“Sell Everything!”

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Rick Kahler MS CFP

[By Rick Kahler MS CFP]

“Sell Everything!”

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

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

Stunning

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

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

Example:

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

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

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

The Crystal Ball

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

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

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

Prediction

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

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

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

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

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

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“Sell Everything?”

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Assessment

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

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

Conclusion

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Healthcare Technology Purchasing in 2015

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Amount of Dollars Invested

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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

And … their Financial Advisors

[An Appendix Styled Special ME-P Report]

Anju D. Jessani, MBA, APM

Accredited Professional Mediator & Arbitrator

Divorce with Dignity

223 Bloomfield Street, Suite #104

Hoboken, New Jersey 07030

201-217-1090 (voice)

201-217-1220 (fax)

www.MedicalBusinessAdvisors.com

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

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

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

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

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

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

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

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Scheduling The First Mediation Session

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

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

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

The mediator will provide the following information during the conversation:

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

Mediation Session #1

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

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

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

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

The mediation agreement includes the following:

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

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

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

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

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

Picture by Ryan McGuire

Mediation Session #2

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

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

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

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

Product DetailsProduct Details

Mediation Session #3

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

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

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

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

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

  1. Work-related childcare.

·         Child’s share of health insurance premiums.

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

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

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

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

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

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

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

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

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

Mediation Session #4

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

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

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

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

Outstanding issues usually addressed in this session include:

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

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

couple

Mediation Session #5

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

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

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

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

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

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

[THE END]

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

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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divorce

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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On Income Inequality

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A Passionate Discussion

Rick Kahler MS CFP

By Rick Kahler MS CFP®

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

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

How bad is it?

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

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

But is that true?

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

Now, consider this

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

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budget

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

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

Assessment

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

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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EMR Security Risk [No protocol for physical emergencies]

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BEWARE “OLD-FASHIONED” CYBER SECURITY PHYSICAL RISKS

By Shahid N. Shah MS]

Shahid N. Shah MS

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

Major Mitigation:

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

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

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

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winter solstice

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Assessment

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

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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

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A direct question that begs for a direct answer

Heart+with+rhythm

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

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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How the Super Bowl could be bad for your health

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How the Super Bowl could be bad for your health

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

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

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Mobile HIPAA Solutions for Hospital & Health Systems

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New-Wave Health Information Technology

Carol S. Miller[By Carol Miller RN MBA] 

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

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

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

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

Enter PCs in the Examination Room

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

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

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HIPAA Not Aging Well?

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

Compliance

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

Examples include:

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

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Assessment

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

More: http://www.BusinessofMedicalPractice.com

Conclusion

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Update on HIPAA Cloud Solutions for Hospitals and Health Systems

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New-Wave Technology and PHI

Carol S. Miller

[By Carol Miller RN MBA]

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

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

Cloud Solutions

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

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

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

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

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

HIPAA Not Aging Well

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

Assessment

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

Conclusion

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

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Value Based Care [VBC] and Physician Performance?

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Prevalence and Metrics within Physician Compensation Plans 

By http://www.MCOL.com

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Is Glaxo Looking To Replace Andrew Witty As CEO?

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Is Glaxo Looking To Replace Andrew Witty As CEO?

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Conclusion

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Investment Lessons Learned from the Poker Table

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“I don’t know”

vitaly

               By Vitaliy Katsenelson CFA                   

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

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

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

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

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

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

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

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

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

Assessment

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

Repeat after me . . . 

Conclusion

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GROUP “Drop-In” DOCTOR VISITS ARE EVOLVING?

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ST. LOUIS STADIUM VACATED BY RAMS TO BE USED FOR GROUP DOCTOR VISITS

By Winona Woodward [Health TurnUp News]

AFTER THE NFL APPROVED relocation of the Rams football team from St. Louis to Los Angeles, Edward Jones Dome stadium administrators knew they faced a big task in front of them, trying to find a new major tenant for the facility. Stadium officials have just announced the Greater Saint Louis Purchaser and Provider Coalition has entered into an exclusive lease for the stadium to be used for group doctor visits.

Group doctor visits, a relatively new innovation garnering increased interest in the past few years, typically involve up to a dozen patients or so and offer various efficiencies as well as benefits of shared discussion and experiences. Warn Kurter, Executive Director of the Greater Saint Louis Purchaser and Provider Coalition says

“we have decided to take group doctor visits to a whole new level, in partnership with area health plans, employers and providers, to create the world’s largest group doctor visit venue. Now tens of thousands of patients can undergo a visit with a team of doctors stationed at midfield and televised over the JumboTron. How cool is that?”

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The Coalition’s Kurter points out that the savings in terms of dollars, time and resources from combining patient visits on a group scale in the tens of thousands will be, in Kurter’s words, “Ginormous.” Not only that, but the Coalition has negotiated financial participation in the stadium food and beverage concessions during the group visits, according to Kurter.

“We’re also going to ensure the group visits are produced as an event that patients won’t want to miss. We will start each session with a rousing Star Spangled Banner performed by a major recording artist, and we’ll provide engaging halftime entertainment in the middle of the session while the doctors and their staff take their break,”

Kurter added.

Conclusion

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US and International Healthcare Comparison

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By http://www.MCOL.com

As a Percentage of GDP and Spending Per Capita 2013

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Assessment

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THE REAL BLIZZARD OF 2016 FOR STOCKS

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On Mean Reversion

Michael-Gayed-sepiaBy Michael A. Gayed CFA
[Portfolio Manager]
www.pensionpartners.com

Mean reversion is perhaps the one and only constant when it comes to markets and life.  Mean reversion is as old as the Bible – he who is first shall be last, and last first.  We go from 75-degree weather on Christmas day, to one of the most historic blizzards on the east coast ever nearly a month later.

Somehow, nature (and markets) return to balance by moving from one extreme to the other. Mean reversion is dependable, but tough to remember when living in the extreme.  This is so because it is hard to imagine that everything can change in the not-too-distant future.  When dealing with markets, study after study concludes that if you take the worst performing asset classes, country indices, or strategies over the last three years, the next three years tend to be very good ones.

Fund Flows

Yet, in looking at fund flows for those areas, inevitably most exit those investments towards the tail end of that cycle which did not favor those particular investments. With volatility on-going, it is worth asking if we are on the cusp of a mean reversion moment in quite literally everything.

The iShares MSCI Emerging Market ETF (EEM) is down 8.8% year to date, with the iShares China Large-Cap ETF (FXI) down 12.92%.  Looks like a crisis, until you look at the performance of the US iShares Russell 2000 ETF (IWM) which is down 9.98%.  Emerging markets more broadly are actually down less than the average small-cap US stock despite continuous hammering of the idea that a global slowdown and fears over China are the source of market volatility. The narrative lags reality, no different than how money flows lag in response to changing cycles.

The real blizzard in 2016 is one of significant mean reversion

There are major investment themes which can change this year.  First and foremost is the theme of passive over active.  For the past several years, passive investment vehicles have been all the rage as ETFs of every stripe came out, allowing for more index allocation options.  Indeed, indexing can be a strong strategy, but what is forgotten is that as more money goes into passive strategies, the less money there is taking advantage of active anomalies and opportunities.

Mean reversion here suggests that we may be entering an environment where passive investors don’t perform as well as they had, as new momentum opportunities and risk-off periods allow for tactical trading to really shine beyond the small sample. Whether stocks have bottomed or not is irrelevant for now.

The greatest opportunities will come from 1) avoiding or minimizing the impact of more frequent corrections in stocks (not one week extremes like the start of 2016), and 2) positioning in reflation trades through commodities and emerging markets which have been left for dead as being investable.

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Bell Curve

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Should mean reversion begin to take hold this year, betting against those areas can result in significant loss.   Investors in those areas now are suffering and doubting their investments, which may be precisely why tremendous money can be made.

Assessment

As 2016 unfolds, we will continue to address these potential opportunities in our writings (click here to read).  The thing about the future is that it’s hard to predict what happens next…except at extremes.

Conclusion

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Top Healthcare Trends of 2015

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By eVisit

A Guide to the Changes

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Conclusion

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ON-CALL AND EMERGENCY DEPARTMENT RISKS

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The  growing revolt

[By staff reporters]

There is a growing revolt of specialists against hospital on-call duties that threatens to violate Federal law and lose status as trauma centers. Specialties most likely to refuse include plastic surgery, ENT, psychiatry, neuro-surgery, ophthalmology and orthopedics.

And, refusing to respond to assigned call is a violation of Federal law and carries fines as much as $50,000 per case.

In contrast, refusing to sign up for call does not violate the law, and more physicians are taking this option. The problem opting-out problem is especially acute in California where hospitals are combating the issues with compensation, reporting the miscreant docs to the authorities, or threatening to remove them from staff completely. In turn, doctors are fighting back with lawsuits.

As an example, essayist Jeff Goldsmith, President of Health Futures Inc, and Associate Professor of Public Health Sciences at the University of Virginia opined back in 1980, that:

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[Foreign Body Aspiration]

“We can expect intensified conflict with private physicians over the hospital’s 24-hour mission and service obligation, specifically providing physician coverage after hours and on weekends. Younger physicians have shown decreased willingness to trade their personal time to cover hospital call in exchange for hospital admitting privileges as their elders did. Those admitting privileges are either less essential or completely unnecessary in an increasingly ambulatory practice environment. The present solution is for hospitals to pay stipends to independent practitioners for call coverage or to contract with single specialty groups large enough to rotate call internally.”

Source: Goldsmith, Jeff: The Long Baby Boom, by Johns Hopkins University Press, May 2008.

Conclusion

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 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

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The PP-ACA’s Impact on Medical Liability Insurance?

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A SPECIAL ME-P REPORT

robert-cimasi

BY ROBERT JAMES CIMASI; MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP

HEALTH CAPITAL CONSULTANTS, LLC

www.HealthCapital.com

Aside from differences in insurer behavior, malpractice lawsuit rates, and political responses at the state level, the ACA may also have an impact on the medical liability insurance market. Following several months of partisan controversy and political debate during President Obama’s first term, Congress passed the ACA in March 2010.[1] While not achieving a universal coverage insurance program or a single payor system, the 2010 healthcare reform legislation marked the beginning of a new era in healthcare reform, resulting in a paradigm change in the way healthcare services are delivered and paid for in the U.S.

Some of the ACA’s initiatives have already had significant impact upon many aspects of the healthcare delivery system, including: (1) increased regulatory scrutiny aimed at combating fraud and abuse and antitrust violations; (2) health plan regulation; (3) addressing physician shortages; (4) access to and quality of care initiatives; and, (5) increased attention to public health and wellness activities, among others.[2]

In contrast, the ACA’s impact on the medical liability insurance market, and the medical malpractice system, is relatively unknown. The Medical Liability Monitor’s 2010 annual rate survey noted that 41% of medical liability insurers did not believe that the ACA would impact medical liability insurance markets;[3] however, by 2011, as stated above, this attitude had changed to reflect increasing concerns about provider consolidation and self-insurance for professional liability by providers.[4] These concerns continue to reflect the thinking of medical liability insurers, in part, because there have been few, if any, answers to alleviate their concerns and measure the ACA’s impact on the incidence and cost of medical malpractice.

Some of the medical liability insurer concerns regarding the ACA’s impact stems from the reality that the only one of two sections of the ACA directly relating to medical liability insurance and the current medical malpractice system have been implemented. Section 6801 of the ACA simply provides a policy statement regarding medical malpractice, stating that the U.S. Senate believes that “health care reform presents an opportunity to address issues related to medical malpractice and medical liability insurance,” and encourages Congress, as a whole, to develop demonstration programs with the goal of discovering alternatives to the current civil litigation system for medical malpractice.[5] Additionally, Section 10607 of the ACA authorizes HHS to award grants to states “for the development, implementation, and evaluation of alternatives to current tort litigation” for medical malpractice claims.[6] This section allows HHS to make $50 million available for these demonstration projects subject to Congressional approval.[7] To date, neither Congress nor the President has requested funding for these projects.[8]

Even without these direct impacts, the medical malpractice system may still face changes as a result of the ACA. First, as providers consolidate with larger health systems, medical liability insurers fear the medical liability insurance market “will shrink as their former customers become their competitors.”[9] From 2011 to 2014, medical liability insurers consistently noted to the Medical Liability Monitor that hospital or ACO acquisitions of physician practices act as “the biggest threat to their market share” because of the entity’s ability to better absorb the risk related to malpractice liability.[10] In theory, this ability to absorb medical professional liability risk will allow higher rates of self-insurance, which can affect the rates of straight indemnity insurers.  Second, the number of malpractice claims is expected to increase as more individuals gain health insurance coverage as a result of ACA enactments.

Obama Care

A 2007 Journal of the American Medical Association study concluded that insured persons who suffer a chronic condition receive higher quality and increased care compared to non-insured persons; reinforcing earlier studies suggesting insured persons receive more care than uninsured persons.[11] Building on this premise, a RAND report on the ACA and liability insurance relationships estimated that with the expected influx of newly-insured individuals, particularly in states expanding Medicaid, more physician-patient encounters will increase the volume of overall medical errors, leading to an increase in medical malpractice lawsuits.[12] Consequently, the RAND report estimates that the number of liability payments in medical malpractice actions will increase by 3.4% between pre-ACA insurance plan enrollment and enrollment post-ACA implementation.[13]

Additionally, the RAND report argues that, due to an increase in insurance plan enrollment, medical malpractice payments per claim will actually decrease in states adopting limitations to the collateral source rule. Under the collateral source rule, the damage awards for injured parties do not take into account payments previously received from other sources; consequently, the damage award includes the value of funds collected by another source (e.g., insurance) while allowing the injured party to keep the benefits of that previous value received.[14] In the medical malpractice context, plaintiffs in states adopting the collateral source rule can collect from the physician (or his medical liability insurer) as well as keep the benefits of healthcare reimbursed by their own health insurer. However, some states limit the application of the collateral source rule in medical malpractice cases where the plaintiff’s health insurance already paid for care resulting from the negligent actions of the physician, thereby preventing the plaintiff from receiving this double windfall. As insurance rates rise, RAND estimates that payouts per claim will decrease by 0.6% nationally.[15] Considering the three effects together, RAND projects that total liability claim costs will increase by 2.8% nationally by 2016 as a result of the ACA.[16]

Conversely, other healthcare industry commentators argue that the ACA’s expansion of coverage to previously uninsured individuals, as well as quality of care initiatives, will actually decrease malpractice costs by reducing the number of adverse events suffered by patients.[17] In a 2010 editorial in the Journal of Law, Medicine, and Ethics, Mark A. Rothstein, the Director of Institute for Bioethics, Health Policy, & Law at the University of Louisville – Louis D. Brandeis School of Law, argued that quality and infrastructure initiatives such as increased EHR usage, expansion of outcomes research and use of evidence-based medical standards, and better care coordination, will limit the number of adverse events that provide the basis for a medical malpractice claim.[18] Further, Rothstein posited that, by simply being insured, “significant numbers of injured patients are likely to forego medical malpractice claims.”[19]

Although President Obama signed the ACA in 2010, the effects of this landmark law on the medical malpractice market remain hazy. The current trend toward healthcare consolidation, accountable care, and self-insurance mirrors similar consolidation practices in the mid-1990s, which increased competition in the medical liability insurance market and eroded proper underwriting practices. Nevertheless, other critical ACA effects remain unknown. The impact of the expansion of health insurance coverage will likely remain unclear for the near future because new enrollees began receiving coverage through health insurance exchanges in 2014, limiting the amount of exposure to healthcare interactions that could give rise to an adverse event and result in a medical malpractice suit. Additionally, the average length of litigation surrounding preventable adverse events lasts 43.1 months from the date of the incident to the date of resolution,[20] which limits medical liability insurers from realizing the full costs of a claim and the aggregate of claims in its risk pool.

RISK

Assessment

Now, assuming that increased enrollment does not affect the average length of medical malpractice litigation,[21] the average newly insured person who suffered a preventable adverse event in July 2014 will not resolve his or her claim until March 2018. With this lag time of almost four years between adverse events and claims, it is likely that the full impact of the ACA on the medical malpractice market and medical liability insurance premiums will not be fully known until the next decade.

Conclusion

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References 

[1]      “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 119 (March 23, 2010); “Health Care and Education Reconciliation Act” Public Law 111-152, 124 Stat. 1029 (March 25, 2010).

[2]       “Restructuring, Consolidation in Health Care Make Reform Top Health Law Issue for 2010,” By Susan Carhart et al., BNA Health Law Reporter, Vol. 19, No. 5 (January 8, 2010).

[3]       “Now Hard & Crunchy on the Outside: Could Strong Financials be Hiding a Market That’s Growing Soft Within?” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 35, No. 10, October 2010, p. 4.

[4]       “From Crunchy Candy to Simmering Frogs: Waiting and Hoping for a Hardening Market as the Market Trends Slowly, Steadily Softer,” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 36, No. 10 (October 2011), p. 5.

[5]       “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 804 (March 23, 2010).

[6]       “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 1009 (March 23, 2010).

[7]       “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 1014 (March 23, 2010).

[8]       “Medical Liability Reform – Demonstration Grants,” American College of Physicians, 2013, http://www.acponline.org/advocacy/where_we_stand/assets/iii12-medical-liability-reform-demo.pdf (Accessed 12/23/14).

[9]       “From Crunchy Candy to Simmering Frogs: Waiting and Hoping for a Hardening Market as the Market Trends Slowly, Steadily Softer,” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 36, No. 10 (October 2011), p. 5.

[10]     “The Slinky Effect: With Medical Professional Liability Insurance Rates Continuing to – Slowly and Steadily – Decline During the Most Recent Soft Market, It Appears It will Take Several More Years Before the Market Hardens and Rates Accelerate Upward,” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 39, No. 10 (October 2014), p. 6; “Casualty Actuarial Society Session Debates Potential Medical Professional Liability Implications of PPACA,” Medical Liability Monitor, Vol. 39, No. 7 (July 2014), p. 4.

[11]     “Insurance Coverage, Medical Care Use, and Short-Term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition,” By Jack Hadley, Ph.D., Journal of the American Medical Association, Vol. 297, No. 10 (March 14, 2007), p. 1080.

[12]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 30.

[13]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 30.

[14]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 18.

[15]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 18.

[16]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 37.

[17]  “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 40-41

[18]     “Currents in Contemporary Bioethics: Health Care Reform and Medical Malpractice Claims,” By Mark A. Rothstein, Journal of Law, Medicine, and Ethics, Winter 2010, p. 871.

[19]     “Currents in Contemporary Bioethics: Health Care Reform and Medical Malpractice Claims,” By Mark A. Rothstein, Journal of Law, Medicine, and Ethics, Winter 2010, p. 872.

[20]     “On Average, Physicians Spend Nearly 11 Percent of their 40-Year Careers with an Open, Unresolved Malpractice Claim,” By Seth A. Seabury et al., Health Affairs, Vol. 32, No. 1 (January 2013), p. 114.

[21]     This assumption is faulty, as it is unknown at this point whether or not claims will increase, whether insurers will or will not enter the market, and whether malpractice caseloads will increase due to the ACA.

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors

[Best Practices from Leading Consultants and Certified Medical Planners™]

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

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

***

On Criminal Penalties for Acts Involving Federal Healthcare Programs

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AN UPDATE

Carol S. MillerBy Carol Miller RN MBA

Individuals and entities are prohibited from “knowingly and willfully” making false statements or presentations in applying for benefits or payments under all federal and state healthcare programs. Individuals also are prohibited from fraudulently concealing or failing to disclose knowledge of an event relating to an initial or continued right to payments. There is also prohibition against knowingly and willingly soliciting or receiving any remuneration (including any kickbacks, bribes, or rebates) directly or indirectly, in cash or in kind, in exchange for referrals. Violations may result in felony convictions with penalties including imprisonment and fines.

Individuals or entities can be excluded from Medicare and Medicaid and more than 200 other federal healthcare programs for a minimum of five years if there is one prior fraud or abuse conviction. Thee exclusions last for ten years and if there are two prior convictions, the exclusion can become permanent. The minimum period of discretionary exclusion is three years, unless DHHS determines that a different period is appropriate.

It is just as important to communicate to the employees when laws or regulations do not impact your organization, such as the Family Medical Leave Act (FMLA), the employment provisions of the Americans with Disabilities Act (ADA) or continuation of health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). These benefits apply only to organization with a specific number of employees, so smaller organizations are not necessarily required to offer these benefits.

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Obamacare

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However, the Patient Protection and Affordable Care Act (PPACA) provides a slightly different situation for the provider’s practice. PPACA mandated coverage, penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively.

Further the Act stated: 1) all individuals not covered by an employer sponsored health plan, Medicare or Medicaid or other public insurance programs such as Tricare to secure an approved private-insurance policy or pay a penalty, unless the individual has a financial hardship or is a member of a recognized religious sect exempted by the Internal Revenue Service and 2) businesses, including larger medical practices which employ 50 or more people but do not offer health insurance to their full-time employees will pay a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means.

Assessment

This is known as the employer mandate. What this means for the provider’s practice is that if the provider is offering healthcare benefits to their staff, the coverage needs to be comparable with the requirements stated in the PPACA and if the practice is not offering healthcare benefits, then the practice must direct the individual to one of the Health Insurance Exchanges that are offering individual coverage plans.

Conclusion

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Comparing “Best-in-Class” Blue Cross Blue Shield Plans Against Their Peers

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Plan Management Navigator

thoughtSherlock

By Douglas B. Sherlock CFA

sherlock@sherlockco.com

This issue of Plan Management Navigator contains a summary of our analysis comparing “Best-in-Class” Blue Cross Blue Shield Plans and the other Plans that we refer to as “Peer” Plans.

Best-in-Class Plans operated with costs, excluding Sales and Marketing and Medical Management that were 32% lower than their Peers.

Low Staffing Ratios was the primary driver in the Best-in-Class cost advantage, while Staffing Costs per FTE and Non-Labor Costs per FTE were also lower.

The functional area of Information Systems was key in superior Best-in-Class performance. Economies of scale played no role in the ranking.

img1

Invitation to Participate in the 2016 Sherlock Benchmarking Study

Our highly valid, well-populated Benchmarks provide an unbiased ranking and helps prioritize activities that will have the greatest impact on improving your health plan’s overall operating performance.

The overwhelming proportion of health plans participating last year are participating this year, and we have added several plans. Please follow this link to see what last year’s participation looked like.

We will meet to finalize the content of the survey in February, distribute the survey forms in March, collect the completed surveys in May and publish beginning in late June or early July. Participation entails efforts on your part since useful outputs require relatively granular inputs. The cost is relatively modest.

Because of the calendar, if you are considering participation, please contact me as soon as convenient. We can answer questions and help get the paperwork out of the way.

Assessment

Thank you again for your continuing interest in the Sherlock Benchmarks. Please visit this link to find the January 2016 Plan Management Navigator.

Conclusion

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Estimated New Cancer Types

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http://www.BusinessofMedicalPractice.com

According to Gender and Type in 2016

ImageProxy

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The Role of MD/DOs in BIOLOGICAL and CHEMICAL Attacks

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Is there REALLY a Role … at all?

DEM white shirt

By Dr. David Edward Marcinko MBA 

Title X of the USA PATRIOT Act contains several calls for strengthening the public health system. Section 1013(a)(4) calls for “enhanced resources for public health officials to respond to potential bioterrorism attacks.” Section 1013(a)(6) calls for “greater resources to increase the capacity of hospitals and local healthcare workers to respond to public health threats.”

PRE 9/11

Prior to September 11, 2001, the capacity of healthcare entities to respond to biological and chemical attacks by terrorists was quite limited. Strictly speaking, however, healthcare organizational preparedness plans are not as directly encumbered by the USA PATRIOT ACT, or by the Department of Homeland Security’s (DHS’s) Chemicals of Concern [COC] List, or the various steps of its Section 550 Program as some other industries. Nevertheless, healthcare organizations may have their sources of contaminants, such as: Mercury, Dioxin: DEHP (2-ethylhexyl), Volatile Organic Compounds and Glutaraldehyde, etc.

For some time now, the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) has also required hospitals to have a disaster preparedness plan mimicking the USA PATRIOT Act [personal communication, Kenneth A. Powers, Media Relations Manager, TJC].

Post 9/11

After September 11, 2001, “disaster preparedness” evolved into something that could more accurately be described as “emergency preparedness.” Experience in New York and Virginia has shown that there will be spillover outside the immediate geographic areas affected by a terrorist attack, which will affect suburban and rural hospitals.

Thus, the emphasis in emergency preparedness is on the coordination and integration of organizations throughout the local system. Hospitals and healthcare entities therefore need to revise existing plans for disaster preparedness to reflect the realities of potential terrorist threats. Mitigation against risk is essential to safeguard the financial position of an entity. Medical practices and healthcare entities can mitigate risks by developing an emergency preparedness plan.

The entity should start by identifying possible disaster situations, such as earthquakes and biological or chemical attacks that could affect the facility. Next, the entity should identify the potential damages that could occur to structures, utilities, computer technology, and supplies. After that, the entity should use resources currently available to safeguard assets, and then budget to acquire any additional materials or alterations required to secure the facility.

travel+airplane

Practices can take several steps to mitigate even in the absence of significant funding:

  • First, establish links with ‘first responders’ such as local law enforcement, fire departments, state and local government, other healthcare organizations, emergency medical services, and local public health departments.
  • Second, establish training programs to educate staff on how to deal with chemical and biological threats.
  • Third, make changes in their information technology to facilitate disease surveillance that might give warning that an attack has occurred. Information technology may be useful in identifying the occurrence syndromes such as headache or fevers that might not be noticed individually but in the aggregate would signal that a biological or chemical agent had been released.
  • Fourth, acquire access to staff and equipment to respond to biological and chemical attack through resource sharing arrangements in lieu of outright purchases.”

In addition to preparedness for an attack within its catchment area, a healthcare organization must be prepared for an attack on its own facility or office. They should assess the vulnerability of the heating, ventilation, and air conditioning (HVAC) systems to biological or chemical attack. The positioning of the air intake vents is especially important because intakes on roofs are fairly secure as compared to intakes on ground level.

One way to increase security is to restrict access to the facility. Some facilities are using biometric screening to restrict access to their facilities. Biometric screening identifies people based on measurements of some body part such as a fingerprint, handprint, or retina. The advantage of this approach is that there are no problems with forgotten badges, and biometric features cannot be shared or lost like cards with personal identification numbers (PINs).

flu+virus+2

Assessment

In preparing for a possible attack, healthcare entities should also examine the federal, state, and local laws that might affect their response to a biological or chemical attack.

And so, is there really a roll; at all?

Unfortunately, there is no central source of legislation, and an extensive search of many sources might be required to determine the legal constraints.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors

[Best Practices from Leading Consultants and Certified Medical Planners™]

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

***

TEAM BASED MEDICAL CARE RISKS

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More on Why I Still Don’t Like It

DEM white shirt

[By David Edward Marcinko MBBS MBA CMP™]

Redundancy occurs when more than one person (or committee) has the responsibility to make a decision or assume a task. Redundancy in a team based care model becomes a problem when it allows tasks to be overlooked or decisions to be avoided. This happens when a person or committee assumes that someone else with responsibility for the same task will make the necessary decisions. This can be due to a misunderstanding, or it can be due to an intentional dodging of the task or decision.

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cropped-header

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Redundancy is best avoided by having only one person, lead physician or committee responsible for each task or decision. Since this is almost impossible in a hospital or large organization, there must be an unambiguous protocol for allocating tasks and decisions among the responsible personnel. The protocol must also establish a system for handling problems that the assigned personnel cannot solve.

Assessment

It is important that such problems be brought to the attention of a supervisor for reassignment to new personnel. Reassignment should not be done by first level personnel; reassignment at that level will make it impossible to prevent the dodging of unpleasant tasks.

More: Why I Rue the Hospital “Team-Based Medicine” Approach to In-Patient Care

Conclusion

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 Our New Textbook – “Take a Sneek Peek InsideNow Available!

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors

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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™
Foreword by: J. WESLEY BOYD MD PhD MA

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

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The Importance of Talking about End-of-Life Care

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By Samantha Wanner  [VITAS Healthcare]

Watch this short animation to learn why advance directives are so important.

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What Do You Want?

It’s not easy, but the medical treatments you would want near the end of life need to be discussed with others. If you never bring up the topic and you were unexpectedly incapacitated and unable to speak for yourself, your medical wishes would never be known.

Despite the topic’s importance, only 27% of Americans report having talked with their families about end-of-life care. The best way to make your medical wishes known is to create an advance directive and share it with your family and your doctor.

Advance Directives

An advance directive is actually two legal documents that enable you to plan and communicate your end-of-life wishes.  When you create your advance directive, you are being proactive about your medical care and sparing your loved ones from having to make difficult medical decisions in a time of crisis.

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end_of_life_infographic

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Assessment

Don’t wait for a crisis. Create your advance directive, share copies with your loved ones and doctor and keep your copy in an accessible location others can find.

Conclusion

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

 Harvard Medical School

Yale University

***

How Much Will a Ticket Raise My Car Insurance Rates?

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[By Dr. David E. Marcinko MBA]

Be careful out there!

A GMAC survey revealed that 1 in 5 drivers would not pass the written driver’s test if they took it today. And, getting a ticket will raise your car insurance rate, but by how much?

The Survey

The survey found that reckless driving triggers the highest hike — an average increase of 22 percent — yet many drivers aren’t even sure what constitute reckless driving?

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DEM in his 1990 Miata

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Reckless Driving

Depending on state laws, reckless driving can be defined as: driving over 80 mph, driving too fast for weather conditions, knowingly driving in a way that endangers others.

Conclusion

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How Physicians and All Investors Should Deal With the Overwhelming Problem Of Understanding The World Economy

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“What the —- do I do now?”

vitaly

By Vitaliy N. Katsenelson CFA

A SPECIAL ME-P REPORT

This was the actual subject line of an e-mail I received that really summed up most of the correspondence I got in response to an article I published last summer. To be fair, I painted a fairly negative macro picture of the world, throwing around a lot of fancy words, like “fragile” and “constrained system.” I guess I finally figured out the three keys to successful storytelling: One, never say more than is necessary; two, leave the audience wanting more; and three … Well, never mind No. 3, but here is more.

Before I go further, if you believe the global economy is doing great and stocks are cheap, stop reading now; this column is not for you. I promise to write one for you at some point when stocks are cheap and the global economy is breathing well on its own — I just don’t know when that will be. But if you believe that stocks are expensive — even after the recent sell-off — and that a global economic time bomb is ticking because of unprecedented intervention by governments and central banks, then keep reading.

Today

Today, after the stock market has gone straight up for five years, investors are faced with two extremes: Go into cash and wait for the market crash or a correction and then go all in at the bottom, or else ride this bull with both feet in the stirrups, but try to jump off before it rolls over on you, no matter how quickly that happens.

Of course, both options are really not options. Tops and bottoms are only obvious in the rearview mirror. You may feel you can time the market, but I honestly don’t know anyone who has done it more than once and turned it into a process. Psychology — those little gears spinning but not quite meshing in your so-called mind — will drive you insane. It is incredibly difficult to sit on cash while everyone around you is making money. After all, no one knows how much energy this steroid-maddened bull has left in him. This is not a naturally raised farm animal but a by-product of a Frankenstein-like experiment by the Fed. This cyclical market (note: not secular; short-term, not long-term) may end tomorrow or in five years. Riding this bull is difficult because if you believe the market is overvalued and if you own a lot of overpriced stocks, then you are just hoping that greater fools will keep hopping on the bull, driving stock prices higher.

More importantly, you have to believe that you are smarter than the other fools and will be able to hop off before them (very few manage this). Good luck with that — after all, the one looking for a greater fool will eventually find that fool by looking in the mirror.

Last Spring

As I wrote in an article last spring, “As an investor you want to pay serious attention to ‘climate change’ — significant shifts in the global economy that can impact your portfolio.” There are plenty of climate-changing risks around us — starting with the prospect of higher, maybe even much higher, interest rates — which might be triggered in any number of ways: the Fed withdrawing quantitative easing, the Fed losing control of interest rates and seeing them rise without its permission, Japanese debt blowing up. Then we have the mother of all bubbles: the Chinese overconsumption of natural and financial resources bubble. Of course, Europe is relatively calm right now, but its structural problems are far from fixed. One way or another, the confluence of these factors will likely lead to slower economic growth and lower stock prices. So “what the —-” is our strategy? Read on to find out. I’ll explain what we’re doing with our portfolio, but first let me tell you a story.

My Story

When I was a sophomore in college, I was taking five or six classes and had a full-time job and a full-time (more like overtime) girlfriend. I was approaching finals, I had to study for lots of tests and turn in assignments, and to make matters worse, I had procrastinated until the last minute. I felt overwhelmed and paralyzed. I whined to my father about my predicament. His answer was simple: Break up my big problems into smaller ones and then figure out how to tackle each of those separately. It worked. I listed every assignment and exam, prioritizing them by due date and importance. Suddenly, my problems, which together looked insurmountable, one by one started to look conquerable. I endured a few sleepless nights, but I turned in every assignment, studied for every test and got decent grades. Investors need to break up the seemingly overwhelming problem of understanding the global economy and markets into a series of small ones, and that is exactly what we do with our research. The appreciation or depreciation of any stock (or stock market) can be explained mathematically by two variables: earnings and price-earnings ratio. We take all the financial-climate-changing risks — rising interest rates, Japanese debt, the Chinese bubble, European structural problems — and analyze the impact they have on the Es and P/Es of every stock in our portfolio and any candidate we are considering.

Practical applications

Let me walk you through some practical applications of how we tackle climate-changing risks at my firm. When China eventually blows up, companies that have exposure to hard commodities, directly or indirectly (think Caterpillar), will see their sales, margins and earnings severely impaired. Their P/Es will deflate as well, as the commodity supercycle that started in the early 2000s comes to an end. Countries that export a lot of hard commodities to China will feel the aftershock of the Chinese bubble bursting. The obvious ones are the ABCs: Australia, Brazil and Canada.

However, if China takes oil prices down with it, then Russia and the Middle East petroleum-exporting mono-economies that have little to offer but oil will suffer. Local and foreign banks that have exposure to those countries and companies that derive significant profits from those markets will likely see their earnings pressured. (German automakers that sell lots of cars to China are a good example.)

Japan is the most indebted first-world nation, but it borrows at rates that would make you think it was the least indebted country. As this party ends, we’ll probably see skyrocketing interest rates in Japan, a depreciating yen, significant Japanese inflation and, most likely, higher interest rates globally. Japan may end up being a wake-up call for debt investors. The depreciating yen will further stress the Japan-China relationship as it undermines the Chinese low-cost advantage.

So paradoxically, on top of inflation, Japan brings a risk of deflation as well. If you own companies that make trinkets, their earnings will be under assault. Fixed-income investors running from Japanese bonds may find a temporary refuge in U.S. paper (driving our yields lower, at least at first) and in U.S. stocks. But it is hard to look at the future and not bet on significantly higher inflation and rising interest rates down the road.

untitled

[Moscow]

A side note:

Economic instability will likely lead to political instability. We are already seeing some manifestations of this in Russia. Waltzing into Ukraine is Vladimir Putin’s way of redirecting attention from the gradually faltering Russian economy to another shiny object — Ukraine. Just imagine how stable Russia and the Middle East will be if the recent decline in oil prices continues much further.

1447968781847

[Defense Industry]

Inflation and higher interest rates

Defense industry stocks may prove to be a good hedge against future global economic weakness. Inflation and higher interest rates are two different risks, but both cause eventual deflation of P/Es. The impact on high-P/E stocks will be the most pronounced. I am generalizing, but high-P/E growth stocks are trading on expectations of future earnings that are years and years away. Those future earnings brought to the present (discounted) are a lot more valuable in a near-zero interest rate environment than when interest rates are high. Think of high-P/E stocks as long-duration bonds: They get slaughtered when interest rates rise (yes, long-term bonds are not a place to be either). If you are paying for growth, you want to be really sure it comes, because that earnings growth will have to overcome eventual P/E compression. Higher interest rates will have a significant linear impact on stocks that became bond substitutes. High-quality stocks that were bought indiscriminately for their dividend yield will go through substantial P/E compression.

These stocks are purchased today out of desperation. Desperate people are not rational, and the herd mentality runs away with itself. When the herd heads for the exits, you don’t want to be standing in the doorway. Real estate investment trusts (REITs) and master limited partnerships (MLPs) have a double-linear relationship with interest rates: Their P/Es were inflated because of an insatiable thirst for yield, and their earnings were inflated by low borrowing costs. These companies’ balance sheets consume a lot of debt, and though many of them were able to lock in low borrowing costs for a while, they can’t do so forever. Their earnings will be at risk.

Charlie Munger speaks

As I write this, I keep thinking about Berkshire Hathaway vice chairman Charlie Munger’s remark at the company’s annual meeting in 2013, commenting on the then-current state of the global economy: “If you’re not confused, you don’t understand things very well.” A year later the state of the world is no clearer. This confusion Munger talked about means that we have very little clarity about the future and that as an investor you should position your portfolio for very different future economies. Inflation? Deflation? Maybe both? Or maybe deflation first and inflation second?

I keep coming back to Japan because it is further along in this experiment than the rest of the world. The Japanese real estate bubble burst, the government leveraged up as the corporate sector deleveraged, interest rates fell to near zero, and the economy stagnated for two decades. Now debt servicing requires a quarter of Japan’s tax receipts, while its interest rates are likely a small fraction of what they are going to be in the future; thus Japan is on the brink of massive inflation. The U.S. could be on a similar trajectory.

Let me explain why

Government deleveraging follows one of three paths. The most blatant option is outright default, but because the U.S. borrows in its own currency, that will never happen here. (However, in Europe, where individual countries gave the keys to the printing press to the collective, the answer is less clear.) The second choice, austerity, is destimulating and deflationary to the economy in the short run and is unlikely to happen to any significant degree because cost-cutting will cost politicians their jobs. Last, we have the only true weapon government can and will use to deleverage: printing money. Money printing cheapens a currency — in other words, it brings on inflation. In case of either inflation or deflation, you want to own companies that have pricing power — it will protect their earnings. Those companies will be able to pass higher costs to their customers during a time of inflation and maintain their prices during deflation.

On the one hand, inflation benefits companies with leveraged balance sheets because they’ll be paying off debt with inflated (cheaper) dollars. However, that benefit is offset by the likely higher interest rates these companies will have to pay on newly issued debt. Leverage is extremely dangerous during deflation because debt creates another fixed cost. Costs don’t shrink as fast as nominal revenues, so earnings decline.

Crystal ball

Therefore, unless your crystal ball is very clear and you have 100 percent certainty that inflation lies ahead, I’d err on the side of owning underleveraged companies rather than ones with significant debt. A lot of growth that happened since 2000 has taken place at the expense of government balance sheets. It is borrowed, unsustainable growth that will have to be repaid through higher interest rates and rising tax rates, which in turn will work as growth decelerators. This will have several consequences:

  1. First, it’s another reason for P/Es to shrink.
  2. Second, a lot of companies that are making their forecasts with normal GDP growth as the base for their revenue and earnings projections will likely be disappointed.
  3. And last, investors will need to look for companies whose revenues march to their own drummers and are not significantly linked to the health of the global or local economy.

The definition of “dogma” by irrefutable Wikipedia is “a principle or set of principles laid down by an authority as incontrovertibly true.” On the surface this is the most dogmatic columns I have ever written, but that was not my intention. I just laid out an analytical framework, a checklist against which we stress test stocks in our portfolio. Despite my speaking ill of MLPs, we own an MLP. But unlike its comrades, it has a sustainable yield north of 10 percent and, more important, very little debt. Even if economic growth slows down or interest rates go up, the stock will still be undervalued — in other words, it has a significant margin of safety even if the future is less pleasant than the present.

Final bits

There are five final bits of advice with which I want to leave you:

  1. First, step out of your comfort zone and expand your fishing pool to include companies outside the U.S. That will allow you to increase the quality of your portfolio without sacrificing growth characteristics or valuation. It will also provide currency diversification as an added bonus.
  2. Second, disintermediate your buy and sell decisions. The difficulty of investing in an expensive market that is making new highs is that you’ll be selling stocks that hit your price targets. (If you don’t, you should.)

Of course, selling stocks comes with a gift — cash. As this gift keeps on giving, your cash balance starts building up and creates pressure to buy. As parents tell their teenage kids, you don’t want to be pressured into decisions.

Assessment

In an overvalued market you don’t want to be pressured to buy; if you do, you’ll be making compromises and end up owning stocks that you’ll eventually regret. Margin of safety, margin of safety, margin of safety — those are my last three bits of advice. In an environment in which the future of Es and P/Es is uncertain, you want to cure some of that uncertainty by demanding an extra margin of safety from stocks in your portfolio.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

[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]

***

The 5 – 100 Rule

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Don’t Fall Asleep on Variable Life Insurance Policies

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[By Dr. David E. Marcinko MBA CMP®]

http://www.CertifiedMedicalPlanner.org

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OK; I admit it. I held life insurance license for almost a decade. But, don’t hold that against me.

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

The Rule

As a professor of health economics, I know the 5 – 100 Rule states that as a result of accounting for these elements, all initial projections of cash value beyond 5 years, will necessarily be 100 percent incorrect when compared to actuality.

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[Don’t Fall Asleep on Variable Life Insurance Policies]

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Assessment

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

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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***

Tax Changes for 2015-16

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By Robert Whirley CPA

[Whirley & Associates, LLC]

Alpharetta, GA

Doctors – Be Aware!

As tax filing season rapidly approaches I wanted to provide you with a few key items to note for 2015 and 2016.  If you are interested I can send you my full list of tax changes for 2015 and 2016 – I warn you, it’s 19 pages long – and this is only my short list.

Welcome to the New Year 2016! 

  • For 2015, the standard mileage rate for business travel is 57.5¢ (54¢ for 2016).
  • The simplified per diem rates for post-Sept. 30, 2015 travel are $275 for high-cost areas and $185 for all other localities (up from $259 and $172).
  • For 2015 and 2016, a HDHP for health savings account (HSA) purposes is a health plan with an annual deductible that is not less than $1,300 for individual coverage and $2,600 for family coverage. Maximum out-of-pocket expenses can’t exceed $6,450 for individual coverage for 2015 ($6,550 for 2016) and $12,900 for family coverage for 2015 ($13,100 for 2016). The maximum annual HSA deductible contribution is the sum of the monthly contribution limits, based on eligibility and health plan coverage on the first day of the month. The monthly limit is 1/12 of the indexed amount for self-only coverage ($3,350 for 2015 and 2016) and for family coverage ($6,650 for 2015 and $6,750 for 2016).
  • Enhanced expensing—in the form of increased limitations and treatment of certain real property as Code Sec. 179 property—was made permanent, as was the ability to revoke a Code Sec. 179 election without IRS’s consent.
  • The mileage rate for use of a car for qualified medical transportation is 23¢ per mile for expenses paid or incurred in 2015 (19¢ for 2016).
  • Bonus first-year depreciation was retroactively extended through 2019 with a number of modifications, including a gradual reduction over that time (50% for qualified property placed in service in 2015 through 2017, 40% for 2018, and 30% for 2019).
  • The de minimis safe harbor for taxpayers that don’t have an applicable financial statement was raised from $500 to $2,500. – For items expensed as miscellaneous supplies.
  • For contributions by individuals (including ranchers and farmers), the increased charitable deduction for qualified conservation easements was made permanent.
  • 15-year straight-line cost recovery for qualified leasehold improvements, qualified restaurant buildings and improvements, and qualified retail improvements was made permanent.
  • Education Tax Breaks:
  • The American Opportunity tax credit (AOTC) was made permanent. It was also made subject to heightened verification processes and paid-preparer due diligence requirements in order to reduce the number of improper payments.
  • The up-to-$250 above-the-line deduction for teachers’ out-of-pocket classroom-related expenses was made permanent.

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IRS

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The above-the-line deduction for qualified tuition and related expenses was retroactively extended through 2016.

  • Starting in 2015, the definition of “qualified higher education expenses” for Sec. 529 qualified tuition programs includes certain computer and technology-based costs.
  • For tax years beginning after June 29, 2015, taxpayers must receive a Form 1098-T from the educational institution containing all required information in order to claim the AOTC, the above-the-line deduction for higher education expenses, or the Lifetime Learning Credit.
  • For 2015 and 2016, the AOTC phases out at the same level of modified AGI—over $80,000 ($160,000 for a joint return).
  • For 2015 and 2016, the maximum AOTC/Hope Scholarship Credit is $2,500.
  • For 2015, the Lifetime Learning credit phases out for taxpayers with modified AGI in excess of $55,000 ($110,000 for a joint return). For 2016, the corresponding figures are $55,000 and $111,000.
  • For 2015, the higher education exclusion for savings bond income phases out ratably for taxpayers with modified AGI between $77,200 and $92,200 ($115,750 to $145,750 for joint filers). For 2016, the corresponding ranges are $77,550 to $92,550, and $116,300 to $146,300.
  • For 2015 and 2016, the deduction for interest paid on qualified higher education loans phases out ratably for taxpayers with modified AGI between $65,000 and $80,000 ($130,000 and $160,000 for joint filers).

Assessment

Just days into 2016 and you’re also facing pressures bearing down on your payroll operations. Are you ready to meet them? For example:

  • You’re not done with tax year 2015 … yet. There are FUTA credit reductions to determine and budget for, the impact of tax extenders legislation to consider (including retroactive reinstatement of parity between mass transit benefits and parking benefits), and more.
  • Major tax reform is probably off the table for now. But don’t let that fool you. New federal laws increase payroll tax penalties, change the due dates for your corporate returns and yank passports from individuals with tax debts. Of course, Payroll will bear the brunt of these new laws.
  • The IRS has issued a raft of payroll tax regulations, and proposed regulations from the Department of Labor will ratchet up the amount employees must earn to be exempt from overtime. Finally, the IRS and its sister agencies continue to issue guidance on compliance with the Affordable Care Act.
  • There’s a key FLSA case pending before the U.S. Supreme Court. Word on the street is that it may continue to permit class action lawsuits for unpaid overtime.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

***

Medicaid Expansion Impact

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On Un-Insured Rates [2013-14]

By http://www.MCOL.com

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Conclusion

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***

Health Insurance Costs [circa 2016]

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The most devious tax increases in modern history? 

Rick Kahler MS CFP

By Rick Kahler MS CFP®

http://www.KahlerFinancuial.com  

A few months ago I scoffed when my wife told me about a report from CNN that the average individual, unsubsidized health insurance premium was going up over 60%.

After receiving my 2016 premium notice from Wellmark Blue Cross and Blue Shield, I’m no longer scoffing. My monthly premium for family coverage went from $1,400 to $2,140, an increase of $740, or 53%. According to healthcare.gov, the average Wellmark increase in South Dakota is 43%.

I immediately started looking for ways to decrease my premiums. This has become an annual ritual ever since Obamacare was pushed through Congress in 2010. Back then, my family health insurance policy (now considered a Platinum plan) had a low deductible with a maximum out-of-pocket of $3,500 and cost $660 a month.

Despite the President’s promise that “If you like your plan you can keep your plan,” I can’t even purchase that same plan today. If I could, I estimate it would cost over $3,500 a month. In order to keep health insurance affordable, each year I’ve reduced my coverage, increased my deductibles, and paid a higher premium than the year before.

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kidney

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I set out to analyze my options for 2016. After spending six hours crunching numbers and pouring over online calculators, I admitted defeat. There is no simple way to analyze plans to determine whether, based on your personal health care expenditures, you are better served to go with a copay or a deductible plan, a Bronze or a Silver plan, or if a Health Savings Account is preferable to a plan with coinsurance. All the online calculators I found were limited in scope and woefully generic. My health insurance agent didn’t know of any better ones, either.

Adding to my angst, while Wellmark makes policyholders’ year-to-date healthcare expenses available on its website, it doesn’t provide any breakdown of costs. You must figure out for yourself how many drug or doctor co-pays you had, the average cost of a copay visit, the average total costs of those visits, and any other information you need for any type of analysis.

This task was daunting for me, a financial planner and numbers guy. How are average consumers supposed to navigate it? The need for this information is so obvious, one wonders what the insurance companies are hiding by not providing it.

Ultimately, I selected a Bronze plan with no copays and an out-of-pocket cap of $11,900 on in-network providers and $18,500 on out-of-network providers. Based on my family’s average health care costs for the last three years, my out-of-pocket spending for premiums, covered drugs, and approved in-network medical providers will be $2,612 per month, or $31,344, in 2016. It was $11,420 in 2010. That’s an increase of 273%, or 18.3% a year.

By comparison, during the same time period medical costs only increased 16.0%, or 2.7% a year. The increase in premiums is clearly not about increasing health costs.

The $1,660 extra per month I had available to spend on consumer goods and services in 2010 is now going to insurance companies to subsidize the health care of others. This is a clear-cut example of a massive transfer of wealth.

Based on my family’s needs, if I earned $97,000 a year I would qualify for a subsidy of $912 a month. But since I earn over $98,000, I pay the full premium.

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incontinence

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Assessment

Clearly, the only people who find the Affordable Care Act affordable are those who receive a subsidy or who have preexisting conditions. For them, Obamacare was a godsend. For the rest of us, it turned out to be one of the most devious tax increases in modern history. 

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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Reasons for Remaining Un-Health Insured

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By http://www.MCOL.com

Among Adults 18-65

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Conclusion

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LinkedIn Ads Will Now Follow You Around The Web

View Ann Miller RN MHA CMP™'s profile on LinkedIn

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OVER HEARD IN THE DOCTOR’S LOUNGE

[LinkedIn Ads Will Now Follow You Around The Web – Here’s How to Opt-Out]

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 [By D. K. Pruitt DDS]

Because we can’t go anywhere online without some social network tracking our data and using it to cash in on targeted advertising, LinkedIn has created its own online ad network that will allow advertisers to follow you around the web based on the information that LinkedIn knows about you.

BusinessInsider reports that the new LinkedIn Network Display service is selling ads not just on the career-oriented networking site but on 2,500 other sites, using data on LinkedIn’s 347 million registered users to carve out niches of as few as 1,000 users for advertisers to target, according to AdAge.

[Source: Chris Morran-Consumerist, February 19, 2015]

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Risk Management Protection Strategies for Doctors and their Advisors

[Best Practices from Leading Consultants and Certified Medical Planners™]

   Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™
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PHYSICIAN-EXECUTIVE LEADERSHIP AND RISK MANAGEMENT

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Human Nature, Medical Ethics and Modern Principles

  • By David Edward Marcinko FACFAS CMP® MBA MBBS
  • By Render S. Davis MHA CAE
  • By Hope Rachel Hetico RN MHA CPHQ CMP®
  • By Gary A. Cook EJD CFP® CLU RHU MSFS CMP®

In any textbook of gravitas on medical risk management, asset protection and insurance planning, a chapter on human nature is usually placed at the end of the book, or as an appendix, or an afterthought if included at all.

However, we elected to prominently place this material as the premier chapter of our textbook.

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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™

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Why?

In the end, the success of any risk management endeavor ultimately comes down to changing human behavior – helping a doctor/nurse/technician alter whatever s/he was doing toward something that will better allow them to avoid errors and pursue quality care and practice management goals.

Yet, there is still remarkably little education or training for medical professionals focused directly on motivation or change theory, in any related area except psychiatry/psychology or perhaps professional liability.

Instead, doctors are increasingly turning to professional consultants to learn best practices on how to help them actually make the behavioral changes necessary to achieve their quality improvement and risk reduction goals; as we attempt to answer these questions.

The Queries:

  • Are you and your medical practice, or clinical, ready for change?
  • How to transition from [traditional] solo practitioner B-models to modern forms?
  • What are leadership, management and governance?
  • In group practices, how is leadership shared?
  • What issues need be considered when hiring a practice administrator or clinic CEO?
  • What is medical ethics and munificence? Why is it needed? How does it work?
  • What are the types of risk?
  • How are risks managed in the medical practice space?

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confirmation-bias

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Leadership Shortcomings

In addition, medical practitioners need to strive to avoid what Zenger and Folkman describe as the 10 most common leadership shortcomings based on a survey of 11,000 leaders. They include:

  • Lacks energy and enthusiasm
  • Accepts mediocre self performance
  • Lacks clear vision and direction
  • Poor judgment
  • Not collaboration
  • Not following standards
  • Resistant to new ideas
  • Doesn’t learn from mistakes
  • Lacks interpersonal skills
  • Fails to develop others.

Source: Zenger and Folkman: The Daily Stat: The 10 Most Common Failures of Business Leaders, Harvard Business Publishing, June 4, 2009. 

More:

Assessment

Want to lean even more about hundreds of medical risk management topics? Order our newest text book, today!

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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

***

2015 State Profiles on Women’s Health‏

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California, Oregon and Washington

By http://www.MCOL.com

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Conclusion

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Product Details

http://www.BusinessofMedicalPractice.com

***

Stock Market Mayhem from 1950 to 2015

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Stock Market Mayhem from 1950 to 2015

The Investment Scientist

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Michael Zhuang

[Principal of MZ Capital]

  • Stocks Decline 14% (June 1950 to July 1950) North Korean troops attack along the South Korean border. The U.N. Security Council condemns North Korea. The U.S. gets involved.
  • Stocks Decline 20.7%, (July 1957 to October 1957) The Suez Canal crisis manifests itself, the Soviets launch Sputnik and the U.S. slips into recession.
  • Stocks Decline 26.4% (January 1962 to June 1962) Stocks plunge after a decade of solid economic growth and market boom, the first “bubble” environment since 1929.

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SHJ

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

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

***

Let’s start 2016 with beautiful music!

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By ME-P Staff Reporters
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The Katsenelsons
(Jonah, Rachel, Mia Sarah, Hannah and Vitaliy)

Vitaliy Katsenelson CFA
 Investment Management Associates, Inc. 
5690 DTC Boulevard, 140W
Greenwood Village, CO 80111
Phone: (303) 796-8333

A Popular Medical Executive-Post “Thought-Leader”

Let’s end 2015 with beautiful music:  

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Continue reading

The FIXATION on Financial Planning “Teams”

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“I Still HATE Teams”

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[By Dr. David Edward Marcinko CMP® MBA MBBS]

http://www.CertifiedMedicalPlanner.org

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The Real Notion of Teams

I HATE teams. There I said it. Now; I repeat. I hate team sports, teams in medicine and especially teams in financial planning. I am NOT a team player; most doctors are independent minded and not team players.

On the other hand, my wife says that I am most assuredly a team player. But, that I just select my teams very carefully. She is much smarter than I; so perhaps she is correct!

Why I Rue the Hospital “Team-Based Medicine” Approach to In-Patient Care

Financial Planning

In financial planning, there seems to be a fixation … that a team is a financial planner [certified; or not] and an attorney; nice-but a couple and not really a team in the true sense of group development as first proposed by Bruce Tuckman PhD, in 1965.

In his model, Tucker maintained that four phases are all necessary and inevitable in order for the team to grow, to face challenges, to tackle problems, to find solutions, to plan work, and to deliver results [Forming – Storming – Norming – Performing].

Later, he added Adjourning to successfully complete the task and break up the team. Timothy Biggs PhD further added the Re-Norming stage to reflect a period where the team re-assembles, as needed. This put the emphasis back on the ME Inc or physician team leader – as too many ‘diplomats’ in a leadership role may prevent the team from reaching full potential.

Source: http://infed.org/mobi/bruce-w-tuckman-forming-storming-norming-and-performing-in-groups/

A Metaphor

This is why “team” must be more than a metaphor. It deserves more than lip service. Delivering client-centered, coordinated financial planning services and products demands true collaboration–a fully integrated team engaged in practices that involve each member at the top, highest and best use of their licensure and education; optimizing their contributions and maximizing their impact on the well being of the client [Boyer Model of Education].

In this context, board Certified Medical Planners™ may play a lead role going forward; along with other like-minded and educated professionals.

Unfortunately, the ranks of CMPs™ while growing; are still painfully small. But, in addition to true expertise, they link physician clients with appropriate providers and resources throughout the holistic professional life/practice planning continuum. They focus on the doctor-client’s totality — emotional, financial, risk and business management and psyche. As fiduciaries at all times; They advocate for the doctor client to connect him/her to the necessary resources, professional advisors and consultants who need to have their voices heard. Such successful, high-functioning financial planning teams give each member a voice.

The medical professional must be an active participant; not a passive bystander. This is not the norm in financial planning today where doctors are urged to hire a team quarterback. But, the NFL-QB is not a generalist at all; his arm is special and unlike all other teams players. He/she is unique, skilled and exceptional. A franchise player!

Past not Prologue

Fortunately, past is not prologue in the era of transparency, information at your fingertips, tablet PCs, Skype® and smart phones. To succeed in the hyper competitive new era of health reform requires education, involvement and active participation.

In short, a new model of physician focused advisor. No longer is there a free lunch of passivity for medical professionals; either as doctors or advisory clients themselves.

For financial planning in the new era of healthcare reform, and robo-advisors, successful doctors will assume the mantle of self-quarterback themselves.

***

a9985330904385_56389b1f75cd9

[Go Team Go]

***

ME Inc., or Going it Alone – but with a Team

The physician, nurse, or other medical professional should easily recognize that there are a vast array of opportunities, obstacles, and pitfalls when it comes to managing one’s finances.

Still, with some modicum of effort, the basic aspects of insurance, investments, taxes, accounting, portfolio management, retirement and estate planning, debt reduction, asset protection and practice management can be largely self-taught. After all, it is NOT rocker science.

After all, anyone can purchase the exact same financial planning software that legions of FAs use, and there are many iterations on the market, as well.  This concept is not unlike patients, using Dr. Google. No license required.

And TAMPs, relegate FAs to the role of “asset gather”; or should I say salesman/woman.

Why Physician-Investors Must Understand TAMPs

Informed Patient [Client]

So, an informed patient or client is ideal; is it not?

Yet, it is realized that nuances and subtleties can make a well-intentioned plan fall short.  The devil truly is in the details.  Moreover, none of these areas can be addressed in isolation. It is common for a solution in one area to cause a new set of problems in another.

Hourly Model 

Accordingly, most health care practitioners would be well served to hire [independent, hourly compensated and prn] financial help.

Unlike some medical problems, financial issues may not cause any “pain” or other obvious symptoms.  Medical professionals tend to have far more complex financial situations than most lay people. Despite the complexities of the new world of health reform, far too many either do nothing; or give up all control totally, to an external advisor. This either/or mistake can be costly in many ways, and should be avoided.

In reality, and at various time in their careers, the medical professional needs a team comprised of at least a financial analyst [CFA], lawyer, management consultant, risk manager [PhD actuary or insurance counselor] and accountant. At various points in time, each member of the team, or significant others, will properly assume a role of more or less importance, but the doctor must usually remain the “quarterback” or leader; in the absence of a truly informed other, or Certified Medical Planner™.

This is necessary because only the doctor [client] has the personal self-mandate with skin in the game, to take a big picture view. And, rightly or wrongly, investments dominate the information available regarding personal finance and the attention of most physicians.  One is much more likely to need or want to discuss the financial markets with their financial advisor than private letter rulings by the IRS, or with their estate planning attorney or tax accountant.

So, while hiring for expertise is a good idea, there is sinister way advisors goad doctors into using all their retail services; all of the time. That artifice is – the value of time. Don’t fall for this out sourcing gambit!

How Doctors Pay for Wealth Management Services

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crowds

[Not Going it Alone]

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Assessment

True integrated physician focused and financial planning is at its core a service business, not a product or sales endeavor. And, increasingly money is more likely to be at the top of the list for providers as the healthcare environment is contracting.

So, eschewing the quarterback model of advice, and choosing to self-educate thru these new book and elsewhere, may be one of the best efforts a smart physician can make.

Enter the CMPs

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

***

Financial Headlines Round-Up for 2015

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LOOKING BACK … In Review  

The Economist Explains’

Art

By Arthur Chalekian GEPC

[Elite Financial Partners]

Each week, The Economist blog expounds on subjects ranging from current events to economics, from philosophical or scientific issues to everyday oddities.

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Let’s take a quick look at a few of its headlines during 2015

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Why the Swiss unpegged the Swiss franc (January 18, 2015). Remember when the Swiss National Bank removed its currency peg last January? The Swiss franc realized double-digit gains in value and the Swiss stock market dropped.

Everything you want to know about falling oil prices (March 18, 2015). “The main reason for falling prices is increased supply from America thanks to its fracking boom, which has reduced its demand for oil imports. Other countries, notably Saudi Arabia, have been loth to curb supply lest they lose their share of the global oil market.”

Why so many Dutch people work part time (May 11, 2015). More than one-half of the working population in Netherlands is employed part-time – a higher percentage than anywhere else in the world. “This is partly a relic of prevailing Christian attitudes which said that mothers should be home for tea time and partly down to the wide availability of well-paid “first tier” part-time jobs.”

What Greece must do to receive a new bail-out (July 14, 2015). After challenging negotiations, Greece and its European creditors cut a deal, allowing the country to remain in the euro area.

China’s botched stock market rescue (July 30, 2015). Chinese stocks lost nearly a third of their value last summer. China’s authorities “resorted to heavy-handed measures to prop up swooning share prices, from pressuring banks to buy stocks to blocking big investors from selling theirs.”

Why is the Nobel prize in chemistry given for things that are not chemistry (October 7, 2015)? Apparently, five of the last 10 Nobel chemistry prizes have been awarded for pursuits that might better be described as biology. A possible explanation is “the diversity of chemistry prizes reflects the fact that chemistry is found everywhere…”

How the Fed will raise interest rates (December 14, 2015). Just as the Fed employed unconventional monetary tools to stimulate the economy, it is using new policy tools to try to increase the Fed funds rate.

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gas_pump_1

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Oil Prices

Down…down…down! Need we say more?

Assessment 

We hope 2015 has been a memorable and rewarding year for you, and we look forward to working with you, and the ME-P, in the New Year.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

[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]

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Managing Risks as [Doctor] Parent

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Kids Create Substantial Risks for 

[Physician] Parents!

IKE

A Special ME-P Report

[By Ike Devji JD]

The number of ways that children are creating substantial risks for their [physician] parents is at an all-time high as many parents are unfortunately aware; as we begin 2016. Increased defensive planning or education by most parents despite increasingly common litigation for this vicarious liability has not increased commensurately with this risk.

Some of you believe that your kids are better behaved, smarter, and more sensible than those we hear about in the news. Such exposures are unpredictable and often arise from mundane activities you never imagined could be so serious.

Part of the discussion we encourage [physician] parents to have with their children includes a detailed explanation of the fact that you as a parents are personally financially and legally responsible (up to the level of criminal liability) for any harm, damage, or loss cause by their minor children.

Example:

In one example; a successful physician left town for the weekend with his wife, and his 17-year-old daughter threw a party at their home in a pattern repeated in nearly city in the country every weekend. Tragically, a teenager whom she had never met before crashed the party and died after he overdosed on drugs he brought with him resulting is a lawsuit against the young lady’s parents that sought damages in excess of three million dollars. Neither the young lady, nor her parents, nor anyone else in the tony private-school community of gated homes imagined that something like could happen in their nice neighborhood and the resulting claim was in excess of the limits of the homeowner’s liability policy the family had in place. Dozens of other parentally liability exposures seen over the years have come from much more mundane issues.

Negligent Supervision and Negligent Entrustment

Two ways liability is linked back to parents include negligent entrustment (providing the means or access to things or situations where some reasonably anticipatable harm occurs) and negligent supervision (basically infers that the harm would not have occurred if the minor had been properly supervised). This liability extends to others that have custody or are entrusted with supervision, so any guardian is at risk if the harm would have been prevented absent the access to the thing that created the harm and/or inadequate supervision. It also creates potential liability for you for the children of others you have custody of, even overnight for a slumber party.

Some Specific Recurring High Risk Issues:

  1. Automobiles: Minor children must be specifically named and insured on any vehicle they drive. Parents are generally liable for what minors do behind the wheel, permitted or not. If they are irresponsible drivers or if they take the car without permission you must take control of the car and treat it like a loaded weapon that’s pointed at everything you own and possibly their very own survival. Your high school senior cutting class with her friends and piling them into your car to go to Starbucks for “ditch day” is remarkably less charming when, for instance, she loses control of the vehicle on the way back to school and two of her passengers are critically injured as happened in one recent case. Thanks to commonly available and inexpensive software and tracking devices, not to mention the tracking software on your kid’s iPhones you can know where they and your vehicle are at all times.

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Waxed Jaguar

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  1. Access to Firearms and Other Dangerous Items: If you have guns in your home (or bows and arrows, ATVs, jet skis, a swimming pool, prescription drugs, or anything else that can be misused) you are legally and financially responsible for not only personal injury and property damage but in some states and fact patterns even criminal liability for the actions of your child and his friends. The cost of defense counsel alone could be financially fatal considering the possibility of someone getting injured or killed and the resulting liability and consequences.

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glock-23-3rd-gen-guns-14515485-2175-1425

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

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

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Second Guessing the FED

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A HISTORICAL CHAIR REVIEW

Art

By Arthur Chalekian GEPC

[Elite Financial Partners]

***

AN AGE OLD AMERICAN PASTIME

Americans have been speculating about the Federal Reserve’s monetary policy choices – rate hikes, rate declines, quantitative easing, etc. – for a long time. It’s clear when you take a look at a few modern Fed Chairs and the Fed’s activities under their leadership.

Paul Volcker (1979-1987) took over an economic quagmire known as The Great Inflation. In the early 1980s, U.S. inflation was 14 percent and unemployment reached 9.7 percent. Volcker unexpectedly raised the Fed funds rate by 4 percent in a single month, following a secret and unscheduled Federal Open Market Committee meeting. His policies initially sent the country into recession. The St. Louis Fed reported “Wanted” posters targeted Volcker for “killing” so many small businesses. By the mid-1980s, employment and inflation reached targeted levels.

Alan Greenspan (1987-2006) was in charge through two U.S. recessions, the Asian financial crisis, and the September 11 terrorist attacks. Regardless, he oversaw the country’s longest peacetime expansion. In the late 1990s, when financial markets were bubbly, critics suggested, “…Mr. Greenspan’s monetary policies spawned an era of booms and busts, culminating in the 2008 financial crisis.”

Ben Bernanke (2006-2014) took the helm of the Fed just before the financial crisis and Great Recession. When economic growth collapsed in 2007, the Fed lowered rates and adopted unconventional monetary policy (quantitative easing) in an effort to stimulate economic growth. In 2012, economist Paul Krugman called Bernanke out in The New York Times, “…the fact is that the Fed isn’t doing the job many economists expected it to do, and a result is mass suffering for American workers.”

Janet Yellen (2014-present) is the current Chairwoman of the Fed. Under Yellen’s leadership, after providing abundant guidance, the Fed raised rates for the first time in seven years. The International Business Times reported several prominent economists think the increase was premature, in part, because there are few signs of inflation in the U.S. economy.

Assessment 

In many cases, it’s difficult to gauge the achievements and/or failures of a leader – Fed Chairperson, President, Congressman, or Congresswoman – until the economic or political dust settles. Sometimes, that’s long after they’ve left office.  

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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

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HISTORIC PURPOSE OF MEDICAL RECORDS and S.E.S.

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An iMBA Inc., Review

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DEM white shirt

[By Dr. David Edward Marcinko CMP® MBA]

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As little as a hundred years ago, detailed medical records were likely to have been compiled by medical researchers such as Charcot and Hughlings-Jackson. The medical record was an aide memoire for detecting changes in patients’ conditions over time, solely for the benefit of the physician in treating the patient.

As health care became more institutionalized, medical records became a communications device among health care providers.  Doctors made progress notes and gave orders.  Nurses carried them out and kept a record of patient responses.  A centralized record, theoretically, allowed all to know what each was doing.  The ideal was that if the doctor were unable to care for the patient, another physician could stand in his or her shoes and assume the patient’s care.

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stack_of_file_12

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Enter Third Parties 

Then pressures from third party payers occurred. As insurance and then government programs became larger players in the compensation game, they wanted to know if the care they were paying for was being delivered efficiently.

  • Why were these tests ordered?
  • Why weren’t these studies done?
  • Why had the patient remained hospitalized after his temperature had returned to normal for so many hours and no pain medications had been required?
  • Why couldn’t this pre-operative work be done on an outpatient basis?

Though the real push behind these questions was the desire to save money, utilization review also directly contributed to better patient care. A patient who was being given inefficient care was getting substandard care as well. Utilization review was mainly retrospective; denial of compensation was rarely imposed, and suasion by peers was the main effector of change.  Though “economic credentialing” was shouted about, it rarely showed itself in public.

PP-ACA

Even health reform which openly admitted economic incentives as one of its motivators preferred to find some other reason for deciding not to reimburse, or admit Dr. Jones to its narrow panel of ACA, or other “skinny” network providers, or not renewing Dr. Smith’s contract an HMO. The medical record remained essentially a record of patient care which was good or not, efficient or not.  If the record wasn’t complete, the doctor could always supplement it with an affidavit, use information from somewhere else, or provide explanations.

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 train station

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Socio Economic Status

Today, the concept known as Socio Economic Status [S.E.S.] is conceptualized as the social standing, or class of an individual or group. It is often measured as a combination of education, income and occupation. Examinations of socioeconomic status often reveal inequities in access to medical resources, plus issues related to privilege, power and control. SES is increasingly being considered as another payment component [CPT® codes] to medical providers, as reflected in the paper medical record, EMR and elsewhere. 

Assessment

Have you encountered any Socio Economic Status initiative in your clinic, hospital or other medical institution?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

[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]

***

Emerging PATIENT Collaborative Medical Marketing Trends

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Seeking End-to-End Solutions?

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[By Dr. David Edward Marcinko CMP® MBA]

http://www.BusinessofMedicalPractice.com

Given today’s economic and political environment, with its’ increasing competitive pressures, medical practices are focused more-than-ever on patient acquisition and patient retention. Modern medical practices are teaming together to offer comprehensive end-to-end solutions.

If you are partnering with other healthcare organizations to pool in your expertise, offer joint solutions and take up joint medical marketing and patient communications programs, be careful how you execute and about what you agree with your partners on sharing patient databases.

Policy

It is advisable to formulate a simple and clear privacy policy and adhere to that in the partnership agreements. Comply with the policy at all patient touch points. Communicate this very clearly with your partners and patients prominently in all your channels of communication. Inventory your data collection processes and gateways. Select appropriate projects to add security to your data across extended networks and partners.

Note there is no silver bullet to protect the privacy. Privacy compliance is as much a business issue as it is a technical issue, sometimes more so.

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value

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Implications for Patient Strategies

While you are formulating and implementing privacy policies; you need to address the following questions:

  • Do your patients respond to your practice’s privacy strategy? It is not enough to have a privacy policy that is so confidential no one is aware of that. It is imperative for practices, once they implement their privacy strategies, to understand how patients are responding and loop the feedback to fine-tune policies accordingly.
  •  How do you consider the impact on the patient from every privacy decision you make? Every privacy decision made will impact the patient and your practice; but to what extent? How do you determine this impact? Some of them will be patient-facing and some will be in the back–end. This step is essential so that you can make appropriate decisions and make optimum usage of resources.
  • Will your medical practice operations support the privacy initiative? Privacy enablement requires resources and training with perhaps no immediate, apparent short-term value-add to the top-line or bottom-line. Medical practices that take a proactive view of privacy enablement as cost of doing business in the 21st century will benefit. Practices still need to adopt critical processes and technology that agree with their resources and gradually privacy enable in an incremental way.

Role of Technology

There is no technology silver bullet. Privacy enabling a practice is composed of elements of company loyalty towards patients, commitment to build long lasting and profitable patient management by building trust, and engaging cross-functional teams that can pick and deploy suitable data security across the network.

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cyber

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Steps

Here are some salient steps for secure data management that affect technology choices of any medical practice:

  • Privacy-compliant database development – healthcare organizations have to “listen” and record what patients are saying, and if and how they prefer to be contacted, or not at all. All these details will have to be stored in a secure database, which is regularly refreshed with the outcome of practice communications with patient. This will be the central repository that the office draws upon to design and execute consistent and privacy enabled patient communications.
  • Protect the data across the practice, from group to group, area to area, or from network to network. It is not enough for a medical practice to protect data from external intruders, but also from internal data abusers. It is not enough that patient data is secure during transmission at the patient touch point. It also needs to be safe where it is stored. It is not unusual to have patient data stored or lying around where it is accessible by internal intruders. Therefore it is imperative for medical practices to go beyond traditional firewalls to have multi-layered security at the data level.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure. 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Product DetailsProduct Details

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HUMANITARIAN WISDOM IN PATIENT CARE AS A MORAL IMPERATIVE AND …

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…. A MEDICAL RISK MANAGEMENT TOOL in 2018!

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DEM white shirt

[Dr. David Edward Marcinko CMP™ MBA MBBS]

http://www.CertifiedMedicalPlanner.org

EDITOR-IN-CHIEF

***

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

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

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

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

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

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

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

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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™

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

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

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

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

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http://www.BusinessofMedicalPractice.com

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MEDICAL Ethics for Challenging Times

[Finding Your Moorings in an Era of Dramatic Change]

Marcinko Ethics

By Render S. Davis MHA

By David Edward Marcinko

***

And so, as you read and reflect on the chapter of SECTION ONE, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.

Dr. David Edward Marcinko; CMP™ MBA MBBS [Hon]

[Chief Executive Officer]

iMBA Inc., Norcross, GA

References

  1. Penfield W. Neurology in Canada and the Osler centennial. Can Med Assoc J. 1949; 61(1): 69-73
  2. Osler W. Aequanimitas. Chapter 9, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 159
  3. Bean WB. William Osler: Aphorisms, CC Thomas, Springfield, IL, p. 129.
  4. Osler W. Aequanimitas. Chapter 3, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 34
  5. Thayer WS. Osler the teacher. In: Osler and Other Papers. Johns Hopkins Press, Baltimore, 1931, p. 1.
  6. Osler W. The reserves of life. St. Mary’s Hosp Gaz. 1907;13 (1):95-8.
  7. Osler W. Aequanimitas. Chapter 7, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 124
  8. Osler W. Valedictory address to the graduates in medicine and surgery, McGill University. Can Med Surg J. 1874; 3:433-42.
  9. Osler W. Remarks on organization in the profession. Brit Med J. 1911; 1(2614):237-9.
  10. Jacobs. AM: PMNews, April, 2015.

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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™ 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]

***

State Health Rankings

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For 2015

By http://www.MCOL.com

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Downhill Racing Meets Value Investing

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vitaly

By Vitaliy Katsenelson CFA

I wrote this article in May. Every time it was destined to be published in the pages of Institutional Investor, it got bumped by another, more timely one I had written. Finally, when a space opened in September, the market had taken a major dive, and what was supposed to be an “evergreen” article was suddenly out of touch with reality.

Here is the irony: This piece addresses complacency, but its author was complacent too. The X-mass market has recouped its summer losses, and this article is relevant again.

The Skier

I am a skier. When someone says this, you assume he or she is good. Well, I thought I was good. I was not Lindsey Vonn, but I had the technique down. I’d be the fastest person going down the mountain, always waiting for my friends at the bottom. Then, at the beginning of last season, I went skiing with my kids at Vail. It had snowed nonstop for a few days. Vail is a very large resort, and the mountain crew could not keep up with the snow, so I found myself skiing on unusually ungroomed slopes in powder more than knee-deep. Suddenly, something changed. I could not ski. I could barely make turns. I was falling multiple times per run. My kids, including my nine-year-old daughter, Hannah, were now waiting for me as I dug myself out of pile after pile of snow. My technique — along with my confidence — was gone. The discomfort froms constant falling turned into fear. I was ready to go back to the hotel after only two hours on the slopes. I was devastated. It was as if I had never skied.

The Ski Instructor

So I talked to a ski instructor about this incident. He told me that I’m a “good skier” on groomed slopes because they allow me to go fast without trying hard. Speed covers up a lot of mistakes and lack of skill. Skiing in powder requires different skis — not the skis I had — but more importantly, it slows you down and makes you rely on skills that I thought I had but didn’t.

The FED

During the past six years, the Federal Reserve neatly groomed, manicured and then finely polished investment slopes for all asset classes by lowering interest rates to unprecedented levels — providing a substantial accelerant that indiscriminately drove valuations of all assets higher. But ubiquitously rising valuations cover up a lot of mistakes and often a lack of skill. Whether you had a rigorous investment process or were throwing darts, over the past six years it hardly mattered — you made money. Bull markets don’t last forever, and this one is not an exception. Stock valuations (price-to-earnings) are just like a pendulum, swinging from one extreme to another.

Modernity

Today the stocks in the S&P 500 index trade at about 50 percent above their average valuation (if you adjust earnings down for very high corporate margins). Historically, above-average valuations have always been followed by below-average ones — taking away the riches that the previous years provided.

In other words, at some point it is going to snow and snow hard. Just as I, the great skier, found myself overconfident and unable to deal with the new terrain, investors will find themselves doing face-plants when the stock market turns from bull to bear. But here is great news:

Now the stock slopes are still finely groomed with stocks near all-time highs, and we all are given a unique opportunity to make adjustments to our portfolios and investment process. You should start by carefully analyzing each stock position in your portfolio. No drooling over how each of them did for you in the past. Drawing straight lines from the past into the future is very dangerous.

The Future

Instead, focus on the future — a future in which average stock valuations will likely be lower. Returns for a stock are driven by three variables: earnings growth, change in P/E and dividend yield. You should impartially examine each variable to determine if a stock deserves to be in your portfolio.

Then make one of three decisions: buy (more), hold or sell. Just remember, hold is a decision. If you choose not to sell an overvalued stock, one that has low or negative expected returns in the long run, that is a decision. We must all reexamine and future-proof our investment process. Six years of rewards and no risk will loosen the process of even the most disciplined investor.

Finally, if you are feeling very confident about your investment prowess today, take a moment to relive that gut-wrenching feeling you had the last time the stock market took a 20 percent dive. This will reset your confidence to the appropriate level and help you to avoid the mistakes that come from focusing too much on reward and too little on risk.

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penn station

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P.S. I took the kids skiing at Beaver Creek a week ago, for the first time this season. My daughter Hannah, who will be ten in a few weeks, has magically improved over the summer. However, Jonah, who is an amazing skier, has completely lost his form. He grew five or six inches since last spring — he’s 14 and pushing 6 feet now. His center of gravity has shifted, and he is still adjusting his technique to his new, oversized body.

Assessment

As a father, I smile when I see Hannah beating Jonah down the slope. Jonah, like any teenager, needs to be humbled. My skiing? The slopes were perfectly groomed. I was awesome! I just hope it doesn’t snow.

***

ABOUT

Vitaliy N. Katsenelson, CFA, is Chief Investment Officer at Investment Management Associates in Denver, Colo. He is the author of Active Value Investing (Wiley 2007) and The Little Book of Sideways Markets (Wiley, 2010).

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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[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]

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R.I.P. Lon Jefferies MBA CFP®

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Dear ME-P Readers and Subscribers

It is with a heavy heart that we inform you that Lon Jefferies passed away unexpectedly this weekend due to complications inherent with a seizure disorder.  We are extremely saddened by Lon’s all-too-soon departure.  He was a vital contributor to this Medical Executive-Post and Financial Planning industry writ large; and he will be greatly missed.

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Lon Jefferies

http://www.NewWorthAdvice.com

***

As you know, Lon was an excellent financial planner and prolific blogger.  To his credit – one of the variables he planned for  – was the possibility of a life altering event such as this.  With this foresight, Lon chose to align his financial planning services with his team at Net Worth Advisory Group.  Lon’s plan ensures that each client can continue to receive the same high level of financial planning and assistance going forward, while allowing his beneficiaries to receive some residual income.

Our most sincere sympathies go out to Lon’s new bride Jen, his parents, and their families.

With best regards and sincere sympathy.

Dr. David Edward Marcinko MBA CMP® MBBS

[Publisher and Editor-in-Chief]

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Top Twelve USA Pediatric Hospitals

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Domestic Hospitals for 2015

By http://www.MCOL.com

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ImageProxy

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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FORECASTS – IT’S THAT TIME OF THE YEAR FOR [Physician] INVESTORS

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No, not the holidays!

Art

By Arthur Chalekian GEPC

[Financial Consultant]

 ***

It’s the time when physician investors begin to consider pundits’ forecasts for the coming year.

Here are a few of those forecasts:     

1. “Flat is the new up,” was the catch phrase for Goldman Sachs’ analysts last August, and their outlook doesn’t appear to have changed for the United States. In Outlook 2016, they predicted U.S. stocks will have limited upside next year and expressed concern that positive economic news may bring additional Fed tightening. Goldman expects global growth to stabilize during 2016 as emerging markets rebound, and Europe and Japan may experience improvement.

2. Jeremy Grantham of GMO, who is known for gloomy outlooks, is not concerned about the Federal Reserve raising rates, according to Financial Times (FT). FT quoted Grantham as saying,

“We might have a wobbly few weeks … but I’m sure the Fed will stroke us like you wouldn’t believe and the markets will settle down, and most probably go to a new high.”

Grantham expects the high to be followed by a low. He has been predicting global markets will experience a major decline in 2016 for a couple years, and he anticipates the downturn could be accompanied by global bankruptcies.

3. PWC’s Trendsetter Barometer offered a business outlook after surveying corporate executives. After the third quarter of 2015, it found:

“U.S. economic fundamentals remain strong, but markets and executives like predictability, and that’s not what we’ve been getting lately … Trendsetter growth forecasts are down, so are plans for [capital expenditure] spending, hiring, and more. It doesn’t help that we’ve entered a contentious 2016 election season …”

4. The Economist had this advice for investors who are reviewing economic forecasts:

“Economic forecasting is an art, not a science. Of course, we have to make some guess. The average citizen would be well advised, however, to treat all forecasts with a bucket (not just a pinch) of salt.”

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0be5f030277425_561bf03bbcd62

[End 2015 – Begin 2016]

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Assessment

Doctor – What are your stock market predictions for 2016?

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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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™

***

Congress Passes Permanent Tax Provisions

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By Cindy Freking CPA

[Tax Manager ]

cfreking@whirleyproactive.com

Late on December 15th, a bipartisan agreement was reached on tax extenders—i.e., the 50 or so temporary tax provisions that are routinely extended by Congress on a one- or two-year basis—and numerous other tax provisions in the “Protecting Americans from Tax Hikes (PATH) Act of 2015” (the Act). This agreement makes permanent many of the individual and business extenders and contains provisions on Real Estate Investment Trusts (REITs), IRS administration and the Tax Courts and miscellaneous other provisions.

Below are some provisions that have been made permanent:

DEPRECIATION & EXPENSING PROVISIONS

  • The Act makes permanent the $500,000 expensing limitation and $2 million phase out amounts under Code Section 179
  • For property placed in service after Dec 31, 2015, the Act provides that air conditioning and heating units are now eligible for expensing
  • Assets for which the De Minimis election applies are not counted in determining the Code Section 179 expensing election or the ceiling
  • 15 Year Write off for Qualified Leasehold , Retail Improvements & Restaurant Property

INDIVIDUALS

  • American Opportunity Credit
  • Enhanced Earned Income Tax Credit
  • Above the line Educator Expenses
  • Exclusion for Employer Provided Mass Transit & Parking
  • State and Local Sales deduction
  • Liberalized rules for Qualified Conservation Contributions
  • Nontaxable IRA transfers to eligible charities

BUSINESSES

  • Research & Development credit & offset now available against taxes in addition to income taxes
  • Reduction in S-Corporation recognition period for Built in Gains Tax
  • Exclusion of 100% Gain on certain small business stock
  • Enhanced deduction for Food Inventory
  • Differential Wage Payment Credit (active duty employees)

Assessment

The above provides a brief overview of the Act. There are various provisions that have been extended through 2016 and 2019 and other miscellaneous provisions. If you need additional information or have questions, please contact your CPA.

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IRS

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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

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On Medical Provider Directory Accuracy?

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By http://www.MCOL.com

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ImageProxy1CUR6RZ6

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

Product DetailsProduct Details

  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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