An FA Hayekian Defense of Evidence Based Medicine

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A Reprint by Andrew Foy MD

A Hayekian Defense of Evidence-Based Medicine

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FA Hayek

[F.A. Hayek]

http://thehealthcareblog.com/blog/2016/05/11/a-hayekian-defense-of-evidence-based-medicine/

ABOUT

Andrew Foy is an academic cardiologist who is taking up blogging, again, for the instant gratification it brings while his real research is under peer-review. His Twitter account is @AndrewFoy82.

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Are you in the American middle class?

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Find out with this income calculator

[By Staff reporters]

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family

http://tinyurl.com/jyjoyy2

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Life Expectancy Income Disparities

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By http://www.MCOL.com

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R.I.P. Jack Lawrence Treynor

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[By Staff Reporters]

Jack Treynor Pioneered Modern Investment Theory; Dead at 86

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jt

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Jack Lawrence Treynor (February 21, 1930 – May 11, 2016) was the President of Treynor Capital Management, Palos Verdes Estates, CA. He was a Senior Editor and Advisory Board member of the Journal of Investment Management, and was a Senior Fellow of the Institute for Quantitative Research in Finance. He served for many years as the editor of the CFA Institute‘s Financial Analysts Journal.

More: http://www.bloomberg.com/news/articles/2016-05-12/jack-treynor-who-pioneered-modern-investment-theory-dies-at-86

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Managing Your 401(k)

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MANAGING YOUR 401(k)

By Dan Timotic CFA

More than 73 million Americans actively participate in employer-sponsored defined-contribution plans such as 401(k), 403(b), and 457 plans.

If you are among this group, you’ve taken a big step on the road to retirement, but as with all investing, it’s important to understand your plan and what it can do for you.

Here are a few ways to make the most of this workplace benefit.

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 investing

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The World Experiments with Negative Interest Rates

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Below Zero

ImageProxy

By Dan Timotic CFA

As of late April 2016, six central banks in Europe and Asia have adopted negative interest rates in an effort to stimulate their national economies. The experiment began in Denmark in 2012, but the big step came in June 2014 when the European Central Bank (ECB) dropped its benchmark rate below zero. Sweden and Switzerland soon followed, and Japan and Hungary went negative in early 2016. Taken together, these economies represent about one-fourth of global economic output.1–2

Although the Federal Reserve remains committed to raising the federal funds target rate, the Fed is watching the efforts of foreign central banks with an eye toward expanding its tools in the event of an economic downturn. On a more immediate level, the overseas experiment is affecting the dollar and helping to suppress interest rates in the United States.3–4

Reverse Economics

Central banks lower interest rates for two fundamental reasons: (1) to encourage business investing and consumer spending by making it cheaper to borrow and less lucrative to hold onto cash; and (2) to lower the value of the national currency in order to make exports more appealing and create an expectation of future inflation, which may further stimulate current spending.

The push into negative territory reflects the same goals, but it reverses traditional economic concepts by turning borrowers into creditors and creditors into borrowers. Although specifics vary, the central banks are pulling rates downward by assessing a negative interest rate on certain short-term deposits from commercial banks. These banks actually lose money on their deposits, which in theory should stimulate the banks to lend money to other banks, businesses, and consumers.

The greatest fear regarding negative rates is a mass exodus from the banking system. The experiments in Europe and Japan are still new and the rates relatively moderate, but so far banks and their customers seem to be weathering the transition, albeit with lower margins and additional fees.5 Deposits in eurozone banks grew by $327 billion from June 2014 (when negative rates were implemented) through October 2015.6 Some banks assess negative rates on large commercial customers, but they have been hesitant to do so with retail customers. One small Swiss bank instituted a charge of 0.125% on savings accounts and gained more customers than it lost.7

These early responses suggest that businesses and consumers may be willing to pay a premium to deposit cash assets safely in a bank. Keeping large amounts of cash outside of a bank can be expensive, requiring guards, safes, and other security measures. Average consumers might keep cash under a mattress, but it is difficult to pay bills — or buy merchandise over the Internet — with cash. This cost-benefit balance may change if rates continue to decline.

Bonds and Mortgage Rates

By April 2016, more than $8 trillion of government bonds in Europe and Japan were trading at negative interest rates.8 As with banking, this suggests that some investors are willing to accept a loss in return for the security of government bonds. However, negative or very low yields may put pressure on pension plans and insurance companies, which depend on low-risk, fixed-rate investments.9

Low rates have driven housing prices up in Denmark and Sweden, creating fears of a “bubble.” Some Danish homeowners have even seen the monthly interest on their adjustable-rate mortgages turn into monthly credits due to negative rates.10

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WA_16051_Experiment_Interest_Rate

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Currency Competition

After the ECB instituted negative rates, the euro dropped sharply against the U.S. dollar and was still down about 17% in April 2016.11 A strong dollar stimulates European exports at the expense of U.S. exports and makes it more difficult to raise U.S. interest rates, which would only make the dollar more appealing for foreign investors.

Denmark, Sweden, Switzerland, and Hungary all dropped rates in large part to keep their currencies competitive with the euro.12 Denmark’s experience, the longest-running experiment, suggests that negative rates may be effective when the primary goal is to control currency but less effective as a stimulus to growth.13 On the other hand, Japan’s initial efforts have seen the yen rise unexpectedly against the dollar, unsettling markets.14

How Low Can They Go?

Early eurozone results are tepid but encouraging. Annual GDP growth improved to 1.5% in 2015 versus 0.9% in 2014, and lending by eurozone banks (which had been decreasing) increased slightly by 0.6% in 2015.15 It’s unclear how much worse the European situation might be without negative rates.

Assessment

After a tentative beginning, central banks have become more aggressive. In March 2016, the ECB dropped its deposit rate to –0.40%, and the Swiss National Bank rate was –0.75%.16 It remains to be seen how banks and consumers will respond to even lower rates, and whether reverse economics will strengthen the global economy or create new challenges.

All investments are subject to market fluctuation, risk, and loss of principal. Investments, when sold, may be worth more or less than their original cost. Investing internationally carries additional risks, such as differences in financial reporting and currency exchange risk as well as economic and political risk unique to a specific country. This may result in greater investment price volatility.

References

1, 5, 9, 16) International Monetary Fund, 2016 2, 12) Reuters, April 10, 2016 3) The New York Times, March 5, 2016 4, 11) European Central Bank, 2016 6) The New York Times, December 3, 2015 7–8, 10, 14) The Wall Street Journal, April 14, 2016 13) Bloomberg, February 15, 2016 15) The Wall Street Journal, February 28, 2016

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

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On Pregnancy Ultra-Sound Price Variations

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By http://www.MCOL.com

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ultrasound

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EXPRESSING YOUR WISHES IN ADVANCE

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dan

By Dan Dan Timotic CFA

EXPRESSING YOUR WISHES IN ADVANCE

 

It’s not pleasant to think about the possibility of being unable to make your own medical or financial decisions; even for doctors and financial advisors.

That may explain why many people don’t take the time to draw up appropriate documents expressing their wishes.

THINK: Prince.

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death

[NOT today … Death!]

READ MORE

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Pharmacists in the Healthcare System

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Changing Roles

By http://www.MCOL.com

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ImageProxy

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Top 40 Medical Technology Trends

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Changing Technology Trends

Bertalan Meskó, MD, PhD

By Bertalan Meskó MD PhD

How The Top 40 Medical Technology Trends Changed In 3 Years

Free Guide And Infographic http://bit.ly/1XxSA3g

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Specialty Medication Cost Trends

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FOR 2015

By http://www.MCOL.com

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ImageProxy

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Identity Management in Health Care

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By http://www.MCOL.com

Importance in Health Care

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On the DOL’s New Fiduciary Rule

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By Rick Kahler MSFS CFP®

Rick Kahler MS CFPThe Department of Labor’s groundbreaking new Fiduciary Rule may change the legal responsibilities of advisors who sell financial products for consumers’ retirement accounts.

Financial services industry pundits aren’t sure whether the new rule is a giant step in the right direction or a successful dodging of a bullet by Wall Street.

Original Intent

The original intent was to require those selling financial products for retirement plans to act as fiduciaries—advisors required to put clients’ interests ahead of their own.

One proposed provision was a “restricted asset list” which would have banned the sale of high-commission products like private REITs and annuities to IRAs and other retirement plans. Wall Street brokers were “expecting a punch in the face that would force a dramatic overhaul of how they dealt with their customers,” notes Joshua Brown, CEO of Ritholtz Wealth Management, in an April 6 article at Fortune.com.

As adopted, the final rule allows financial salespeople to still sell all the controversial illiquid high-commissioned products they currently sell, as long as the brokerage firm can document the product is in the client’s best interest. Brown says this amounts to a “love tap.”

The Pundits

Bob Veres, editor of Inside Information, sees the new Fiduciary Rule as still a big win for consumers and fiduciary advisors. In an April 8 column, he writes, “professional financial planners and advisors have achieved a victory, and the Wall Street and independent broker-dealer service models have been dealt a blow.”

Veres argues that the new fiduciary duty to act in the client’s best interest will by itself preclude financial salespeople from justifying the sale of high-commissioned products in IRAs. He also points out that salespeople will no longer be allowed to receive “fat commissions” for recommending annuities and non-traded REITS, and therefore are unlikely to recommend these products.

Financial planner and writer Michael Kitces [a friend of this ME-P and advocate of iMBA’s online Certified Medical Planner® fiduciary focused professional charter education certification program] suggests the DOL’s concession allowing the current questionable financial products to still be purchased by IRAs may be “a brilliantly executed strategy of conceding to the financial services industry the exact parts that didn’t actually matter in the long run . . . yet keeping the key components that mattered the most,” the fiduciary duty to the client.

MORE: http://www.CertifiedMedicalPlanner.org

Brown believes salespeople will continue recommending higher-cost products “so long as a justification can be made for their being recommended (quality, performance, etc.).”

He adds, “Advisors will still be able to sell the proprietary products of their own firm so long as they can enunciate the reason why these products are in their customers’ “best interests” – a hurdle whose height will probably be adjusted on a case-by-case basis as no one really knows what it means yet.”

Kitces contends the new law will ultimately give the consumer the power through the courts to define what is and isn’t in their best interests. He points out:

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“In other words, while the DOL fiduciary rule didn’t outright regulate what Wall Street can and cannot do, it did change the legal standard by which those actions will be judged and ensure that eventually the courts will have the opportunity to rule on these fiduciary conflicts.”

While the new rule only applies to retirement assets, Veres and Brown see it as a step toward requiring a fiduciary standard for all investment advice. I tend to agree.

Assessment

Since so many small investors hold retirement accounts, applying a fiduciary standard to those investments may help more consumers understand the difference between fiduciary advisors and product salespeople. As the industry moves toward full compliance with the rule by the April 2017 deadline, we may see an increase in consumer demand for financial advisors who put clients’ interests first.

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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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Does the FED REALLY Matter?

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Does the Fed REALLY matter?

eric

By Erik Kobayashi-Solomon

[intelligent option investor]

Does the Fed REALLY matter?

This is an update to research done in the fall of 2015.

Common wisdom holds that Federal Reserve interest rate policy changes have a large effect on equity returns. The Fed represents, many believe, the ultimate market traffic light.

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NY Fed Reserve Bank

[FEDERAL RESERVE BANK OF NEW YORK]

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And, everyone takes this mental model for granted, but is it really true?

Read more

Was the 2008 Financial Crisis Caused by the Big Banks?

Assessment

The conclusions should be compelling to all ME-P readers, physician-executives and intelligent investors!

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

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It’s Still Harder to Become a Hairdresser than a Financial Adviser?

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How Come and Why?

[By Jason Zweig]

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The great journalist H.L. Mencken wrote decades ago
,

“The essence of a genuine professional man is that he cannot be bought.”

And that, in turn, can spring only from a culture of exhaustive training and the highest standards of conduct.

Professions like accounting, law and medicine took decades, often centuries, to advance to the point of requiring rigorous education and licensing for all their members.

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vintage-beauty-salon-equipment-9

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Assessment

The field of investment advice remains a long way from being able to call itself a profession.

More: http://blogs.wsj.com/moneybeat/2016/04/08/how-come-its-still-harder-to-become-a-hairdresser-than-a-financial-adviser/

On Wall Street’s Suitability, Prudence and Fiduciary Accountability

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CMS Announces New Random Payment Generator

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Center for Medicare & Medicaid Innovation

By CMS and CMMI

CMS JUST ANNOUNCED a new Innovation Model from the Center for Medicare & Medicaid Innovation, the Random Payment Generator, which will launch as a demonstration in January 2017.

“We’re pleased to add an eighth category of Innovation Models to our innovation portfolio,”

says CMMI spokesperson Dr. Emmett Brown.

“We felt that with the wide range of models developed to date, we needed to develop a ‘placebo’ initiative that could be measured against the various concepts we have been testing. We’ll be able to better determine if simply taking random actions while facing the formidable challenges in purchasing and coordinating healthcare services yields any different results than the complex models we have undertaken.”

The Random Payment Generator will simply randomize payment amounts to be paid for billed services, based on an algorithm that has programmed into repurposed surplus portable equipment being distributed to Medicare Administrative Contractors. Doctor Brown explained that the older equipment has no Internet connectivity and thus is not susceptible to breaches from outside hackers.

CMS is seeking hospital and medical group applicants to participate in the one-year Medicare trial in which they may render services and submit billings without being subject to most provider program requirements, but will accept whatever payment amount is assigned by the Random Payment Generator as payment in full.

“A number of provider participants in our other models have complained that they can’t understand or find any logic in how they are getting paid, and the basis for payment under this new model will certainly be easier to communicate and understand,”

Doctor Brown continued.

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ImageProxy

[A Random Payment Generator being shipped to Medicare Administrative Contractors]

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Leader Of The Healthcare REIT Industry?

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About Ventas, Inc

tim

By Timothy McIntosh MBA MPH CFP® CMP™ [Hon]

Ventas, Inc. is a real estate investment trust (REIT). The Company has a portfolio of seniors housing and healthcare properties located throughout the United States, Canada and the United Kingdom.

The Company operates through three segments: triple-net leased properties, senior living operations and MOB operations. The triple-net leased properties segment invests in seniors housing and healthcare properties throughout the United States and the United Kingdom and lease those properties to healthcare operating companies under triple-net or absolute-net leases that obligate the tenants to pay all property-related expenses.

The senior living operations segment invests in seniors housing communities throughout the United States and Canada and engages independent operators, such as Atria and Sunrise, to manage those communities. The MOB operations segment, acquires, owns, develops, leases, and manages MOBs throughout the United States. It invests in seniors housing and healthcare properties.

Ventas: Leader Of The Healthcare REIT Industry

house

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“We Can Never Know About The Days [FINANCIAL MARKETS] To Come”

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AS CARLY SIMON USED TO SING …

ArtBy Arthur Chalekian GEPC

[Financial Consultant]

However, that doesn’t stop anyone from making educated guesses about the future of companies, financial markets, and economies.

So, as we enter the second quarter, investment and business professionals have been offering their insights:

  • McKinsey & Company’s March Economic Conditions Snapshot indicated 80 percent of surveyed executives “… expect demand for their companies’ products and services will grow or stay the same in the coming months, and a majority believe (as they have in every survey since 2011) their companies’ profits will increase.” However, they are not as optimistic about the global economy as they were in December. About one-half of executives in developed and emerging markets said economic conditions globally are worse than they were six months ago
  • The Wall Street Journal’s April 2016 Economic Forecasting Survey, which queries 60 economists, reported three-of-four survey participants expect a Fed rate hike in June. Few expect a recession during the next 12 months, putting the odds at 19 percent. Almost one-half stated global risks were the greatest threat to the U.S. economy, followed by financial conditions, a slowdown in consumer spending, falling corporate profits, and U.S. politics.
  • PIMCO’s Cyclical Outlook predicts China’s gross domestic product (GDP) growth may be in the 5.5 to 6.5 percent range. The target is 6.5 percent. In addition, a gradual devaluation of the yuan is possible, although China’s currency policy often produces unexpected twists and turns.
  • BlackRock Investment Institute’s second quarter outlook centered on three themes. First, returns are likely to remain muted in the future. Second, monetary policies appear to be less divergent, which could be a positive for some markets. Third, volatility may persist as the Federal Reserve normalizes monetary policy. Diversity and careful asset selection are likely to be critical in this environment.

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Photo of hands of businesspeople during discussing

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Conclusion

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While it’s interesting to read experts’ predictions and expectations for coming months and years, it’s important to remember forecasts are not always accurate. An organization that tracked forecasting results through 2012 found forecasts were correct about 47 percent of the time.

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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DOL’s Fiduciary Rule Brings Good News

The DOL and Your Retirement Account

 
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By Michael Zhuang,

[Principal of MZ Capital Management]
Contributor to Morningstar and Physicians Practice
Michael Zhuang
 
Recently the Department of Labor issued a fiduciary rule that requires financial advisors who manage retirement accounts to act in clients’ best interests.
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Here is the quote from a Wall Street Journal report … 

About $14 trillion in retirement savings could be affected by the rule, which requires stockbrokers providing retirement advice to act as “fiduciaries” who will serve their clients’ “best interest.” That is stricter than the current standard, which only says they need to offer “suitable” recommendations, a standard that critics say has encouraged some advisers to charge excessive fees or favor investments that offer hidden commissions.

Still, reflecting intense lobbying from the financial industry, which has fought the regulation since it was first proposed six years ago, the final version includes a number of modifications. 

This might come as a surprise to many physician-executives and people that financial advisors do not need to act in clients’ best interests up until this day.  

Alas, as I explained in this article, there are really two types of financial advisors: those who have a broker license (series 7) and those who have a registered investment advisor license (series 65).

Here is the kicker:

93% of all financial advisors are licensed brokers. These are advisors from major Wall Street brokerages like Merrill Lynch, Morgan Stanley and etc., as well as many independent broker-dealers. By law, they do NOT need to act in clients’ best interests. 

Those who have a registered investment advisor license have always been required by law to act in clients’ best interests, but they account for only 7% of all financial advisors. 

The financial industry benefits tremendously from not needing to act in clients’ best interests, for instance, by selling clients high hidden cost financial products. That’s why they fight the fiduciary rule tooth and nail, and with the help of many Senators and Congressmen.

It’s better late than never. I am glad that seven years after the financial crisis that nearly brought the country to its knees, something is finally done to address the rampant conflict of interests in the financial industry. 

There is a caveat though. The fiduciary rule only applies to retirement accounts. So if you have a brokerage account and an IRA account with Merrill Lynch. Your Merrill Lynch broker needs to act in your best interests with your IRA account, but needs NOT with your brokerage account! 

Assessment 

The best way to check whether your financial advisor is a broker is to ask “Do you have a series 7 license?” If the answer is “Yes.” You need a second opinion review. Chances are good that it will find many hidden costs and bad investments.

More: The DOL’s Final Fiduciary Rule: What’s in it and what does it mean for advisors?

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™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Inviting Patients to Read Their Doctors’ Notes

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OVER HEARD IN THE DOCTOR’S LOUNGE

DEM white shirt

By Dr. David E. Marcinko MBA CMP™

In an OpenNotes study, researchers examined the impact on patients and doctors when patients were allowed access to their doctors’ notes via a secure Internet portal.

Through the use of surveys, patients’ benefits, concerns, and behaviors, as well as physicians workload, were measured.

The Study

Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Seattle were selected for this quasi-experimental year-long study.

The study included 105 physicians and 13,564 of their patients. Patients were notified when their notes were available, but whether or not to open the note was at their own discretion. The authors analyzed both pre- and post-intervention surveys from the physicians who completed the study; 99 physicians submitted both pre- and post-intervention surveys. Of the patients who viewed at least one note, 41 percent completed post-intervention surveys.

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Physician Executive

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Almost 99 percent of patients at BIDMC, GHS, and HMC wanted to have continued access to their visit notes at the completion of the study; no physician elected to end this practice.

Assessment

Although a limited geographic area was represented, the positive feedback and clinically relevant benefits demonstrate the potential for a widespread adoption of OpenNotes.

Moreover, it may be a powerful tool in helping improve the lives of patients.

Citation: Inviting Patients to Read Their Doctors’ Notes: Author(s): Delbanco, T; Walker, J; Bell, SK and Darrer, JD et al: American College of Physicians, Annals of Internal Medicine, October 2012

Open Notes, a grantee of the Robert Wood Johnson Foundation, was developed to demonstrate and evaluate the impact on both patients and clinicians of fully sharing (through an electronic patient portal) all encounter notes between patients and their primary care providers.

Conclusion

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The Need for Anti-Authoritarians in the Medical Profession

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327518caf4de6ca81321ea8b469a3d42

Question Authority

By Michael Lawrence Langan MD

Anti-authoritarians question whether an authority is a legitimate one before taking that authority seriously.

To evaluate the legitimacy of  an authority it is necessary to do the following:

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Question Authority: The Need for Anti-Authoritarians in the Medical Profession

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Conclusion

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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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Don’t forget 1st. Quarter Estimated Tax

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Andrew Schwartz

By Andrew Schwartz CPA

Doctors –Don’t forget 1st Quarter Estimated Tax payments for 2016; due April 18th.

‘Estimated Tax’

Estimated taxes are usually paid on a quarterly basis. If the estimated taxes that are paid do not equal at least 90% of the taxpayer’s actual tax liability (or 100% or 110% of the taxpayer’s prior-year liability, depending on the level of adjusted gross income), then interest and penalties are assessed against the delinquent amount.

Don’t forget- 1st Quarter Estimated Tax

IRS

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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The Medical Profession under Dictatorship

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327518caf4de6ca81321ea8b469a3d42By Michael Lawrence Langan MD

Revisiting Dr. Leo Alexander’s prescient warnings from 1949

 Dr. Leo Alexander (October 11, 1905 – July 20, 1985) was an American psychiatrist, neurologist, educator, and author, of Austrian-Jewish origin. He was a key medical advisor during the Nuremberg Trials. Alexander wrote part of the Nuremberg Code, which provides legal and ethical principles for scientific experiment on humans.

Source: https://en.wikipedia.org/wiki/Leo_Alexander

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The Medical Profession under Dictatorship–Revisiting Dr. Leo Alexander’s prescient warnings from 1949

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leoalexander

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Conclusion

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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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Be a Journalist!

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Be a Journalist!

Via Megan McArdle:

j

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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On Investor Sentiment?

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HOW DO INVESTORS REALLY FEEL ABOUT STOCK MARKETS?         

Art

By Arthur Chalekian GEPC

Individual Investors (AAII) surveys investors weekly about whether they are bullish, bearish, or neutral on stock markets for the next six months.

Last week, the majority of participants indicated they were neutral. There was less bullish sentiment than the previous week, but bulls maintained a slight edge over bears:

The Results

  • Bullish: 27.2 percent
  • Neutral: 47.1 percent
  • Bearish: 25.8 percent

Assessment

The AAII also asked whether participants were better off, worse off, or as well off as they had been eight years ago (early in the Great Recession). More than one-half (54 percent) said they were better off. The remainder was almost evenly split. Twenty-four percent indicated they were not better off, and 23 percent said they were as well off.

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Bear + A Falling Stock Chart[A BEAR Market]

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Conclusion

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Capitation?

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What Capitation?

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By Ira Nash, MD

By Policy makers who are responsible for shaping how the federal government (the country’s biggest payer of health care services) pays physicians are pushing CMS on a rapid path away from traditional …

Capitation? What Capitation?

Conclusion

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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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I’m an APHA Abstract Reviewer for the 2016 Annual Meeting & Expo

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My Invitation Letter with Acceptance

By the APHA Annual Meeting Team

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Dear Dr. David Marcinko,

Thank you for volunteering to review abstracts for the APHA 2016 Annual Meeting & Expo (Oct. 29 – Nov. 2, 2016). Your efforts and expertise are critical to ensuring the meeting is a successful contribution to our goal of making the U.S. the healthiest nation in one generation.

Selection

You have been selected to review abstracts for the Health Administration program. All abstract reviews must be completed no later than Thursday, March 31, 2016.

COIDs

If you have not completed a conflict of interest disclosure form you will be prompted to do so – on the electronic portal – before accessing your assigned abstracts. Once you have completed the disclosure form you will see a list of your abstracts to review. Simply click on the abstract number and hit “go” to begin your reviews.

Criterion

The criterion and rating scale will be provided at the bottom of each abstract. Abstracts without abstracted text are considered incomplete and should not be reviewed.

NOTE: PLEASE DO NOT REVIEW ANY ABSTRACTS THAT YOU YOURSELF HAVE SUBMITTED.

If you have specific questions regarding your assignment or if you are no longer able to review please contact the program planner for your Section, SPIG, Caucus or Forum or Student Assessment

Assessment

Thank you for your contribution in this very important process. We hope that the online abstract review system makes your work easy however, if you see ways in which we can improve this process please let us know.

Acceptance

Yes, I accepted and completed this professional invitation with thanks and all due humility and gravitas.

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APHA2016emailbanner

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Seeking the “Perfect” Investment

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If I only had a crystal ball

Rick Kahler MS CFP

By Rick Kahler MS CFP®  http://www.KahlerFinancial.com

“If I only had a crystal ball.” Every investor has probably made this wish from time to time; even physician-executives. We would all like a way to avoid the emotional pain and anxiety that are sure to come when our portfolios lose value due to inevitable market downturns.

The Pain – The Pain

Surely a perfect investment would spare us that pain. Suppose a mutual fund manager with a crystal ball knew which 10% of the 500 largest U. S. stocks would earn the highest returns for each upcoming five-year period. Investing only in those stocks should ensure gain with no pain.

According to an article by Bob Veres, editor of Inside Information, someone has looked back over more than 80 years to track such a hypothetical perfect fund. Alpha Architect, a research company, divided the 500 largest U.S. stocks into deciles and imagined a fund investing in only the 10% known to have the highest returns for the next five years. Beginning January 1, 1927, the hypothetical portfolio was adjusted every five years. If you could have purchased it then and held it to the end of 2009, you would have earned just under 29% a year. Lots of gain, no pain at all, right?

Enter the Bear

Except for the particularly bad bear market that started in 1929, when you would have seen your investment plummet 75.96%. Or the one-year period starting at the end of March 1937, when the fund would have fallen more than 44%.

Or, the nine more times over the years that the fund dropped by 20% or more. It lost 22% in 1974 when the S&P 500 was up 20%. In 2000-2001 you’d have watched it plummet 34% while the S&P 500 was only down 21%. Or how about the 20% drop from the end of September through the end of November 2002, at a time when the S&P 500 was sailing along with a 15% positive return.

Yes, the long-term returns in this “perfect” investment were amazing. The full ride, however, offered many opportunities for anxiety and even terror, when investors would have been strongly tempted to bail.

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Alpha Architect

Alpha Architect concluded that even if God—who presumably doesn’t need a crystal ball to have perfect foresight—were running this mutual fund, He would have lost a lot of investors. During the rough patches, many would have lost faith in His management skill.

Investors who are ultimately successful learn to hang on through thick and thin, knowing that markets eventually recover. Yet even if we could choose a perfect investment, staying with it for the long term is a challenge.

Speed Demons

One of the reasons market declines are so frightening is that they happen much faster than market gains.

Ben Carlson, author of A Wealth of Common Sense: Why Simplicity Trumps Complexity in Any Investment Plan, looked at all the bear markets and bull markets going back to 1928. The bull market rallies averaged 57% returns, while bear markets averaged losses of 24%. The bull markets lasted an average of 474 days. The bear market drops were more intense, compressed into an average of just 232 days before the next upturn.

Even when, by percentage, the gains far outweigh the losses, the more gradual pace of the bull markets doesn’t attract our attention in the same way as the heart-stopping downturns of bear markets.

Assessment

Veres calls the Alpha Architect research “a lesson in humility and patience.” We can’t look into the future with a real crystal ball. However, looking back at market patterns with an imaginary one can help us protect ourselves from our own tendency to bail out in the face of adversity.

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]

Front Matter with Foreword by Jason Dyken MD MBA

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Medication Use in Older Adults

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http://www.MCOL.com

Including Supplements for 2005-2011

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ImageProxy

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Conclusion

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pills+many+colors+mrc

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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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Product DetailsProduct DetailsProduct Details

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An Open Letter from the APHA Government Relations Director

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National Public Health Week

By Don Hoppert
[APHA Government Relations Director]

Dear Dr. David E. Marcinko,

Sen. Tom Udall, D-N.M., and Rep. Lucille Roybal-Allard, D-Calif., are joining the audacious goal of creating the healthiest nation in one generation by introducing resolutions recognizing National Public Health Week and the importance of public health in our daily lives in supporting a strong, healthy nation.

While resolutions, such as the NPHW resolution, do not become laws, they function as statements of intent for Congress. This is an excellent opportunity to encourage your members of Congress to acknowledge the importance of public health, and potentially pave the way for additional support on other public health issues.

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APHA

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Send a message to your senators and representative urging them to support public health and co-sponsor the NPHW resolution!

Assessment

Note that the following representatives have already committed to joining the resolution as original co-sponsors:

•    Rep. Rob Wittman, R-Va.
•    Rep. Gene Green, D-Texas
•    Rep. Jim McGovern, D-Mass.

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:

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

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The Ambulance Drone Defibrillator?

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[By staff reporters]

Ambulance drone delivers help to heart attack victims

An ambulance drone carrying a defibrillator for rapid response to heart attacks has just been unveiled in the Netherlands.

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ambulance-drone

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Source:

Via: Aditi Chopra – HR Admin at Universe Jobs – New Delhi Area, India  Human Resources

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Why A Global Diversified Portfolio?

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Investing at Home or Away?

Michael ZhuangBy Michael Zhuang

Recently a client asked me why we bother with investing in international markets.  After all, the S&P 500 has done quite well in the last year. Indeed, it has outperformed foreign markets three years in a row, and by a huge margin to boot.

Take 2014 for example-the S&P 500 was up 13%, while the international markets on aggregate were down 5%. So; why then?

Table

Well, let’s look at this table

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untitled

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The Lost Decade

The decade between 2000 and 2009 is what investors call “The Lost Decade,” but only if you invested solely in the S&P 500. If you had owned a globally diversified portfolio, the decade would not have been lost. In fact, after The Lost Decade, some of my clients asked me “Why bother with investing in US stocks at all?”

Assessment

My answers then and now are the same: because we don’t know what the future will bring and we don’t know which market will do best or worst, so we need a globally diversified portfolio to limit our risk of falling victim to another lost decade.

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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Sherlock Health Administration Expense Benchmarks Invitation

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Sherlock Benchmarks – Participation and Licensing

By Douglas B. Sherlock CFA

sherlock@sherlockco.com

thoughtSherlockHello All ME-P Readers and Subscribers:

This email invites your participation and/or licensing of the Sherlock Benchmarks.

A central effect of the Affordable Care Act is to sharply increase the incentive for health plans to minimize their administrative expenses. The Sherlock Benchmarks can be a catalyst to respond to these incentives since they identify and prioritize cost variances.

Use of the Sherlock Benchmarks reflects this:

• At least 40 health plans serving at least 40 million people with health insurance are so far committed as participants in this year’s Sherlock Benchmarking study.

• Of the 36 U.S. – based Blue Cross Blue Shield primary licensees, one-half are participating in this year’s Sherlock Benchmarking Study, either as an enterprise or through a subsidiary.

• Of the 13 members of the Alliance of Community Health Plans that are not focused on public programs or are staff-model plans, 11 are participating in this year’s Sherlock Benchmarking Study for Independent / Provider – Sponsored Health Plans.

• Most of the largest members of the Health Plan Alliance that are not focused on public programs are participating in this year’s Sherlock Benchmarking Study for Independent / Provider – Sponsored Health Plans.

• Health plans serving at least one-half of all insured Americans are licensed users of Sherlock Benchmarks since January 1, 2015.

Licensing and participation is available to all health plans

We have recently launched the Independent / Provider – Sponsored and Blue Cross Blue Shield surveys. There is still time, but the financial metrics survey form must be returned to us by the end of April.

So please contact me immediately if you wish to join these robust panels.

Our universes of Medicaid and Medicare plans will launch in a few months to avoid conflict with your Medicare bid process. If a plurality of your members are in either Medicare or Medicaid, please contact us about participation. Note that all costs are segmented by product as well as by function to assure an apples-to-apples comparison between the plans.

Licensing is available without participation. Licensing costs more but it entails less effort.  The 2016 Sherlock Benchmarks for Blue Cross Blue Shield Plans and Independent / Provider – Sponsored plans will be available beginning in July. The 2016 Sherlock Benchmarks for Medicare plans and Medicaid plans will be available beginning in September. 

Assessment

We look forward to working with you.

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:

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

      Product DetailsProduct DetailsProduct Details

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The State of Obesity in the USA

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Prevalence of SELF-REPORTED Obesity by US States in 2014

By http://www.MCOL.com

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ImageProxy

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lean

[Self-Reportage?]

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Conclusion

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Protect Privacy – DO NOT Use EMRs!

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OCR pays its own way

1-darrellpruittSubmitted By‏ Darrell Pruitt DDS

“OCR unleashes second wave of HIPAA audits, but will it diminish patients’ privacy and security expectations?

Healthcare entities should expect the Office for Civil Rights to levy fines that help fund the program.  And until OCR delivers a draft audit protocol breaches will continue at patients’ expense.”

By Tom Sullivan for HealthcareIT News

[March 23, 2016]

http://www.healthcareitnews.com/news/ocr-unleashes-second-wave-hipaa-audits-will-it-diminish-patients-privacy-and-security

Sullivan: “Here come the HIPAA audits. And even though OCR has yet to clearly outline what healthcare providers should expect exactly, one thing to anticipate is plenty of financial penalties.”

And David Harlow, a health lawyer, consultant and founder of The Harlow Group, tells HealthcareIT News,

“Who loses out as a result? Patients. The breaches continue, free credit monitoring services are offered, and we all move forward with a diminished expectation of privacy and security.”

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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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Proposed IRA Changes in the Obama Federal Budget

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Reviewing Potential IRA Changes 

Rick Kahler MS CFP

By Rick Kahler CFP® http://www.KahlerFinancial.com

The President has fired the first warning shot indicating that politicians are eying the tax advantages of the Roth IRA. For years I’ve strongly encouraged maximum funding of Roth IRAs & 401(k)s.

Physician-Clients have sometimes expressed concern that politicians would someday retroactively change the rules and strip the plans of their tax advantages. I’ve seen that concern as a possibility (for example, in 2008 Argentina confiscated the assets in IRAs and 401(k)s and replaced them with less than desirable Argentinian Government Bonds), but not much of a probability. 

With the introduction of the President’s 2016 budget, the probability of losing some Roth IRA tax benefits has increased.  

Each February the President submits a budget to Congress which is about far more than spending requests. It also contains scores of proposed changes to existing tax laws. One such proposal in the current budget would eliminate two tax advantages of the Roth IRA.  

The first change would require required minimum distributions (RMDs) for Roth IRAs as well as traditional IRAs.  

Currently, one of the benefits of a Roth IRA is not having to take RMDs. At age 70 1/2, owners of traditional IRAs are required withdraw a certain percentage annually, often around 4%. They must pay the tax due and, if they don’t need the funds for living expenses, must invest the remainder in a taxable account. The RMD denies them the option of leaving the money in the tax-deferred environment of the IRA and further compounding.  

Under the President’s proposal, owners of Roth IRAs will need to start withdrawing funds annually at age 70 1/2. While there won’t be any taxes due because contributions to Roths are post-tax, it will remove the funds from the tax-free environment, decreasing future returns by up to 40%. That’s a big deal. 

The second proposed change would eliminate tax-deferred inheritance of IRAs (sometimes called “stretch IRAs) for anyone except spouses. All other inherited IRAs would need to be dissolved and the funds distributed and taxed within five years after death. This will really impact Baby Boomers counting on their parents’ IRAs to assist them with their own retirement needs. 

Other budget proposals would also end Roth conversions to any after-tax IRAs, limiting them to IRAs where the contributions were before taxes. This would prohibit taxpayers with earnings above the traditional and Roth IRA threshold from making non-deductible contributions to a traditional IRA and then doing a Roth conversion. 

The final proposal would limit new IRA contributions for total retirement savings totaling over $3.4 million. This includes the aggregate total of IRAs, 401(k)s, and any other pension plan balances. Once the total reaches $3.4 million at the end of the tax year, no new contributions are possible. 

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Capping IRA Growth?

To many Americans, especially the youth, this looks like a cap they will never see in their lifetime. Yet consider what $3.4 million will be worth in purchasing power 40 years from now, when today’s 30-year-olds will have to start RMDs. If inflation maintains its historical average of 3%, in 40 years $3.4 million will have the purchasing power of just over $1 million today. If someone wants to be assured they will never run out of money in retirement, $1 million only provides $30,000 a year of retirement income.

Capping IRA growth is another big deal.

Assessment 

These are a few of the tax changes proposed by the President’s budget. The chances for any to become law in 2016 are remote, given that Congress is currently controlled by Republicans. However, the proposals do signal the current thinking of lawmakers. In considering their retirement planning, taxpayers would be advised to pay attention to such signals.

Conclusion

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An Obesity Pic to Consider!

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By Staff Reporters

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NHS06ic

[David]

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Source: http://imgur.com/NHS06ic

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R.I.P. Andy Grove

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SAN FRANCISCO

March 21, 2016 (2016-03-21) (aged 79)

Andy Grove, legendary leader of Intel, noted author of business books and one of the pioneers of Silicon Valley.

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time-person-of-the-year-1997-andy-grove

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Assessment

Grove, 79, was one of the earliest leaders at Intel. He became president in 1979 and CEO in 1987 and served as Chairman of the Board from 1997 to 2005.

MORE: https://en.wikipedia.org/wiki/Andrew_Grove

Product DetailsProduct DetailsProduct Details

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Gilead Sciences’ Miracle Drug Combination

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More on Gilead Sciences

vitaly

By Vitaliy Katsenelson CFA

It is easy, exciting and uplifting to talk about how Gilead has saved millions of lives. But I have to admit I found myself to be slightly conflicted as a capitalist investor and human being when it came to analyzing the company.

So, here is my take on Gilead Sciences in essay form 

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drugs

Gilead Sciences’ Miracle Drug Combination

Conclusion

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

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

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

Front Matter with Foreword by Jason Dyken MD MBA

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On Chronic Disease Prevention

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By http://www.MCOL.com

In the USA for 2013

ImageProxy

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Shoppable Healthcare Spending

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For the USA in 2011

By http://www.MCOL.com

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ImageProxy

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The White Coat Investor

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By Staff Reporters

OVERHEARD IN THE DOCTOR’S LOUNGE

[The White Coat Investor]*

Dahle

James M. Dahle MD FACEP

Although I think a physician is perfectly capable of doing his own financial planning and investment management, the majority of doctors want, and would benefit from hiring a competent, fiduciary, fee-only advisor who can give them good advice at a fair price. The more familiar an advisor is with the unique financial planning issues associated with physicians, such as properly managing hundreds of thousands of dollars in students loans and acquiring specialty-specific disability insurance, the better.

Unfortunately, it is surprisingly difficult for a doctor to hire such an advisor as the vast majority of those who bill themselves as financial advisors are little more than commissioned mutual fund or insurance salesmen. Many of these so-called advisors state that they “specialize in physicians,” but in reality, merely specialize in marketing to physicians.

To make matters worse, a doctor may assume that these advisors are trained professionals comparable to accountants, attorneys, or physicians, when in reality the advisor may only have a few days of formal training, and most of that in sales.

Assessment

Obtaining high-quality, physician-specific, financial advice offered at a fair price sometimes seems like trying to find the Holy Grail.

*NOTE: The white coat ceremony is a medical school ritual that marks the transition from the study of preclinical to clinical health sciences. WCCs typically involve a formal “robing” or “cloaking” of students in white coats, the garb doctors have traditionally worn for over a century.

About the Author

The White Coat Investor: [A Doctor’s Guide to Personal Finance and Investing] Editor: www.whitecoatinvestor.com

Conclusion

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

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

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

Front Matter with Foreword by Jason Dyken MD MBA

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Advisor V. Adviser [The Ultimate “Terminology” Fraudster?]

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Anonymous Doctor

[By Anonymous]

Are the US Securities Acts the Ultimate “Terminology” Fraudster?

As a doctor and investor, I have learned thru the internet that Larry Elford, an Investment Misconduct and Malpractice Consultant – and many others – believe that the ultimate terminology fraudster is the US Securities Acts (1935 & 1940) and the Investment Adviser Act. Why?

They have no such category as “advisor” in the Acts.

Industry lawyers know this well, as does FINRA, and may be using this “spelling ruse” to dupe and deceive millions of Americans into believing that their commission sales “broker” is some kind of fiduciary “adviser” professional.

Some even believe it to be an industry pandemic of “bait and switch” to deceive and then shortchange investors.

Source: http://www.investoradvocates.ca/viewtopic.php?f=1&t=193&sid=1cc2690bde2ebdfaa749be1d35395083#p3867

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th

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VIDEO: Here is an under 2 minute glimpse into the Three Card Monte game being played, upon investors, when your Securities Commission proudly tells you to “check your “adviser’s” registration”.

Link: https://youtu.be/zIjt0qRsJKg

Assessment

Is this a mere lexicon conundrum; or truer pathology?

And, did you know that a Certified Medical Planner® is a client fiduciary at all times? Visit: http://www.CertifiedMedicalPlanner.org

cmp-logo16

Enter the CMPs

Conclusion

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

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

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

Front Matter with Foreword by Jason Dyken MD MBA

***

Not Today; DEATH!

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Beware the Ides of March – Public Health

DEMM high-def WhiteBy Dr. David Edward Marcinko MBA CMP®

Welcome, all ME-P readers and subscribers, to the Fulton County Department of Health & Wellness Website, and department, in Atlanta, Georgia.

The interim Director of Health Services is David A. Sarnow, M.D, MPH.

On the site, and in the department itself, you will find information on health topics to keep the community safe from health threats, promoting better health and helping Fulton County, Georgia residents find the health care information they need.

Of course, the others states have similar public health programs. And so, you are welcomed to enjoy the virtual website and explore the physical department – which I bypass almost daily.

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death

Not Today; DEATH!

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Margaret Farenger says this is on the side of Fulton County Health Services, Atlanta GA and the artist is Julian Hoke Harris.

Assessment

More information about the Fulton County Georgia Department of Health and Wellness.

Conclusion

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

8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

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Invite Dr. Marcinko

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Altered Medical Records – OLD SCHOOL!

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ON ALTERED RECORDS

By Dr. David Edward Marcinko MBA CMP®

http://www.CertifiedMedicalPlanner.org

DEM white shirtThe health care provider should not alter the medical record under any circumstances.

The office, clinic or hospital must zealously guard its medical records from alterations by physicians or members of the nursing staff.

Even an inconsequential alteration will throw the validity of the entire record into question. If an entry must be changed, a single line should be drawn through the entry, taking particular care to make sure that the original entry is clearly legible. The new entry should be written above or next to the old entry, and the date of the new entry, as well as the name of the person making the entry, should be recorded. The entry must also be signed by that person.

Juries are very intolerant of altered medical records; and even innocent mistakes, such as the loss of a few pages of a record, will be construed as an intentional cover-up. Under no circumstances should materials such as liquid paper or other opaque liquids be applied to the record in order to correct any entry.

Assessment

The health care provider should not alter the medical record under any circumstances.

Conclusion

Is there an emerging migration back to paper medical records?

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 Harvard Medical School

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Yale University

Medical Records as Malpractice Defense

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The BEST Defense

J. Christopher Miller, EsqBy Christopher Miller JD

[Alpharetta, Georgia]

www.NorthFultonWills.com

The best defense against any medical malpractice liability claim is a complete and accurate written or electronic record of the facts. In particular, medical malpractice claims will frequently be stalled or thwarted by a consistent written description of the symptoms you observe and the treatments you prescribe.

Extensive record keeping will not only help formulate a defense against a claim, but it will also (and perhaps more importantly) create the appearance that you are careful and highly competent in all of your affairs. Members of a jury may not be able to discern whether the medical judgments you made in a particular case were good or bad, as they do not have the years of education and training that you do.

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Jurors can, however, sense whether your practice is organized and professional. If your records are thorough and consistent, jurors will assume that you dedicate as much attention to the substantive aspects of your work as you do to the tedium of recordkeeping. If you are active in the management of your office, you should keep track of its operations and establish logs for your employees to complete as they perform their daily tasks.

Assessment

Not all information, however, ought to be written down. Keep your written records to the facts you have observed and leave your speculations for department meetings. 

And, is there an emerging movement back to paper medical records?

Conclusion

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 Harvard Medical School

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Yale University

***

The Types of Healthcare Compliance Audits

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TYPES OF MEDICAL COMPLIANCE AUDITS

By Carol Miller RN MBACarol S. Miller

There are several types of audits that a healthcare organization might need to perform.

The starting point is to obtain a baseline audit.  Next steps include periodic audits or reviews that are performed after all the information is obtained from the baseline audit; periodically. Finally, there are new employee audits.

Additional audits can be performed whenever new employees are added or if there are complaints or issues that arise in the course of business.

The Types:

  • Self Audit. Routine self-assessments demonstrate proactive measures established to ensure compliance and thus reduce the likelihood of a failed audit
  • Baseline Audit. Baseline audits are preliminary assessments to develop a reference point. This preliminary audit can help an organization understand where the program is and establish a base to gauge or compare future activities. Without this initial assessment, it is difficult for anyone within the practice or even an external consultant to determine if there are any performance issues.
  • Periodic Audits. Periodic audits are performed on an on-going basis, based on the decision of the practice. They may occur at random or at a scheduled time, monthly or quarterly.
  • New Employee Audits. New employees require regular training and reviews until there is confidence in their capabilities. Background checks are helpful to find out whether there are any potential conflicts; however, many independent medical practices do not have access to this type of information and may have to rely on other organizations to obtain the information. The OIG and General Services Administration maintain a database of excluded persons and entities that can be accessed through the internet. As part of the organization’s initial and periodic audits, queries of these two databases should be performed for all employees and any independent contractors.

HIV

Conclusion

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Yale University

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Announcing the Philosophic Medical Records Revolution

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Enter the Revolution

DEM blue

By David Edward Marcinko MBBS MBA CMP®

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

To understand the MR revolution that has occurred the past decade , place yourself for a moment in the position of third-party payer.

You want to know if Dr. Brown actually gave the care for which he is submitting a bill.  You want to know if that care was needed.  You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.

Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits?

Of course not!  You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a CAT scan on the patient at the imaging center.  What you can do is review the medical record that underlies the bill for services rendered from Dr. Blue.

Most of all, you can require the doctor to certify that the care was actually rendered and was indicated.  You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made [Stark Laws].  You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.

This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate that point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart.  As far as the patient was concerned, everything was correct and beneficial to the patient.  As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment.  We have left the realm of quality of patient care far behind.  Shall we change it back to the way it was?  That is not going to happen.

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Instead, practitioners must adjust their attitudes to the present function of patient records. They must document as required under pain of punishment for failure to do so.  That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal.  They are also aware of the fact that full documentation can be provided without a reality underlying it.

“Fine, you want documentation?  I’ll give you documentation!”

Some have given in to the temptation of “cookbook” entries in their charts, or canned computer software programs, EHR [electronic medical record] templates, listing all the examinations they should have done, all the findings which should be there to justify further treatment; embedded “billing engines” not with-standing. We have personally seen records of physical examinations which record a patient’s ankle pulses as “equal and bounding bilaterally” when the patient had only one leg; hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.

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EMRs

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Whether electronic medical records (EMR) will really be helpful, in the future, is still not known.

In fact, according to Ed Pullen MD, a board certified family physician practicing in Puyallup WA, electronic health records are defined primarily as repositories of patient data [much like paper records].

But, in the era of meaningful use [MU], patient-centered medical homes, and Accountable Care Organizations [ACOs], mere patient data repositories are not sufficient to meet the complex care support needs of clinical professionals. These complaints arise because EHR systems are being used as clinical care support systems, which means they should enhance the productivity of clinical professionals and support their information needs, not hinder them [personal communication, and DrPullen.com]. 

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™

 Harvard Medical School

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Yale University

The REAL Costs of Health Fraud

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Carol S. Miller

By Carol Miller RN MBA

The Cost of Health Fraud

There is no question that real fraud, waste and abuse exists in healthcare today. The Office of Inspector General of the Department of Health and Human Services (HHS) saved American taxpayers a record $21 billion a dozen years ago, according to Inspector General Janet Rehnquist. Savings were achieved through an intensive and continuing crackdown on waste, fraud and abuse in Medicare and over 300 other HHS programs for which the Office of Inspector General (OIG) has oversight responsibility.

More recently, according to the Centers for Medicare and Medicaid Services [CMS] and under the tenure of Eric Himpton Holder, Jr., 82nd Attorney General of the United States and more recently Loretta Lynch, Recovery Asset Contractors [RACs] collected almost $1-B in improper payments during their beta testing period in 2009-10.

Of these payments; 96% were over-payments, 4% were under-payments; and 77% of providers failed to appeal, 7% appealed successfully and 15% appealed unsuccessfully.

And, by Fiscal Year 2016, recovery auditors collectively identified and corrected more than 1,532,249 claims for improper payments, which resulted in more than $3.75 billion dollars in improper payments being corrected. The total corrections identified include more than $3.65 billion in overpayments collected and $102.4 million in underpayments repaid to providers and suppliers.

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Money

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After taking into consideration all fees, costs, and first level appeals, the Medicare FFS Recovery Audit Program returned over $3.0 billion to the Medicare Trust Funds.

More Costs

These savings did not take into account program costs and administrative expenses incurred at the third and fourth levels of appeal (Office of Medicare Hearings and Appeals (OMHA) and Medicare Appeals Council within the Departmental Appeals Board (DAB), respectively), as these components do not receive Recovery Audit Program funding for those appeals.

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™

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University