Presidential Election Day 2016

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A MACRA Info-Graphic by CMS

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6 Key Takeaways from MACRA Final Rule

  1. Flexibilities provided in the first transition year may continue in 2018.
  2. During the first year of MIPS, providers will not be evaluated on cost or resource use.
  3. Despite flexibilities allowed under the final rule, it is in providers’ best interest to participate as much as possible during the transition year — and not just for the practice.
  4. Quality measure benchmarks will be published this year.
  5. Vendors need to prepare, too.
  6. Small group providers and solo physicians could get squeezed out.

Source: Becker’s Hospital Review

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Are Soaring Health-Care Costs Hurting the U.S. Economy?

Are Soaring Health-Care Costs Hurting the U.S. Economy?

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By Dan Timotic CFA

About 8% of U.S. household spending went toward health care in 2015, up from 5.8% in 2007. Even though the growth of nationwide health-care spending has slowed, the cost burden is falling more heavily on consumers.1

More than 118 million people qualify for coverage through government programs such as Medicare, which serves individuals age 65 and older and the disabled, or Medicaid, which provides care for the poor. Still, more than 55% of the U.S. population rely on health insurance provided by an employer.2

The health-care landscape has changed over the last decade, but some economists believe uncontained costs still pose a threat to broader economic growth. Here’s a closer look at recent trends, and why it’s more important than ever to be an informed health-care consumer.

Public Spending

Growth in U.S. health-care spending has outpaced total economic growth over the past five decades. In 2014, health-care expenditures accounted for about 17.5% of GDP, up from 5.6% in 1965.3 Though major advances in medical technology have contributed to spending growth, they have also led to better health and well-being overall.4

Public-sector spending has grown more quickly than private spending, largely due to an aging population, rising Medicare enrollment, and the expansion of Medicaid. The share of total spending by Medicare and Medicaid increased from 6.8% in 1966 to 36.8% in 2014.5

ACA Under Way

The Affordable Care Act created state-based exchanges where self-employed individuals, part-time workers, and others without access to group coverage can buy private health insurance. Consumers can compare plans online, and families with incomes up to 400% of the federal poverty level may be eligible for tax credits that reduce premiums. As income rises, subsidies decrease. In 2016, about 85% of the 12.7 million individuals who purchased coverage from the Health Insurance Marketplace received a subsidy.6

Since 2014, all citizens and legal residents have been required to have “minimum essential” health coverage or pay a penalty. The health insurance mandate was intended to add healthy individuals to the insurance pool and counterbalance a provision that prohibits insurers from excluding people with pre-existing conditions. As a result, the uninsured rate has decreased from 13.3% in 2013 to 9.1% in 2015.7

division-of-population-health-logo_crop

Workplace Plans

Employers have been paying around 80% of individual health insurance premiums, but plan changes, including higher deductibles and coinsurance rates, have shifted costs to workers who use health-care services.8

For example, the average deductible for individual coverage in an employer-provided health plan was $1,318 in 2015, up from $917 in 2010. A deductible is the amount the patient must pay before the insurance payments kick in. Health insurance deductibles grew 67% between 2010 and 2015, almost three times as fast as premiums and about seven times as fast as wages and inflation.9

If health insurance premiums continue to rise, it is conceivable that employers could pass more of the costs on to workers by raising premiums and coinsurance or limiting wage increases.

Accounting for Costs

It’s estimated that total U.S. health- care spending increased 5.5% to reach $3.2 trillion in 2015, and growth is projected to average 5.8% annually through 2025. Cost increases have moderated after averaging nearly 8% annually over the previous two decades, but they are still increasing much more than overall inflation.10 Prescription drug prices have been rising at a faster pace. According to one drug-benefits manager, the average price of brand-name drugs rose 16.2% in 2015, surging 98.2% since 2011.11

The research and development of breakthrough medical technologies is undoubtedly a valuable endeavor. Even so, experts say newer and more expensive treatments are not always more effective than existing lower-cost options. It has also been suggested that the fee-for-service payment model — in which insurers reimburse providers based on the number and type of treatments — may drive inefficiency and unnecessary spending by rewarding the quantity rather than the quality of care.12

Economic Impact

Even with insurance coverage, an illness or injury can cause financial pain for a middle-class family with limited disposable income. The prospect of medical bills may cause some families to skip or postpone necessary care, and those who do seek treatment have less money available to spend on other basic needs. A Brookings Institution analysis found that middle-income household spending on health care increased nearly 25% between 2007 and 2014, while spending on restaurant meals and clothing dropped significantly (–13.4% and –18.8%, respectively).13

Health spending across the economy is expected to accelerate and reach 20% of GDP by 2025, which could put additional strain on consumers, employers, and the federal budget.14

Obama Care

Open Enrollment

This is the time of year when employers introduce changes to their benefit offerings, so choosing — and then using — your health plan carefully could help you save money. Before you sign up for a specific plan, consider the extent to which your prescription drugs are covered, estimate your potential out-of-pocket costs based on last year’s usage, and check to see whether your doctors are in the insurer’s network.

Citations:

1, 8, 11, 13) The Wall Street Journal, August 25, 2016 2, 7) U.S. Census Bureau, 2016 3, 5, 10, 14) Centers for Medicare and Medicaid Services, 2016 4, 12) The Brookings Institution, 2015 6) U.S. Department of Health and Human Services, 2016 9) Kaiser Family Foundation, 2015. 

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Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership

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By Michael Lawrence Langan MD

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Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership — Disrupted Physician

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Wearable Technology as Medical Devices Revolutionize Healthcare

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By Salisu Bala Bello

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White Paper: Wearable Technology as Medical Devices Revolutionize healthcare

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Welcome Original Thinkers

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Welcome Original Thinkers

By Nina Martin – Dreamer nina@wotquiz.com

Hi Dr. David E. Marcinko,

I’m reaching out to you because I thought you and the readers of Medical Executive-Post News [Trends, Info & Insights for Savvy Doctors and Their Advisors] might like to take and share a short fun personality quiz we call Welcome Original Thinkers or the WOT Quiz.

www.wotquiz.com

Kimberly-Clark thrives on original thinking and we are currently recruiting original thinkers to add to our teams. We’ve launched a new recruitment campaign, “Welcome Original Thinkers,” to find great talent that can help us solve problems and create solutions before consumers even know they need them. I’ve put all the info including videos, images and more on this microsite:

www.wotquizinfo.com

Be sure to let me know what kind of Original Thinker you are (I’m a Dreamer) and if you post, tweet or share, please use the hashtags #wot, #wotquiz and #welcomeoriginalthinkers

Assessment

Also, please send me the link as I’d love to share it with my team. I’m here if you have any questions. Thanks so much!

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[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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

[Dr. Cappiello PhD MBA]                                         [Foreword Dr. Krieger MD MBA]

Front Matter with Foreword by Jason Dyken MD MBA

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Choose the STEM Sciences

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Choose Science, Technology, Engineering and Mathematics

By Bert Mesko MD

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Kids, Please, Choose Science, Technology, Engineering and Mathematics (STEM) for Your Future!

It is as simple as the ABC: if you are thinking about your future now, please choose Science, Technology, Engineering and Mathematics (STEM). If you are way in your career, please send this to those who are still considering their options. Read more.

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The POWER of Three

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Rick Kahler MS CFP

By Rick Kahler MSFS CFP®

At a recent workshop sponsored by the Center for Action and Contemplation, I was introduced to a principle that could be a helpful way to frame and change hurtful money behaviors. It’s based on the work of Adrian Bejan, a professor of mechanical engineering at Duke University, whose Constructal Law describes the physics of life as a flow system.

Flow Systems

Flow systems consist of three interweaving forces: affirming (what moves or flows), denying (what opposes or resists), and reconciling (what brings the first two into a new relationship).

With a sailboat, for example, the affirming force is the wind. The denying force is the rudder. The reconciling force is the helmsman who figures out how to bring the two oppositional forces together. When the helmsman finds the right balance between the wind and the rudder, the boat sails forward. Without the helmsman there is no forward progress, and a sailboat floats aimlessly.

Law of Three

In human interaction, philosophers often refer to this principle as the Law of Three. One place we can see it is in the US government. We have an affirming force (a Democratic Senator, say) that proposes a bill and the denying force (perhaps a Republican House member) that opposes it. The result is gridlock unless the third reconciling force (perhaps moderate members of both parties) can merge mutually acceptable pieces of both the affirming and denying forces into new legislation.

It’s important to recognize that no force is inherently good or bad, and neither is the reconciliation always positive. For example, Hitler was the reconciling force of the two opposing forces in pre-WWII Germany.

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SIB flow chart

The key to transformation—creating a new system or behavior—is becoming aware of the two conflicting forces and finding a way forward

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How can we apply the Law of Three to our finances?

Take the example of a chronic overspender who tried for years to reduce his spending and live within his means. The problem was his love for “big boy” toys. There wasn’t a boat, ATV, motorcycle, or power tool that didn’t call to him. Predictably, like a sailboat without a helmsman, his financial ship was blown about aimlessly and in danger of sinking deeper and deeper in debt.

When he learned about the Law of Three, he initially thought the affirming force was his desire for financial solvency and the resisting force was his penchant for the toys. Actually it was just the opposite. The affirming force was his unrestrained desire for the toys and the resisting force was the nagging reminder of financial insolvency. He came to recognize that the missing third force was a conscious relationship with the toys.

He had a long-time pattern of struggling with the desire, unsuccessfully trying to resist it, and feeling ashamed and guilty when he finally gave in and bought the new toy. His first step toward change was to notice what went on emotionally when he began craving another toy, and he identified a pattern of feeling empty, lonely, and anxious at those times. Focusing on the anticipation of buying the new toy pushed aside the difficult feelings. He also came to see that he found much of his identity as the guy with the newest toy.

Assessment

With financial therapy, he was able to reconcile the historical causes of those emotions with the desire for the toys and financial solvency. This shift allowed him to greatly reduce his spending on toys but still occasionally and consciously buy one. He was able to live within his budget and begin funding a retirement plan. Becoming able to apply the reconciling force allowed him to move forward with his financial goals. 

Conclusion

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

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Generational Attitudes Toward HIT

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By http://www.MCOL.com

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MORE: foreword-mata-2

MORE: Glossary IT Terms

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The New Social Security Wage Base for 2017

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Social Security wage base increases to $127,200 for 2017

[By Robert Whirley CPA & Associates, LLC + ProActive Advisory]

The Social Security Administration has announced that the wage base for computing the Social Security tax (OASDI) in 2017 will increase to $127,200.

The Federal Insurance Contributions Act (FICA) imposes two taxes on employers, employees, and self-employed workers—one for Old Age, Survivors and Disability Insurance (OASDI; commonly known as the Social Security tax), and the other for Hospital Insurance (HI; commonly known as the Medicare tax).

For 2017, the FICA tax rate for employers is 7.65%—6.2% for OASDI and 1.45% for HI.

For 2017, an employee will pay:

  1. 6.2% Social Security tax on the first $127,200 of wages (maximum tax is $7,886.40 [6.2% of $127,200]), plus
  2. 1.45% Medicare tax on the first $200,000 of wages ($250,000 for joint returns; $125,000 for married taxpayers filing a separate return), plus
  3. 2.35% Medicare tax (regular 1.45% Medicare tax + 0.9% additional Medicare tax) on all wages in excess of $200,000 ($250,000 for joint returns; $125,000 for married taxpayers filing a separate return). (Code Sec. 3101(b)(2))

For 2017, the self-employment tax imposed on self-employed people is:

  • 12.4% OASDI on the first $127,200 of self-employment income, for a maximum tax of $15,772.80 (12.40% of $127,200); plus
  • 2.90% Medicare tax on the first $200,000 of self-employment income ($250,000 of combined self-employment income on a joint return, $125,000 on a separate return), (Code Sec. 1401(a), Code Sec. 1401(b)), plus
  • 3.8% (2.90% regular Medicare tax + 0.9% additional Medicare tax) on all self-employment income in excess of $200,000 ($250,000 of combined self-employment income on a joint return, $125,000 for married taxpayers filing a separate return). (Code Sec. 1401(b)(2))
  • There is a maximum amount of compensation subject to the OASDI tax, but no maximum for HI.

IRS

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Good Companies Don’t Always Make Good Stocks

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By Vitaliy Katsenelson CFA

 Institutional Investor

 

Good Companies Don’t Always Make Good Stocks

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Medicare Spending on EpiPens

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Part D

By  http://www.MCOL.com

*** graphoid101216

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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

*** original

Your Surgeon Is Probably a Republican, Your Psychiatrist

 ***

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

Conclusion

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***

Navigating Health Care Integrated Delivery Networks

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It’s Complicated

http://www.MCOL.com

*** infographic100516

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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 …

***

journalism_grants_image

 Financial Instability Hypothesis

***

Conclusion

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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

 ***
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%.”
***
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!

Conclusion

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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.

***

stock-exchange

***

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

***

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.

***

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

***

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

Conclusion

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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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graphoid081716

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More on Childhood Obesity Trends

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By http://www.MCOL.com

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graphoid090716

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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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210_1

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50 Things Every Gentleman Should Know, presented by Practical Psychology

Conclusion

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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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327_1

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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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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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Conclusion

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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 […]

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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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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…

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“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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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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HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET

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