should never be based on their (or our) speculation.

Conclusion

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What is the right relationship to money?

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Money often costs too much.

-Ralph Waldo Emerson

By Gus: https://www.wisedrugged.com

Presented By J. Krishnamurti

As the Dow Jones soars to new peaks, it seems many of us feel a sense of security within the realm of money.

Less preoccupation maybe? Is th…

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Money

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What is the right relationship to money? presented by J. Krishnamurti

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Physician “Burnout” Rates

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By Medical Specialty

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Your-Physician-Can’t-See-You-Yet-–-She’s-Busy-Filling-Out-Paperwork-21

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MORE:

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Retirement Investing with Vanguard Founder John Bogle [video]

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Campaigning for Safer Retirement Investing with Vanguard Founder John Bogle

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When it comes to making retirement investing safer, Rebalance IRA strives to be on the right side of history. Our latest efforts saw Managing Director Scott Puritz joining legendary investing innovator John Bogle, and other industry leaders, in a landmark pro-consumer initiative.

Watch Rebalance IRA Join John Bogle In The ‘Campaign for Investors’

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On Prospect Theory

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And … the reality of decision making!

By David Shahrestani

In the early 1980s, Daniel Kahneman and Amos Tverskey proved in numerous experiments that the reality of decision making differed greatly from the assumptions held by economists.

They published their findings in Prospect Theory: An analysis of decision making under risk, which quickly became one of the most cited papers in all of economics. To […]

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Human Nature #9: Prospect Theory — Wiser Daily

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Are You a One Percenter?

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Well … Are you Doctor?

Rick Kahler MS CFP

By Rick Kahler MSFS CFP

What would it take for you to become a one percenter? How much net worth would put you in the wealthiest one percent in the United States?

In a recent discussion with a colleague, I suggested this number was $1.2 million. He said $9 million. Turns out the real answer, which is surprisingly hard to find, probably falls somewhere in between $1.2 million and $9 million. I have read several articles that put it in the range of $3 to $5 million.

Joshua Kennon, author of The Complete Idiot’s Guide to Investing, 3rd Edition, discusses this topic in more detail in an article posted to his blog in September 2011. He cites several sources and points out the differing methods used by the Federal Reserve Board (which uses the $9 million figure) and the IRS (which favors $1.2 million) to arrive at their numbers.

Regardless of the net worth needed to enter the top 1%, the media usually focuses on the amount of a household’s annual income as what really determines what makes someone rich. We know the income of the rich is growing faster than the income of the poor and middle class. What isn’t reported as often is that the percentage of Americans considered “rich” is also increasing by leaps and bounds. This is different from the rich getting richer. This means an increasing number of Americans are joining the ranks of the rich and the upper middle class.

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In June 2016, Stephen J. Rose, a nationally recognized labor economist affiliated with the Income and Benefits Policy Center at the Urban Institute, published a report titled “The Growing Size and Incomes of the Upper Middle Class.” His research covered a 36-year period from 1979 through 2014. He found that the number of households earning $350,000 or more a year (adjusted for inflation) increased eighteen times, from 0.1% of the population in 1979 to 1.8% in 2014. The upper middle class, those households earning between $100,000 to $350,000, increased two and one-half times, from 12.9% to 29.4%.

With more people earning more money and moving into the rich and upper middle class categories, it would stand to reason that fewer people would be left in the categories of middle class, lower middle class, and poor. The middle class, households earning $50,000 to $100,000, shrank from 38.8% to 32.0%. The lower middle class, households earning from $30,000 to $50,000, declined from 23.9% to 17.1%. The poor, households earning under $30,000, contracted from 24.3% to 19.8%.

Good News?

That is really good news. It means that today, the average American is earning more money than was the case 36 years ago. Perhaps our economic system isn’t as broken as some would have us believe.

With so many political candidates and activists focused on issues like income inequality, it’s easy to assume that more and more Americans are sinking to the bottom economically. Before making such assumptions, it’s important to factor in real data like that cited in Rose’s report.

The plight of those who unfortunately remain on the bottom is a real concern that deserves attention. Yet it is only one part of the whole picture. Many others are able to move upward, an individual and societal accomplishment that is worth celebrating.

Assessment

Instead of taking more from those who do succeed, it would be more useful to focus on what we can do to help others emulate them. The middle and upper middle classes tend to receive less attention than either the poor or the rich, yet these categories make up the majority of Americans. There is always room for others to join them. 

Conclusion

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The State of Health Information Technology

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In Six Visuals

By Venture Scanner

The-State-of-Health-Technology

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http://www.HealthDictionarySeries.org

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Hippocrates and the Internet

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Langan MD[By Ira Nash MD via Michael Lawrence Langan MD]

The Hofstra Northwell School of Medicine recently graduated its second class. The commencement was a wonderful “feel-good” event, complete with beautiful weather, happy graduates and proud families…

Hippocrates and the Internet

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Is medicine the “holy grail”?

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Finding satisfaction in medical practice

By DR RNJB MD

Every day I read many letters and posts from undergraduate students who view a career in medicine as the ultimate prize for academic achievement.

While this view may keep many pre-med students on the road to high academic achievement, a more realistic view of this profession and it’s practice is a better choice for […]

942ef818796363_562d14c1238cb

Is medicine the “holy grail”(finding satisfaction in practice)? — Medicine From The Trenches

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“New Paradigm” is a business model not a medical model

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327518caf4de6ca81321ea8b469a3d42

By Michael Langan MD

“I’m only here for a four day evaluation”– T-shirt sold at Talbott Recovery Center The  New York Times article below written by Robert Dupont advocates coercion to facilitat…

img1-9

“New Paradigm” is a business model not a medical model

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The Age of Technology 2006-2016

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By Public Company Market Capitalization

[via Bertalan Meskó, MD, PhD]

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ext

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Top 10 Best US Cancer Hospitals?

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US News & World Report 

By http://www.MCOL.com

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Request Medical School Administrators Question PHP Authority to Prevent Future Medical Profession Brain Drain

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[Pediatric] Physician Health Programs

Langan MD[By Michael Lawrence Langan MD]

Physician Health Programs (PHPs) are now targeting medical students and the stories I am hearing are heartbreaking.   Medical students who do not fit the diagnostic criteria for psychological probl…

 Request Medical School Administrators Question PHP Authority to Prevent Future Medical Profession Brain Drain

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Today happens only once!

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In the end … We are guaranteed nothing

By Michael P. Jones MD

To fret over the past and put things off on the future only squanders today.

Be kind to yourself. Be kind to others. Become the person that you always wanted to be.

Look around and find the good things because they are out there.

When I can do that, my days are full and rich and satisfying, and I feel like I help make the lives of people around me better, too.

And in the end, that’s all that matters.

***

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ABOUT

Michael P. Jones is a gastroenterologist.

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10 Reasons Why People Should Not Fear Digital Health Technologies

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Fear NOT!

By  Bertalan Mesko, MD PhD 

10 Reasons Why People Should Not Fear Digital Health Technologies

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HDS

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Gay Doctor Coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins

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Langan MD[By Michael Lawrence Langan MD]

State Physician Health Programs – coercion, control and abuse. This anecdote concerning  a gay doctor’s revelation he liked his non monogamous lifestyle leading  to a forced acceptance of a &#… …

 Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins

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Massachusetts Governor Charlie Baker Moves to Control Professional Boards

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But has the Medical Board made a Counter Move?

Langan MD[By Michael Lawrence Langan MD]

Governor Baker’s recent move to control professional boards seemed a promising step and I provided detailed documentation to the Director of Constituent Services at the Office of the C…

Massachusetts Governor Charlie Baker Moves to Control Professional Boards (But has the Medical Board made a Countermove?) 

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An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

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Langan MD[By Michael Lawrence Langan MD]

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.   But that…

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

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R.I.P. Donald Henderson MD

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By David E. Marcinko MBBS DPM MBA

Donald Henderson, an American doctor and public health official who led the successful global drive to wipe out smallpox in the 1960s and ’70s, credited with saving tens of millions of lives, has died. He was 87.

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[Donald Henderson MD]

http://www.msn.com/en-us/health/medical/da-henderson-doctor-who-eradicated-smallpox-dies/ar-BBvSTZe?ocid=U348DHP

smallpox-vaccination-scar

[Vaccination Scar]

Johns Hopkins Vaccine Initiative

Dr. Henderson was founder of The Johns Hopkins Vaccine Initiative [JHVI] which promotes collaborative and interdisciplinary  vaccine research,  education, and implementation efforts to improve health worldwide.

Assessment

The JHVI is a Johns Hopkins Bloomberg School of Public Health affiliate in my home town of Baltimore, MD. 

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US State Healthcare Price Transparency Laws

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REPORT CARD: Healthcare Incentives Improvement 

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Salary Negotiation Skills for Doctors & Hospitalists

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As well as Nurses, Allied Healthcare Providers … and the Rest of Us

  • By Dr. David E. Marcinko MBA
  • By Dollars Direct

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Much More:

Physician 2.0 Recruitment

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http://www.BusinessofMedicalPractice.com

Recent EHR News

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1-darrellpruitt

Recent EHR News

By Darrell K. Pruitt DDS

“Cerber ransomware decryption tool was available for 1 day before hackers rendered it useless – The authors of Cerber fixed the flaw in the ransomware’s code that made decryption possible.” By India Ashok for International Business Times, August 18, 2016.

http://www.ibtimes.co.uk/cerber-ransomware-decryption-tool-was-available-1-day-before-hackers-rendered-it-useless-1576662

“HIPAA Breach Case Results in Record $5.5 Million Penalty.” By Aldrin Brown for MSP Mentor, August 18, 2016.

http://mspmentor.net/msp-mentor/hipaa-breach-case-results-record-55-million-penalty

“HIT Costs Rose 40% Per Physician Since 2009.” By Christine Kern, contributing writer, Health IT Outcomes, August 19, 2016.

http://www.healthitoutcomes.com/doc/hit-costs-rose-per-physician-since-0001

Kern:  “Healthcare organizations are facing serious financial challenges as they are forced to convert their practices and patient records to digital formats.”

“Office for Civil Rights to Increase Investigations of Smaller HIPAA Breaches.” By National Law Review, August 19, 2016

http://www.natlawreview.com/article/office-civil-rights-to-increase-investigations-smaller-hipaa-breaches

NLR:  “HHS Office for Civil Rights will cast a wider net and increase its investigations into smaller HIPAA privacy breaches starting this month. OCR announced a new initiative to increase its efforts examining breaches that affect fewer than 500 individuals. OCR Regional Offices already investigate every reported breach affecting 500 or more individuals, and will continue to do so, but now they will intensify efforts to scrutinize smaller breaches.”

“2016 is the year to Go Paperless’ – Stop putting it off, going paperless can save you tens of thousands of dollars.” By Larry Emmott for Emmott on Technology, August 19, 2016.

http://emmottontechnology.com/

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On MACRA

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By ACR and AAN

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MACRA

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CMS Reveals MACRA Rules

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A CMS … Proposal

[By Andy Salmen]

The Centers for Medicaid and Medicare Services (CMS) have finally released the much anticipated unveiling of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rule proposal.

The goal of this rule is to establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These two paths for compliance allow doctors more flexibility in achieving compliance.

MIPS

MIPS scores clinicians based measures and activities chosen by physicians and is based on their specialty. MIPS would basically streamline and combine three of the different programs that currently exist under Medicare. These programs are Physician Quality Reporting System, the Value-Based Modifier Program, and the ‘Meaningful Use’ of electronic health records.

There will be four performance categories for clinicians (clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, etc.) to be scored on. These performance categories are:

  • Quality
  • Advanced Care Information
  • Clinical Practice Improvement Activities
  • Cost

APMs

CMS proposed implementing an Advanced Payment Models (APM) pathway, allowing eligible clinicians to become “qualified participants”. This means that eligible clinicians will be able to earn statutorily specified incentives for participation.

CMS predicts most providers to initially opt for MIPS. It is expected that participation in APMs, both number of physicians and number of payment models, will grow over time, as this program will qualify clinicians for financial bonuses in exchange for taking the risks associated with providing “coordinated, high-quality care”, according to CMS. 

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More on Long Term Care Insurance

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LTCI

By Rick Kahler MSFS CFP®

Rick Kahler MS CFP

Knowing how long you may live is an important variable to consider in putting together a successful retirement plan. Many online sites can give you a scientific estimate of your life expectancy; one that I recommend is livingto100.com. When I retook the evaluation recently, I was surprised that my life expectancy had increased from 93 to 98.

In an instant I related to one of the greatest fears of older Americans: outliving your sources of income.

The greatest financial risk for depleting retirement resources is an unexpected and lengthy stay in a long-term health care facility, like a nursing home or an assisted living center. Not surprisingly then, “What do you think about long term care insurance (LTCI)?” is one of the questions I often hear.

LTCI is a difficult product to analyze and recommend. It has existed in some form for 40 years, but the industry seems to exist in a continual state of disarray. Low interest rates, low lapse rates, and rising longevity have driven premiums high enough that sales of the insurance have declined 70% from their high in 2002.

The “Guarantee”

Exacerbating the problem is that most LTCI companies issued policies with “guaranteed” premiums.

According to a report by Michael Kitces at kitces.com, just a small variation in actuarial assumptions can have a significant impact on premiums. He says “it’s estimated that as little as a 1% change in interest rates correlates to a 15% required change in premiums to keep an LTC insurance policy actuarially sound. Having a 1% lapse rate instead of a 5% lapse rate can increase future claims for an insurer by as much as 50%.”

As a result, Kitces notes, LTCI providers have struggled to be profitable. In some cases, companies were unable to honor their original prices and had to request permission from state insurance departments to increase premiums on existing policies by as much as 85%. Premiums for new policies have gone even higher.

Simply stated, a guaranteed premium LTC policy needs to be priced high enough to provide a cushion against these variables or the company may be unable to regain profitability with rate increases later.

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One way of addressing this challenge is to eliminate any aspect of a “guaranteed” premium and make long-term care insurance premiums more flexible. One flexible premium policy envisions paying dividends similar to a participating life insurance policy issued by a mutual insurance company. Kitces notes, “To the extent that future claims (or the insurance company’s investment returns) turn out to be better than the original (conservative) projections, the ‘excess’ results will be returned to the policy owner in the form of either an “Insurance Credit” or an “Interest Credit”, to help reduce future premiums.” One such policy is currently priced 20 to 30% under traditionally priced policies with “guaranteed” premiums.

Naturally, there is no guarantee a flexible premium policy will end up costing less than the traditional polity with a guaranteed premium. Probably the biggest concern is the conflict of interest a shareholder-owned company will face in deliberately refunding any savings in the form of dividends to the policy holders. This conflict does not exist with a mutual insurance company, where the owners of the company are the policy holders.

Assessment

Still, the potential benefits look interesting enough that taking a hard look at a flexible premium LTCI policy makes sense. Long-term health care is one of the aspects of aging that most of us don’t want to think about but many of us will need. While LTCI is not for everyone, considering it is a worthwhile part of financial planning for retirement. 

Conclusion

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Connecting Healthcare Fraud Schemes with Fraudsters

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And  … their Leaders

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