The Economic “American Dream”

Posted on February 21, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

On Income Earners

Understanding the Top 50 Percent

[By Anonymous Reader]

QUESTION: How much do you need to make to be in the top 50 percent of earners?

ANSWER: Just $36,055. Fall below that level and you are in the bottom half, along with about 68 million of your fellow taxpayers. All told, that group earned just 11.1 percent of the AGI reported on 2012 Federal returns.

Half of all taxpayers earn less than $35,055

If the top one percent where the decision makers live were to quit squeezing so hard, the rest of the population might be subject to paying more taxes.

The problem with the American Dream sold to the masses is that it is not achievable for them. Yet, they keep on voting for it. The biggest problem with voters is they do not have a solid grounding in economics.

Thus, they cannot judge economic policy in any rational way. If the voting public voted for what was truly in their interest, the top one percent would see their influence wane rapidly. It is the height of insanity that the public keeps on voting for politicians who espouse policies that are designed to benefit the economic elite.

***

Note: A recent finding by Oxfam that the top one percent will control fifty percent of the worlds’ wealth by 2016.

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Filed under: Op-Editorials, Taxation | Tagged: American Dream, Income, OxFam | Leave a comment »

Hospital Data Does NOT Equal Community Health

Posted on February 20, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

More on Big Healthcare Data

[By Edward Bukstel]

ME-P SPECIAL REPORT

***

Hospital Data does not Equal Community Health.

***

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Information Technology | Tagged: big medical data, Community Health, Edward Bukstel, EHRs, Hospital Data | 2 Comments »

The Social Media Shakeup in Healthcare

Posted on February 19, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

An Info-Graphic

By Matthew Smith [CDW]

Patients are increasingly turning to social media channels to seek health information and become more informed about their care, rate the quality of care they receive from providers, and communicate with their peers regarding health advice.

For their part, physicians are seeing increased value in social media for their own research discussions with colleagues — utilizing it to become more informed on patient care resources and for career development and networking.

Social media is slowly starting to foster meaningful results in the healthcare industry. This infographic from CDW Community IT claims social media enables:

Better knowledge of health conditions
Increased dialogue
Connected support
Improved patient engagement

Doctors and hospitals alike are tapping into social media. Consider these stats:

87 percent of physicians ages 26 to 55 use social media.
65 percent of physicians ages 56 to 75 are interacting online.
In 2012, four in five (79 percent) of hospitals were using social media. That number increased to 91 percent in 2013.

***

[To view a full-size version of the infographic, please click here and then click the image when it opens]

***

More:

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: Information Technology | Tagged: medical socia media, Social Media Shakeup in Healthcare | 3 Comments »

Understanding MD Employee Accident and Health Benefits

Posted on February 18, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Tax-free benefits provided to employees

[By Perry D’alessio CPA]

More and more physicians are employees; not employers.

So, here are the most common types of tax-free benefits provided to employees.

They include payments for health care insurance, payment to a fund that provides accident and health benefit directly to the employee, company direct reimbursements for employee medical expenses and contributions to an Archer MSA (medical savings account).

The IRS definition of employee, for health care benefit purposes, is very broad

Health benefits are exempt from income, FICA and FUTA (Federal Unemployment Tax). This saves the employer 7.65% that would otherwise be the “matching” 6.2% Social Security tax and the 1.45% Medicare Tax components due if these were true wages. The employer also saves the 0.8% FUTA tax, but since FUTA taxes only the first $7,000 of calendar year wages, per employee, this usually doesn’t factor in.

Calculation:

If you pay the full state unemployment tax, then your FUTA tax = Gross Salary * .08% – The maximum amount is $56 per employee:

$50,000 Salary = ($7,000)*(.8%) = $56.00
$5,000 Salary = ($5,000)*(.8%) = $40.00

The hospital employee saves federal income taxes on health benefits received, at their marginal tax rate, and, their components of FICA taxes. Depending on the coverage provided, these plans, when fully funded by the employer, can save the employee thousands of dollars in taxes each year.

IRS restrictions include:

Certain payments to S Corporation employees who are 2% shareholders are subject to FICA taxes.
Certain long term care benefits.
Certain payments for highly compensated employees.

Example 1: Let’s say the annual cost of providing medical coverage for an employee, age 50, with a spouse and two minor children is $7,500. An employee in the 30% tax bracket who received this amount in cash each year and then paid for his or her own medical coverage would be liable for as much as $2,250 in income taxes. In addition, FICA taxes save another 7.65% or $574, for a total savings to the employee of $2,824. The employer saves $574 in FICA taxes.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security Dictionary of Health Insurance and Managed Care

Filed under: Accounting, Health Insurance, Taxation | Tagged: Accident and Health Benefits, MSA, Perry D'alessio, Taxation of Accident and Health Benefits | 2 Comments »

On “Best-in-Class” Independent / Provider Sponsored Health Plans

Posted on February 16, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

February 2015 Edition of Plan Management

[By Douglas B. Sherlock CFA] Sherlock@sherlockco.com

Please find attached, the February 2015 Edition of Plan Management Navigator.

In this issue, we highlight characteristics among Independent/Provider-Sponsored plans in the lowest 25th percentile in costs, which we consider Best-in-Class health plans. We found that Best-in-Class plans operated with administrative costs that were lower by $10.99 PMPM, excluding Sales and Marketing and Medical Management.

A lower Staffing Ratio was mainly responsible for low costs, while low Staffing Costs also contributed. Non-Labor Costs, however, were actually higher in the Best-in-Class plans. Almost every functional area was lower for the Best-in-Class plans with IS, Claims, and Corporate Services most responsible for overall low costs. Finance and Accounting was the exception in that its costs were higher.

The Analysis

To perform this analysis, we endeavor to quantify and eliminate the effect of factors largely beyond management control. We then isolate and measure the specific contributing factors that are more susceptible to management.

In addition, we are building the universes for the Sherlock Benchmarks. For the Independent/Provider-Sponsored universe we have 23 plans committed to participate in this year’s study. This is up by 44% from last year and collectively, the committed plans serve 10.5 million people with comprehensive products.

***

Participation Solicitation

We are meeting to finalize the survey form in about one month, will distribute the survey forms in late March, collect the completed surveys in May and publish results beginning in July. Participation entails notable efforts on your part since useful outputs require relatively granular inputs. However, the cost is relatively modest.

Link: Navigator – February 2015

Assessment

Please contact me if you are interested in participating. You will be among good company.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

← Back

Thank you for your response. ✨

Filed under: Health Insurance, Healthcare Finance | Tagged: America's Health Insurance Plans, Douglas B. Sherlock CFA, health insurance plans, Plan Management Navigator | 1 Comment »

No More 10 and 90 Day Global Periods

Posted on February 15, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

New Changes on the [CMS Payment Reform] Horizon

[By Dreama Sloan-Kelly MD CCS]

Did you hear about the changes that are coming down the pike in regards to global services when billing for surgical procedures — be they in the office, in an ambulatory surgical center, or in the hospital?

CMS released their final 2015 Medicare Physician Fee Schedule (MPFS) ruling late last year. Embedded in this document was a proposal by CMS to get rid of both the 10 day and 90 day global periods! In fact, they want to do away with global period billing all together and have all procedures paid based on the work required to do the procedure itself — thereby billing for all post-surgical visits separately using E/M codes.

According to the final ruling, CMS proposes to transform all 10 day global services to ZERO global days starting in 2017. They will do the same in regards to 90 day global services starting in 2018. And, according to the U.S. Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) they have “identified a number of surgical procedures that include more visits in the global period than are being furnished”. They go on to say that they are “also concerned that post-surgical visits are valued higher than visits that were furnished and billed separately by other physicians such as general internists or family physicians”. Based on the final ruling, they plan to begin the transition as previously stated in 2017 after they have considered all comments.

The ruling goes on to state, “as the agency begins revaluation of services as 0-day global periods, we will actively assess whether there is a better construction of a bundled payment for surgical services that incentivizes care coordination and care redesign across an episode of care”. So let’s talk reality and my take on this change.

Over the past few weeks I have read a lot of articles on this subject from various pundits in the industry — they are actually arguing that this change will mean increased reimbursement when you combine the separate payment for the procedure itself along with the visit by visit billing for the post-surgical follow up care when compared to the current reimbursement rate.

***

Personally, I think they are all wrong for the following reasons:

Procedure Reimbursement Amount: This is the wild card. They are going to use the same RVU system that has always been used to calculate payment — but I guarantee you the payment for the procedure will not be anywhere near the reimbursement for the global package. I think the closest we could get to estimating the reimbursement rate of the procedure is to figure out what the current surgical care only rate would be (ie. as if you appended Modifier 54 to the procedure code). Beware that this rate would still encompass the pre-surgical evaluation — which I am assuming would be carved out since that is a part of the current global package they are trying to phase out.

Post Op Visits: Getting a patient to comply with medical visits is hard enough — now adding in the fact they would have to pay a copay each time — most often a specialty co-pay is going to make it even harder. Patient’s understand their follow up visits are currently covered in the cost for the surgery, and hence they tend to show up to these visits knowing they do not have any out of pocket expenses. If the proposed change comes to fruition many of the post-surgical visits may become cost prohibitive for a lot of patients and actually lead to a decrease in the number of follow up visits the patient actually schedules. Once the patient starts to feel better their motivation to return dwindles.

Lower Reimbursement Rate for Post-Surgical Visits: It is clearly stated in the CMS ruling that it is felt the post-surgical follow up care visits are paid at a higher rate than what a regular E/M visit would be paid for had the patient been seen by a primary care provider or an internist. That simple statement confirms to me that when the new procedure rate is combined with the individual visit payment rate, the overall reimbursement rate will be less than what is currently being paid.

So, how do you prepare?

First, stay on top of all bulletins coming from CMS in regards to this issue. Most of your medical societies and/or specialty societies have taken clear positions in regards to this matter — so be sure to stay in the loop and become a part of the process.

Run a report that allows you to pinpoint the average number of post-surgical follow up visits for your most billed procedures. This will give you an idea of the average number of follow up visits for particular procedures you know you will bill for if this transition does occur. Does this mean this number will be exact — NO — I would factor in a decrease of 15-20% for visits across the board based on the dynamics I previously described.

Lastly, begin creating a policy in regards to post-surgical follow up care that can act as an education tool for the patient, teaching them the important benefits of being compliant with their post-surgical care schedule and also warning them about the possible increase in out of pocket cost. Being transparent can go a long way into easing patient’s fear and encouraging their follow through.

As always I have included documentation for your library of information — you can find the CMS 2015 MPFS final ruling fact sheet HERE! I also created a brief video presentation on this hot topic HERE.

***

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Healthcare Finance, iMBA, Inc., Practice Management | Tagged: CMS global periods, CPT codes, Dreama Sloan-Kelly MD | Leave a comment »

2015 Medicare Part D [What it is = How it works]?

Posted on February 13, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Update on the Medicare prescription drug benefit program

[By Staff Reporters]

Medicare Part D, also called the Medicare prescription drug benefit, is a United States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. It was enacted as part of the Medicare Modernization Act of 2003 (which also made changes to the public Part C Medicare health plan program) and went into effect on January 1, 2006.

Medicare Part D Premiums

The monthly Medicare Part D base premium is set to pay 25.5 percent of the cost of standard coverage, established by bids submitted annually by Part D plans. CMS releases the Medicare Part D base premium in early August each year. Actual premiums are based on this set premium, but can vary greatly. The premium for 2014 was $32.42.

As of 2011, beneficiaries with higher incomes must pay a premium adjustment based on their income. This premium adjustment is called the Income-Related Monthly Adjustment Amount (IRMAA), and is paid directly to the Federal government (deducted from Social Security, Railroad Retirement Board, or Office of Personnel Management benefits).

Medicare Part D Deductible

The annual deductible for the standard Medicare Part D benefit was $310 in 2014, which is a decrease of $10 from the 2013 deductible. No Medicare drug plan may have a deductible more than $310 in 2014, although some plans may have a lower deductible or no deductible at all.

***

CMS Part D 2015 Standard Benefit Model Plan Details

Here are the highlights for the CMS defined Standard Benefit Plan changes from 2014 to 2015. The chart below shows the Standard Benefit design changes for plan years 2011, 2012, 2013, 2014 and 2015. This “Standard Benefit Plan” is the minimum allowable plan to be offered.

Initial Deductible: will be increased by $10 to $320 in 2015
Initial Coverage Limit: will increase from $2,850 in 2014 to $2,960 in 2015
Out-of-Pocket Threshold: will increase from $4,550 in 2014 to $4,700 in 2015
Coverage Gap (donut hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($2,960 in 2015) and ends when you spend a total of $4,700 in 2015. In 2015, Part D enrollees will receive a 55% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 65% co-pay on generic drugs purchased while in the coverage gap.
Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: will increase to greater of 5% or $2.65 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.60 for all other drugs in 2015
Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: will increase to $2.65 for generic or preferred drug that is a multi-source drug and $6.60 for all other drugs in 2015.

******

Medicare Part D Benefit Parameters for Defined Standard Benefit 2011 through 2015 Comparison
Part D Standard Benefit Design Parameters:	2015	2014	2013	2012	2011
Deductible – (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.	$320	$310	$325	$320	$310
Initial Coverage Limit – Coverage Gap (Donut Hole) begins at this point. (The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold)	$2,960	$2,850	$2,970	$2,930	$2,840
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap – Catastrophic Coverage starts after this point. See note (1) below.	$6,680.00 (1)	$6,455.00 (1)	$6,733.75 (1)	$6,657.50 (1)	$6,447.50 (1)
Out-of-Pocket Threshold – This is the Total Out-of-Pocket Costs including the Donut Hole. 2015 Example: $320 (Deductible) +(($2960-$320)25%) (Initial Coverage) +(($6680.00-$2960)100%) (Cov. Gap) = $4,700 (Maximum Out-Of-Pocket Cost prior to Catastrophic Coverage – excluding plan premium)	$4,700 $320.00 $660.00 $3,720.00 $4,700.00	$4,550 $310.00 $635.00 $3,605.00 $4,550.00	$4,750 $325.00 $661.25 $3,763.75 $4,750.00	$4,700 $320.00 $652.50 $3,727.50 $4,700.00	$4,550 $310.00 $632.50 $3,607.50 $4,550.00
Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2).	$7,061.76 plus a 55% brand discount	$6,690.77 plus a 52.50% brand discount	$6,954.52 plus a 52.50% brand discount	$6,730.39 plus a 50% brand discount	$6,483.72 plus a 50% brand discount
Catastrophic Coverage Benefit:
Generic/Preferred Multi-Source Drug (3)	$2.65 (3)	$2.55 (3)	$2.65 (3)	$2.60 (3)	$2.50 (3)
Other Drugs (3)	$6.60 (3)	$6.35 (3)	$6.60 (3)	$6.50 (3)	$6.30 (3)
Part D Full Benefit Dual Eligible (FBDE) Parameters:	2015	2014	2013	2012	2011
Deductible	$0.00	$0.00	$0.00	$0.00	$0.00
Copayments for Institutionalized Beneficiaries	$0.00	$0.00	$0.00	$0.00	$0.00
Maximum Copayments for Non-Institutionalized Beneficiaries
Up to or at 100% FPL:
Up to Out-of-Pocket Threshold
Generic/Preferred Multi-Source Drug	$1.20	$1.20	$1.15	$1.10	$1.10
Other	$3.60	$3.60	$3.50	$3.30	$3.30
Above Out-of-Pocket Threshold	$0.00	$0.00	$0.00	$0.00	$0.00
Over 100% FPL:
Up to Out-of-Pocket Threshold
Generic/Preferred Multi-Source Drug	$2.65	$2.55	$2.65	$2.60	$2.50
Other	$6.60	$6.35	$6.60	$6.50	$6.30
Above Out-of-Pocket Threshold	$0.00	$0.00	$0.00	$0.00	$0.00
Part D Full Subsidy – Non Full Benefit Dual Eligible Full Subsidy Parameters:	2015	2014	2013	2012	2011
Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources < $8,580 (individuals) or < $13,620 (couples) (4)
Deductible	$0.00	$0.00	$0.00	$0.00	$0.00
Maximum Copayments up to Out-of-Pocket Threshold
Generic/Preferred Multi-Source Drug	$2.65	$2.55	$2.65	$2.60	$2.50
Other	$6.60	$6.35	$6.60	$6.50	$6.30
Maximum Copay above Out-of-Pocket Threshold	$0.00	$0.00	$0.00	$0.00	$0.00
Partial Subsidy Parameters:	2015	2014	2013	2012	2011
Applied and income below 150% FPL and resources between $8,581-$13,300 (individuals) or $13,621-$26,580 (couples) (category code 4) (4)
Deductible	$66.00	$63.00	$66.00	$65.00	$63.00
Coinsurance up to Out-of-Pocket Threshold	15%	15%	15%	15%	15%
Maximum Copayments above Out-of-Pocket Threshold
Generic/Preferred Multi-Source Drug	$2.65	$2.55	$2.65	$2.60	$2.50
Other	$6.60	$6.35	$6.60	$6.50	$6.30
****** (1) Total Covered Part D Spending at Out-of-Pocket Threshold for Non-Applicable Beneficiaries – Beneficiaries who ARE entitled to an income-related subsidy under section 1860D-14(a) (LIS)

(2) Total Covered Part D Spending at Out-of-Pocket Threshold for Applicable Beneficiaries – Beneficiaries who are NOT entitled to an income-related subsidy under section 1860D-14(a) (NON-LIS) and do receive the coverage gap discount. For 2015, the weighted gap coinsurance factor is 90.693%. This is based on the 2013 PDEs (85.9% Brands & 14.1% Generics)

(3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2015, beneficiaries would be charged $2.60 for those generic or preferred multisource drugs with a retail price under $52 and 5% for those with a retail price greater than $52. As to Brand drugs, beneficiaries would pay $6.60 for those drugs with a retail price under $132 and 5% for those with a retail price over $132.
(4) The actual amount of resources allowable may be updated for contract year 2015.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: Health Insurance, iMBA, Inc. | Tagged: Medicare Part D, Medicare prescription drug benefits | 7 Comments »

“Vesalius on the Verge”

Posted on February 11, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

The Book and the Body

[By Dr. David Edward Marcinko MBA]

“Vesalius on the Verge: The Book and the Body” explores the groundbreaking work of 16th century professor and physician Andreas Vesalius, who changed the way that human anatomy was taught forever with “De humani corporis fabrica (On the fabric of the human body)”.

The book did two things not seen before: it corrected errors in the conception of the human body that existed for over a millennia, and it combined text with artistic illustration, which enabled interactive learning.

Where else can you see a first edition of the 1543 published text, a desiccated body juxtaposed with a full skeleton, and a contemporary recreation of Vesalius’ dissection table?

Plan your visit today! #muttermuseum #vesalius #anatomy #medicine #rarebooks” By muttermuseum on Instagram

***

Source: tumblr_inline_nhs0feL7wW1qzgziy

***

Assessment:

I went to medical school in Philadelphia PA, and visited the Mutter Museum many times. If you’ve never been there – I urge you to check it out!

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Book Reviews, Ethics, iMBA, Inc. | Tagged: Anatomy Dissection, David Edward Marcinko, Mutter Museum, Vesalius, Vesalius on the Verge | 1 Comment »

Dentists for De-Identification

Posted on February 10, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

A Start-Up Idea

[By Darrell K. Pruitt DDS]

An early, shoestring proposal for a non-profit dedicated to common sense security solutions.

Why? if patients’ identities are unavailable, they cannot be hacked.

Recently, I’ve considered starting a non-profit dedicated to keeping patients’ identities off of dentists’ computers where they are far too easily fumbled thousands at a time. I think I might call it “Dentists for De-identification.” What do you think?

My son Ryan and I have discussed putting together an educational YouTube cartoon – comparing the cost, convenience and security of encrypted Protected Health Information (PHI), to storing PHI, including medical information, only on paper in bulky metal filing cabinets – leaving only nameless, unencrypted dental records on the computer. De-identification is the “other” HIPAA Safe Harbor, meaning if patients’ de-identified dental information is stolen or hacked, nobody has to be notified. And, since the patients’ nameless dental records remain unencrypted, de-ID should not slow down work flow like encryption does.

***

One could call employing in-house reference numbers to re-connect patients’ digital dental information to paper-based PHI a hybrid solution to an otherwise intractable security problem. The solution is nothing new, and has a long history of success. For decades, police departments have been substituting in-house reference numbers for citizens’ names to protect the owners. I see no reason it cannot work for dental radiographs as well.

Depending on staff’s familiarity with the alphabet, pulling a patient’s thin paper record from a loud filing cabinet might even take less time than correctly typing in an encryption key (on the first try). What’s more, since there is a limit to the number of patients even the fastest dentists can treat in one day, 4000 or so active patients per dentist is a reasonable estimate of the number of records in a busy dental practice – which is probably one third of the records in the average physician’s practice. Since the dental information remains digital and only a couple of sheets of paper are needed to reveal the patients’ reference number along with a brief medical history, very little filing space should be needed.

The problems with encryption don’t end with correctly entering the key. Once permitted access to encrypted ePHI, it will take much more time to de-crypt one radiograph than it takes to open a manila folder. Depending on the number of radiographs and other digital images – including complex cone-beam radiographs – a patients’ encrypted diagnostic history could require several minutes to view.

I would want to witness the De-ID non-profit professionally investigate whether de-identification indeed offers a cheaper and more secure solution to data breaches from dental offices. I think we all know by now that full disk encryption will never be the answer.

***

Assessment

Still too soon? Give it time. The FBI assures us that more massive data breaches are just around the corner.

Channel Surfing the ME-P

More:

Encrypt or De-identify PHI

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: Darrell Pruitt DDS, de-ID, dental eHRs, Dentists for De-Identification, ePHI, HIPAA, PHI | 3 Comments »

Publishing Impact of the ME-P Website

Posted on February 8, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Who needs it … What for?

[By Ann Miller RN MHA]

What’s the point of publishing your essays, thoughts, comments and articles on this ME-P?

Today, many physicians, FAs and health economic experts still don’t have the potential to express themselves to a large audience. By adding articles to their own blogs, with poor attendance, they deprive a wide audience of the opportunity to familiarize themselves with their works.

That’s why material from our ME-P website is available to all English-speaking inhabitants of the world. Some website owners even visit our web portal to pick up or re-post the best articles to place on their own websites.

Why publish with the ME-P?

All this is interesting, but what is the use of the website to an author? So, here is what you get by publishing with us:

• A unique method of promoting your website, self, financial advisory or medical practice; or ideas. If your essay is really interesting – many others will want to read our related books, white-papers and texts; so you will become well-known among our readers.

• The content of our website is automatically placed on other main web sources via RSS feeds. By this you can attract a wide range of readers – and with little effort. The readers will get acquainted with your thoughts, articles and the personal data you share in your included profile.

• Our website is a great launching pad for new doctors, starting academics, medical practitioners, FAs, CPAs, health economists and fledgling writers. By publishing your articles here, you will be able to raise your prestige among colleagues and ME-P readers.

• You may use any free articles from our website to fulfill your own web project (you must add a link to our original material) via RSS feeds. The probability that someone will be interested in you is increased many times.

• Everyday our website is visited by many people, and their numbers are growing constantly. By adding articles the number of your readers will grow in geometric sequence.

• Once placed on the ME-P, your essay will stay on our website [almost] forever. All published materials [probably] will not be deleted with the lapse of time. This means that many years later – your articles will be still available to everyone.

Assessment

The number of ME-P subscribers and regular visitors is growing rapidly. And, the traffic to our authors’ web sources are growing too. Join us – we welcome all authors who are willing to cooperate with our vision and mission!

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: Experts Invited, iMBA, Inc. | Tagged: ME-P, medical executive post | 1 Comment »

Understanding Stock Market Performance Benchmarks

Posted on February 4, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

An important role in monitoring investment portfolio progress

By TIMOTHY J. McINTOSH; MBA, MPH, CFP®, CMP™ [Hon]

Performance measurement has an important role in monitoring progress toward any portfolio’s goals. The portfolio’s objective may be to preserve the purchasing power of the assets by achieving returns above inflation or to have total returns adequate to satisfy an annual spending need without eroding original capital, etc.

Whatever the absolute goal, performance numbers need to be evaluated based on an understanding of the market environment over the period being measured.

So, here is a brief review for our ME-P readers, doctors and subscribers; after a good market day today.

▲17,666.40 +305.36 +1.76%

Time-weighted Returns

One way to put a portfolio’s a time-weighted return in the context of the overall market environment is to compare the performance to relevant alternative investment vehicles. This can be done through comparisons to either market indices, which are board baskets of investable securities, or peer groups, which are collections of returns from managers or funds investing in a similar universe of securities with similar objectives as the portfolio. By evaluating the performance of alternatives that were available over the period, the investor and his/her advisor are able to gain insight to the general investment environment over the time period.

The Indices

Market indices are frequently used to gain perspective on the market environment and to evaluate how well the portfolio performed relative to that environment. Market indices are typically segmented into different asset classes.

Common stock market indices include the following:

Dow Jones Industrial Average- a price-weighted index of 30 large U.S. corporations.
Standard & Poor’s (S&P) 500 Index – a capitalization-weighted index of 500 large U.S. corporations.
Value Line Index – an equally-weighted index of 1700 large U.S. corporations.
Russell 2000 – a capitalization-weighted index of smaller capitalization U.S. companies.
Wilshire 5000 – a cap weighted index of the 5000 largest US corporations.
Morgan Stanley Europe Australia, Far East (EAFE) Index – a capitalization-weighted index of the stocks traded in developed economies.

Common bond market indices include the following:

Barclays Aggregate Bond Index – a broad index of bonds.
Merrill Lynch High Yield Index – an index of below investment grade bonds.
JP Morgan Global Government Bond – an index of domestic and foreign government-issued fixed income securities.

The selection of an appropriate market index depends on the goals of the portfolio and the universe of securities from which the portfolio was selected. Just as a portfolio with a short-time horizon and a primary goal of capital preservation should not be expected to perform in line with the S&P 500, a portfolio with a long-term horizon and a primary goal of capital growth should not be evaluated versus Treasury Bills.

***

While the Dow Jones Industrial Average and S&P 500 are often quoted in the newspapers, there are clearly broader market indices available to describe the overall performance of the U.S. stock market. Likewise, indices like the S&P 500 and Wilshire 5000 are capitalization-weighted, so their returns are generally dominated by the largest 50 of their 500 – 5000 stocks. Although this capitalization-bias does not typically affect long-term performance comparisons, there may be periods of time in which large cap stocks out- or under-perform mid-to-small cap stocks, thus creating a bias when cap-weighted indices are used versus what is usually non-cap weighted strategies of managers or mutual funds. Finally, the fixed income indices tend to have a bias towards intermediate-term securities versus longer-term bonds.

Peer Groups

Thus, an investor with a long-term time horizon, and therefore potentially a higher allocation to long bonds, should keep this bias in mind when evaluating performance.Peer group comparisons tend to avoid the capitalization-bias of many market indices, although identifying an appropriate peer group is as difficult as identifying an appropriate market index.

Furthermore, peer group universes will tend to have an additional problem of survivorship bias, which is the loss of (generally weaker) performance track records from the database. This is the greatest concern with databases used for marketing purposes by managers, since investment products in these generally self-disclosure databases will be added when a track record looks good and dropped when the product’s returns falter. Whether mutual funds or managers, the potential for survivorship bias and inappropriate manager universes make it important to evaluate the details of how a database is constructed before using it for relative performance comparisons.

***

Channel Surfing the ME-P

The Author

Timothy J. McIntosh is Chief Investment Officer and founder of SIPCO. As chairman of the firm’s investment committee, he oversees all aspects of major client accounts and serves as lead portfolio manager for the firm’s equity and bond portfolios. Mr. McIntosh was a Professor of Finance at Eckerd College from 1998 to 2008. He is the author of The Bear Market Survival Guide and the The Sector Strategist. He is featured in publications like the Wall Street Journal, New York Times, USA Today, Investment Advisor, Fortune, MD News, Tampa Doctor’s Life, and The St. Petersburg Times. He has been recognized as a Five Star Wealth Manager in Texas Monthly magazine; and continuously named as Medical Economics’ “Best Financial Advisors for Physicians since 2004. And, he is a contributor to SeekingAlpha.com., a premier website of investment opinion. Mr. McIntosh earned a Bachelor of Science Degree in Economics from Florida State University; Master of Business Administration (M.B.A) degree from the University of Sarasota; Master of Public Health Degree (M.P.H) from the University of South Florida and is a CERTIFIED FINANCIAL PLANNER® practitioner. His previous experience includes employment with Blue Cross/Blue Shield of Florida, Enterprise Leasing Company, and the United States Army Military Intelligence.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Investing, Portfolio Management | Tagged: •Barclays Aggregate Bond Index, •JP Morgan Global Government Bond, •Merrill Lynch High Yield Index, •Russell 2000, •Value Line Index, CMP™ Course, DJIA, EAFE, S&P 500 Index, Timothy J. McIntosh, Wilshire 5000 | Leave a comment »

Questioning the Wisdom Behind Removing Third Molars

Posted on February 3, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

On Dental Economics?

By Mary Otto

Link: http://healthjournalism.org/blog/2015/01/questioning-the-wisdom-behind-removing-third-molars/

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ’s topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Americans spend about $3 billion annually getting wisdom teeth removed. But some experts are now questioning whether the procedure is always necessary, Elise Oberliesen recently reported in a story for the Los Angeles Times.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Practice Management | Tagged: Mary Otto, third molars, wisdom teeth | 1 Comment »

State Abortion Coverage PP-ACA

Posted on January 31, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Market-Place Plans 2015

By http://www.MCOL.com

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Ethics, Health Economics, Health Insurance | Tagged: HIE abortion coverage, HIE's, PP-ACA, State Abortion Coverage | 3 Comments »

The Initial [Estimated] Costs of Electronic Health Records Systems

Posted on January 30, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

A Decade Look-Back Analysis

[By Richard Mata MD MIS]

Studies by the Organization for Economic Cooperation and Development (OECD) showed that healthcare spending in the U.S. accounted for 15.3% of GDP, which is more than six percentage points higher than the average of 8.9% in other OECD countries. This translates into per capita health spending of $5,635 in the U.S. compared with median costs of $2,280 in other OECD countries.[1]

Suggestions as to the economic drivers of U.S. health spending include excessive service use, administrative complexity, population aging, threats of malpractice litigation, defensive medicine practices, and the lack of patient waiting lists. In further comparisons with the OECD countries, it appears the U.S. overpays for physician visits, hospital stays, and pharmaceuticals.

In 2004

A 2004 OECD paper suggested that one way of improving performance would be to move towards EHR:

Health systems should invest in automated health-data systems, including electronic medical records and systems to automate medication orders in hospitals. Better systems for recording and tracking data on patients, health and health care are needed to make major improvements in the quality of care. [2]

In the U.S., possible savings from the adoption of EHR have been projected to reach $142 billion in physician office visits, and $371 billion in hospital costs over a 15-year period. These projections have not been validated by the experience in other OECD countries where the adoption movement is ahead of U.S. efforts by anything from four to thirteen years.

Nevertheless, the U.S. began its quest to move towards EHR in 2004 as medical software companies began actively marketing their systems, although funding for this endeavor did not come through until 2006.

In spite of this effort, the U.S. has the lowest percentage of physician providers using any EHR compared to Germany, Canada, United Kingdom, and Australia. The U. S. physicians’ low adoption rate involves fear of the loss of productivity, lack of financial incentives, and high startup costs of as high as $40,000 per physician EHR adoption.

When spending on IT implementation in the healthcare system is compared on an international level, the U.S. lags dramatically behind the major OECD countries. The U.S. spends $0.43 per capita compared to a high of $193 in the U.K. This difference is even more dramatic when compared with the German experience, where IT adoption in the healthcare system is almost universal. In thirteen years, Germany has spent $1.88 billion. Their annual per capita cost has been $1.63. The U.S. has reached only 25% of that expenditure so far.

The greatest barrier to adoption of EHR in most OECD countries has been the need to simplify the health insurance contracts payment structures with standard nomenclatures that can be adapted to EHR. The major OECD countries also report that there must be a national adoption of IT standards in the healthcare system as well as a national effort to focus on privacy and confidentiality standards. This assures better coordination of implementation and provides better strategies for adoptions through public incentives and grants.

In the U.S., the five-year costs for a national IT healthcare network have been estimated to be as high as $103 billion in capital and $53 billion in interoperability. Hospital costs for functionality were estimated to be $51 billion, skilled nursing facilities would bear $31 billion of costs, and physician offices would bear $18 billion of the costs. (Anderson, 2006) EHR systems that have been implemented have been used mainly for administrative rather than clinical purposes.

***

In 2005

A 2005 study by Richard Hillestad and colleagues at RAND [3] estimates that implementation of a nationwide EHR network would take about 15 years and cost hospitals about $98 billion and physicians about $17 billion. Over the 15-year period, the average annual cost to hospitals would be $6.5 billion and the average annual cost to physicians would be $1.1 billion (CQ HealthBeat [1], 9/14).

However, if 90% of providers adopted such a network, annual savings would total $81 billion, including $77 billion from improved efficiency and $4 billion from reduced medical errors, the RAND study found. The study estimates that an EHR network would reduce adverse drug events in inpatient hospital settings by 200,000 annually and reduce such events in ambulatory settings by two million annually, saving $1 billion annually in hospitals and $3.5 billion in ambulatory settings.

For hospitals, about 60% of these savings would be from reduced adverse drug events in patients ages 65 and older, while 40% of savings to ambulatory practices from reduced medication errors would be in patients 65 and older (CQ HealthBeat [1], 9/14).

In addition, the study estimates that a national EHR network would save Medicare about $23 billion annually and save private insurers about $31 billion annually. The study projects that the estimated total annual savings of $81 billion would double if providers followed all checkup reminders and other prompts from the system (AP/Las Vegas Sun, 9/14). Currently, about 20% to 25% of hospitals and 15% to 20% of physician offices have EHR systems, according to the study (CQ HealthBeat [1], 9/14).

Assessment

What about today in 2015? How close have these estimates been?

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[1] For details of the report, see http://www.oecd.org/dataoecd/29/52/36960035.pdf.

[2] OECD, Towards High-Performing Health Systems, see http://www.oecd.org/document/26/0,2340,en_2649_37407_31734042_1_1_1_37407,00.htm.

[3] See http://www.rand.org/health/feature/2006/060414_shekelle.html. The report is also discussed in some detail in Neergaard, AP/Las Vegas Sun, 9/14/05. See http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=114707.

Filed under: Information Technology | Tagged: Cost of EHRs, EHRs, Richard Mata MD | 1 Comment »

On Medicare ACOs

Posted on January 28, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Percent of Regionally Covered Populations

By http://www.MCOL.com

Channel Surfing the ME-P

ENTER the Certified Medical Planner™
Enter the CMPs

More Articles on Accountable Care Organizations:

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Health Insurance | Tagged: ACA, ACOs, Medicare ACOs | 6 Comments »

Driven Analytics Coming Soon?

Posted on January 25, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Leveraging connected car technology to provide piece of mind for car owners and effective marketing for Dealers

[By Dr. David Edward Marcinko MBA]

What it is

Driven Analytics uses connected car technology to better target car owners on behalf of dealerships, all the while reducing the anxiety associated with routine car maintenance for drivers.

How it works

Using advanced algorithms and a data transmission device installed on new cars by the dealership, Driven Analytics provides a marketing platform that allows dealers to advertise maintenance services to their customers exactly when they need them.

***

******

***

Sale Disposition

Once a vehicle is sold, Driven Analytics monitors the vehicle’s systems and provides the car owner with actionable maintenance information via a smartphone app, text or email.

Customer Retention

Information includes details about the needed service, as well as discounts and coupons based on their needs. Coupons are designed to bring customers back to the car dealership that sold them their car, increasing customer retention for the dealership and ultimately leading to future sales.

Channel Surfing the ME-P

More Soon: http://www.DrivenInfo.com

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security

Filed under: LifeStyle, Touring with Marcinko | Tagged: Dr. David Marcinko, Driven Analytics, Jaguar XJ V8 | 1 Comment »

What’s New with Renter’s Insurance?

Posted on January 23, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Affordable and Ideal for Future Physicians

[By Thomas A. Mudlowney MSFS CLU AIF® CFP® CMP™]

http://www.SavantCapital.com

Renters insurance can protect you from damage caused by weather events like wind, rain, snow or lightning, as well as fire, vandalism or theft.

Some policies also include liability protection. This would be valuable if someone got injured in your home and sued you; doctor’s are at high-risk for this sort of liability.

Costs

Renters insurance tends to be cheap. For a low payment, usually annually, you can often get replacement coverage for your belongings and living expenses if you are displaced.

This means that you can get money to replace a damaged or stolen item as well as paying for a hotel or alternative rent if you are forced to leave your home because of damage.

Assessment

Renter’s insurance may be ideal for medical residents, fellows and interns etc; as they travel around the country for education and post-graduate training; etc.

Channel Surfing the ME-P

More: http://www.CertifiedMedicalPlanner.org

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Insurance Matters, Risk Management | Tagged: Renter’s Insurance, Thomas A. Mudlowney | Leave a comment »

Overview of Hospital Information Systems Architecture

Posted on January 22, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

On Configurations and Varieties

[By Brent Metfessel MD MIS]

Hospitals can use a variety of configurations for HIS implementation depending on business needs and budgetary constraints.

Staffing needed for these systems can range from a few full-time equivalents (FTEs) per 100 beds for very basic off-site processing systems to 15 or more FTEs per 100 beds for sophisticated systems that attempt to combine several architectures into one system (e.g., combination of client-server systems with mainframe processing). Resource use and customizability tend to vary in tandem; the greater the flexibility of the system to meet unique user needs, the greater the cost outlay for capital and/or additional FTEs.

***

Relationship of Resource Use and Customizability Based on System Architecture Selected

Values range from one (low) to four (high) stars
Architecture	Hospital resource use	Customizability
Off-site processing	*	*
Turnkey systems	**	**
Mainframe systems	***	***
Client-server	***	****

***

The Possibilities

The basic system architecture possibilities are as follows:

Off-site (remote) processing: In this case the hospital contracts with a vendor external to the hospital. The hospital sends data over to the vendor site where the actual processing takes place. When processing is complete, the vendor sends the data back to the hospital, usually in electronic form.

Turnkey systems: A vendor provides the hospital with systems that are “pre-packaged” so that hospital-based system development is minimal. Limited customization of the system is possible using systems analysts or programmers.

Mainframe systems: Most applicable to large hospitals, this configuration is highly centralized. A large and powerful computer performs basically all the information processing for the institution and connects to multiple terminals that communicate with the mainframe to display the information at the user sites. Hospital IT departments usually use in-house programmers to modify the core operating systems or applications programs such as billing and scheduling programs.

Client-server systems: In this configuration one or more “repository” computers exist, known as “servers,” that store large amounts of data and perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use. Both customizability and resource use is high, depending on the desired sophistication.

Many clinical information systems that process data directly related to patient care use this configuration. For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture. Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers. VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.

Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.

Broad Categories

The above architectures are broad categories. Modifications and combinations of the above also exist, such as the use of client-server technology with mainframe systems and the addition of wireless technology, smart phones, laptop PCs and tablets, and various personal digital assistants (PDAs) to supplement the core computing functionality.

In considering the optimal architecture for a hospital, management needs to take into account factors such as size of the institution, desired sophistication of the application, IT budget, and anticipated level of user community involvement.

Assessment

Another important aspect of HIS is the need for integration. Often, different hospital departments have their own stand-alone systems — such as a Laboratory Information System (LIS) and pharmacy systems — that do not communicate with each other. Duplicate data may be kept in separate systems, creating additional work to enter the data multiple times.

In an integrated system, each departmental system communicates with the other systems through either a centralized or decentralized. A computerized physician order entry (CPOE) system, for example, would be much less effective if it did not communicate electronically with the pharmacy system that would process the medication orders.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

NOTES: Resource use refers to the need for FTEs and hospital capital expenditure. Customizability refers to the ability for users to alter the system structure or function to meet the unique needs of the institution.

Filed under: iMBA, Inc., Information Technology | Tagged: graphical user interfaces, GUI, health information technolgy, HIT, hospital information systems, Mainframe systems, Veterans Health Information Systems and Technology Architecture, VistA | 4 Comments »

On Money Withdrawn from Tax-Deferred Accounts before Age 59½

Posted on January 21, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

For Doctors … Un-Locking the Money

By SHIKHA MITTRA; MBA, CFP®, CRPS®, CMFC®, AIF®

http://www.RetireSmartConsulting.com Email: info@retiresmartconsulting.com

Withdrawing funds from a tax-deferred retirement account before age 59½ generally triggers a 10% federal income tax penalty; all distributions are subject to ordinary income tax.

However, there are certain situations in which you are allowed to make early withdrawals from a retirement account and avoid the tax penalty. IRAs and employer-sponsored retirement plans have different exceptions, although the regulations are similar.

IRA Exceptions

The death of the IRA owner: Upon death, your designated beneficiaries may begin taking distributions from your account. Beneficiaries are subject to annual required minimum distributions.
Disability: Under certain conditions, you may begin to withdraw funds if you are disabled.
Unreimbursed medical expenses: You can withdraw the amount you paid for unreimbursed medical expenses that exceed 10% of your adjusted gross income in a calendar year. Individuals older than 65 can claim expenses that surpass 7.5% of adjusted gross income through 2016.
Medical insurance: If you lost your job or are receiving unemployment benefits, you may withdraw money to pay for health insurance.
Part of a substantially equal periodic payment (SEPP) plan: If you receive a series of substantially equal payments over your life expectancy, or the combined life expectancies of you and your beneficiary, you may take payments over a period of five years or until you reach age 59½, whichever is longer, using one of three payment methods set by the government. Any change in the payment schedule after you begin distributions may subject you to paying the 10% tax penalty.
Qualified higher-education expenses: For you and/or your dependents.
First home purchase, up to $10,000 (lifetime limit).

Employer-Sponsored Plan Exceptions

The death of the plan owner: Upon death, your designated beneficiaries may begin taking distributions from your account. Beneficiaries are subject to annual required minimum distributions.
Disability: Under certain conditions, you may begin to withdraw funds if you are disabled.
Part of a SEPP program (see above): If you receive a series of substantially equal payments over your life expectancy, or the combined life expectancies of you and your beneficiary, you may take payments over a period of five years or until you reach age 59½, whichever is longer.
Separation of service from your employer: Payments must be made annually over your life expectancy or the joint life expectancies of you and your beneficiary.
Attainment of age 55: The payment is made to you upon separation of service from your employer and the separation occurred during or after the calendar year in which you reached the age of 55.
Qualified Domestic Relations Order (QDRO): The payment is made to an alternate payee under a QDRO.
Medical care: You can withdraw the amount allowable as a medical expense deduction.
To reduce excess contributions: Withdrawals can be made if you or your employer made contributions over the allowable amount.
To reduce excess elective deferrals: Withdrawals can be made if you elected to defer an amount over the allowable limit.

Assessment

If you plan to withdraw funds from a tax-deferred account, make sure to carefully examine the rules on exemptions for early withdrawals. For more information on situations that are exempt from the early-withdrawal income tax penalty, visit the IRS website at www.irs.gov.

Channel Surfing the ME-P

About the Author

Shikha Mittra has two decades industry experience working with physicians, dentists and top level executives in both public and private sector businesses and foundations; with several awards for her work. She was rated one of the top Financial Planners in the Country from 2006 – 2013. As a Certified Financial Planner®, she is also a Chartered Mutual Fund Counselor®, Chartered Retirement Plan Specialist® and Certified Cash Balance Consultant. Ms. Mittra is Adjunct Professor of Finance and Business, Rutgers University, New Brunswick, NJ; Regional Board Member of the National Association of Personal Financial Advisors NAPFA (2011-2013) Board of Trustees of Financial Planning Association of New Jersey Chapter (2008-2011), Advisory Board Member of the ”Journal of Financial Planning” (2008-2009). Medical Economics listed her as a best financial advisor for doctors in 2012. Ms. Mittra is also an Accredited Investment Fiduciary® helping employers reduce their fiduciary liability by following global fiduciary standards of care in managing their retirement plans.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Retirement and Benefits | Tagged: Money Withdrawn from Tax-Deferred Accounts before Age 59½, Shikha Mittra | Leave a comment »

UNDERSTANDING THE ALLOCATION OF MEDICAL PRACTICE PURCHASE PRICE

Posted on January 20, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Delineation of Various Practice Assets

[By Dr. Charles F. Fenton III JD PC]

The final purchase price of a medical practice upon sale will actually be the amalgamation of various assets of the practice.

These assets include the tangible and intangible assets. The tangible assets include the hard assets (such as computers, treatment tables, chairs and furniture, DME and x-ray machines, etc) and the soft assets (such as Q-tips, paper and cotton balls). The intangible assets will include going concern value, goodwill, and the value of any restrictive covenant.

The parties should delineate the allocation of the purchase price amongst those various categories to reach a mutual best fit with the potential tax obligations. The buyer is the one who should strive to make the allocation fit his needs as best as possible.

Generally, the sale of the assets will be ordinary income to the seller and taxed at the seller’s usual rate. The buyer will be able to depreciate the purchased items. However, the characterization of those assets and the allocated portion of the purchase price will determine how much can be depreciated and over what time period the items can be depreciated.

As a general rule, soft assets can be depreciated fully in the year of purchase. Generally, hard assets can be depreciated over a three to seven year time period, depending upon the class of the asset. Also, under Section §179, a certain dollar amount can be “expensed” or deducted in the year of purchase. The sooner and the faster that the assets can be deducted the less current taxes that the buyer will be required to pay. However, intangible assets generally must be deducted over a 15-year period. This prolongs the tax benefits of any payments characterized as such.

***

Nonetheless, purchase of the assets results in better tax consequences that purchase of the stock of the practice. When stock is purchased, there is no depreciation allowance allocated in the current or subsequent years. Instead, the cost of the stock becomes the “basis” of the buyer in the practice. Any gain or loss from that basis will only have tax benefits or tax consequences in the year that the stock is sold or becomes worthless.

Because of the tax consequences of the characterization of the allocations of the purchase price, it is important that the agreement delineate the portion of the practice price which is allocated to each category. Each party should further agree never to claim a different allocation in any future tax filings.

Assessment

Generally, the soft and hard assets will be valued at their current actual cash value. In no event should the purchase price allocated to the soft and hard assets exceed the actual initial cost that the seller paid for the item. The only exception to the foregoing would be if the sale involved the transfer of an appreciable asset.

More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Practice Management | Tagged: Charles F. Fenton, medical practice sale, medical practice valuation | Leave a comment »

Beware Dubious Insurance Policies for Doctors

Posted on January 19, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Careful Consideration is Required

[By Dr. David Edward Marcinko MBA MBBS] http://www.CertifiedMedicalPlanner.org

The following insurance policies should be carefully considered before purchase, since they may be unnecessary, too expensive, provide only minimal benefits, or be duplicated in your other policies.

The Culprits

Disclosure: I was a licensed insurance agent for more than a decade.

So, the culprits include: credit life or home mortgage insurance (decreasing term), life insurance for children, accident policies for students, hospital indemnity policies, dread disease insurance, credit card insurance, pet health insurance, life insurance for the elderly, funeral insurance, flight insurance, pre-paid legal insurance and most extended warranties on automobiles, televisions, stereos, home computers; other gadgets and the like.

New wave Health 2.0 culprits include: terrorist insurance, cyber security insurance and reputation management policies.

Assessment

On the other hand, the following types of coverage may be important, for some medical professionals, and in selected cases: trip cancellation insurance, termite insurance and flood and earthquake insurance.

Channel Surfing the ME-P

***

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

Filed under: Insurance Matters, Risk Management | Tagged: David Edward Marcinko, Dubious Insurance Policies | 2 Comments »

The Cost of Headaches

Posted on January 18, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Treatment Expenses 1999-2010

By http://www.MCOL.com

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Health Economics | Tagged: headache costs, headache treatments | Leave a comment »

An Educational Niche Resource Supporting Doctors and their Consulting Advisors

Posted on January 15, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

By Eugene Schmuckler PhD MBA MEd CTS [Academic Provost]

www.CertifiedMedicalPlanner.org

About the Medical Executive-Post

We are an emerging online and onground community that connects medical professionals with financial advisors and management consultants.

We participate in a variety of insightful educational seminars, teaching conferences and national workshops. We produce journals, textbooks and handbooks, white-papers, CDs and award-winning dictionaries. And, our didactic heritage includes innovative R&D, litigation support, opinions for engaged private clients and media sourcing in the sectors we passionately serve.

Through the balanced collaboration of this rich-media sharing and ranking forum, we have become a leading network at the intersection of healthcare administration, practice management, medical economics, business strategy and financial planning for doctors and their consulting advisors. Even if not seeking our products or services, we hope this knowledge silo is useful to you.

In the Health 2.0 era of political reform, our goal is to: “bridge the gap between practice mission and financial solidarity for all medical professionals.”

More: Letterhead.iMBA_Inc.

***

Enter the Certified Medical Planners™

There is no certification program, course of study or professional designation for FAs who wish to enter the lucrative financial planning space serving physicians and healthcare professionals.

That’s why the R&D efforts of our governing board of physician-directors, accountants, financial advisors, academics and health economists identified the need for integrated personal financial planning and medical practice management as an effective first step in the survival and wealth building life-cycle for physicians, nurses, healthcare executives, administrators and all medical professionals.

Now – more than ever – desperate doctors of all ages are turning to knowledge able financial advisors and medical management consultants for help. Symbiotically too, generalist advisors are finding that the mutual need for extreme niche synergy is obvious.

But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now!

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Video: http://vimeo.com/84247360

An Interview with Bennett Aikin AIF®

Physician-Investors and the “F” Word

More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

How may we assist you?

← Back

Thank you for your response. ✨

Filed under: "Doctors Only", Career Development, CMP Program, Experts Invited, Health Economics, iMBA, Inc., Investing, Portfolio Management, Practice Management | Tagged: certified medical planner, fiduciary, Financial Planning, Institute Medical Business Advisors, medical practice management | 1 Comment »

On Nursing Assistants

Posted on January 13, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Occupational Injuries for 2013

By http://www.MCOL.com

***

More:

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Risk Management | Tagged: Nursing Assistants | Leave a comment »

2015 Could Be Rough on Stocks?

Posted on January 12, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Here’s Why!

By Daniel Crosby, Ph.D.

“In the short run, the market is a voting machine but in the long run, it is a weighing machine.” – Benjamin Graham

***

Believing as I do in the sage advice of Mr. Graham, I recently set out to quantify my growing unease with the heights obtained by the bull market of the last five-plus years. As you read below, please realize that this is not a forecast or prognostication about what will happen – especially not in the short term. Timing the market on any sort of a short-term basis is a fool’s errand, as is deviating from your specific financial plan on the advice of a stranger.

Consider this more of a “Where are we at?” with respect to market valuations, secure in the knowledge that times of sensational highs and lows tend to be fleeting and that the market has a tendency to mean-revert (that is, become a weighing machine) in the long term. Having now sufficiently hemmed and hawed my way through the legal stuff – let me say that I find the market significantly overvalued and think that some sort of defensive measures will be wise for most investors in the year(s) to come.

The Levels

To corroborate this belief, I’d like to present you with four measures of market value, all at historically high levels. They are:

Shiller Cyclically Adjusted Price to Earnings Ratio (CAPE)

What it is – The work of Nobel Prize winning behavioral economist Robert Shiller, the CAPE is the price/earnings ratio based on average, inflation-adjusted earnings for the previous ten years.

What it says – The CAPE currently sits at 27.2, 63.9% higher than its’ historical mean of 16.6. The CAPE has only crested or approached 27 three other times – 1929, 1997-2000, and 2007.

What it means – The CAPE is a poor predictor of short-term market movements (most everything is), but is much more reliable in speaking to the long term return horizon. Using Shiller’s own expected return formula (taken from value investing site GuruFocus), yields an expected return over the next 8 years of .3%. What is much more informative than a single prediction, however, is considering the range of possible distributions for the longer term, which are as follows:

Scenario Returns for next 8 years from today

Really Lucky 5.2%

Lucky 3%

Unlucky -3%

Really Unlucky -7.5%

It is certainly worth noting that even the “Really Lucky” scenario that might play out over the next 8 years vastly underperforms the market average.

S&P 500 Price to Earnings Ratio

What it is – A simple measure of the price paid for every dollar of earnings among some of the best capitalized and most liquid US securities.

What it says – The current P/E ratio of the S&P 500 is 19.96, well above it’s historical mean of 15.53 and median of 14.57.

What it means – As with the Shiller CAPE, greatly elevated levels of price to earnings have signaled a much lower return environment in the years to come. Ned Davis research has done the math on times when the market has been over or undervalued relative to fundamentals and has discovered the following:

Returns of S&P 500 Percentage Over/Under Valued (3-31-1926 to 5-31-2014)

More than 20% Overvalued (parentheses denote negative returns)

6 months – (.2)

1 year – (3.6)

2 years – (1.6)

3 years – 6.8

More than 20% Undervalued

6 months – 14

1 year – 19.4

2 years – 30.1

3 years – 47.3

Market Performance

6 months – 3.9

1 year – 8

2 years – 16

3 years – 23.6

According to Ned Davis and company, we are now well over 30% overvalued, comfortably above the threshold for the paltry “Overvalued” returns you see above.

*** ***

Wilshire 5000/GDP – aka, “Buffett Valuation Indicator”

What it is – A sort of price to sales marker for the broader economy, once mentioned by Buffett as his favorite measure of market valuation.

What it says – The current market cap/GDP ratio sits at 127.3%, which is more than two standard deviations from the mean value of 68.8%.

What it means – Given historical returns from this significantly elevated level of market cap to GDP, the predicted return for ’15 is .7%, which includes dividends. Drawing on Buffett’s comments, GuruFocus considers a 75 to 90% ratio fair value, with 90 to 115% modestly overvalued and anything over 115% significantly overvalued. The only other time since 1950 that this indicator has broken past two standard deviations of overvaluation is, you guessed it, in the run up to the 2000 crash.

Crosby Irrationality Index

What it is – A measure of market sentiment that is comprised of sub-measures of volatility, valuation, fund flows, momentum and interest rate spreads.

What it says – The CII has spent all of 2014 at a level of elevated optimism just short of mania. While valuations have driven the score up, it has not reached “manic” levels, largely as a result of this having been “the most hated bull run in history.”

What it means – The CII provides one and three year projections based on the current levels of market sentiment. These projections should be understood less as specific predictions and more as headwinds or tailwinds to growth. The current projections are for slightly negative (-1.001) returns this year that persist even three years down the road (-2.6266).

Caveats

As with any measure, those listed above are subject to a number of failings. The CAPE includes data from the Great Recession that skew the results, a number of the measures fail to account for the interest rate environment, and so on. While no single measure is flawless, when so many measures point in the same direction, I believe it is worth taking note.

This information in and of itself is meaningless but should take on meaning as you discuss your individual needs with your advisor (you DO have an advisor, right?).

More:

For very long-term investors, even profound hiccups in the market may be little more than a contrarian buying opportunity. After all, there are more fun and important things to do in life than obsess over financial footnotes.

Assessment

But for those nearing retirement, an unambiguous picture seems to be emerging that returns for the next 8 to 10 years are likely to be depressed in light of the eye-popping returns of the more recent past. Do not act in haste or deviate from your plan if one is in place, but please accept this gentle warning from a concerned party who knows that “this time is never different.”

Even More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Investing, Portfolio Management | Tagged: 2015 Could Be Rough on Stocks?, Buffett, Daniel Crosby, Investing, Robert Shiller, Shiller Cyclically Adjusted Price to Earnings Ratio, Wilshire 5000/GDP | 3 Comments »

Psychopathy and the Medical Profession

Posted on January 9, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Psychopathy Everywhere?

A SPECIAL ME-P REPORT

By Michael Lawrence Langan MD

Psychopathy is present in all professions.

In The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success, Kevin Dutton provides a side-by-side list of professions with the highest (CEO tops the list) and lowest (care-aid) percentage of psychopaths.

Interestingly surgeons come in at #5 among the professions with the highest percentage of psychopathy while doctors (in general) are listed among the lowest [more ……>]

Psychopathy and the Medical Profession

More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Book Reviews, Career Development, Ethics, Risk Management | Tagged: Kevin Dutton, Michael Lawrence Langan MD, Psychopathy and the Medical Profession | 4 Comments »

On Hospital Endowment Fund Management

Posted on January 8, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

A Case Model Example

[By Dr. David Edward Marcinko MBA]

http://www.CertifiedMedicalPlanner.org

Just as the field of medicine continuously changes, so too does the field of endowment management.

Endowment managers continue to increase their knowledge of the science and expand their skill in the art.

However, successful endowment managers will continue to focus on the areas that they can control in order to minimize the risk of the areas they cannot.

***

So, here is a case model to show you how it is done.

[Case Model]

Endowment Fund

***

Invite Dr. Marcinko

***

Channel Surfing the ME-P

More:

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: CMP Program, iMBA, Inc., Investing, Portfolio Management | Tagged: Dr. David Edward Marcinko MBA CMP™, hospital endowments, Investing, Portfolio Management | 2 Comments »

“Crowd-Sourced” Health Predictions for 2015

Posted on January 7, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

The “Gift of Wonder” Flip Book

A SPECIAL ME-P REPORT

[Download and share your free copy]

By Gautam Gulati MD

Gosh. What a year it’s been!

2014 was a wild ride filled with the unexpected, unimaginable, and unusual. And you know what? I wouldn’t have had it any other way.

So what’s in store for 2015?

All the healthcare futurists and pundits are taking stabs at predictions with the odds of a poorly played roulette table. In reality your guess is as good as mine. So I decided to have some fun with it this year and opened up predictions to the community-at-large.

The results are finally in

So, to all those who have inspired me over the years to do the unimaginable, the impossible, and the unusual, I say thank you and offer you a small token of appreciation to stir your sense of wonder and curiosity into the New Year.

Please accept this “Gift of Wonder” – a crowdsourced flip book of the community’s wildest predictions for health in 2015.

I hope you enjoy it and I wish you all an unusual new year full of hope, wonder, and curiosity! Please pass-it-on and pay-it-forward!

With sincere admiration for all my readers and supporters who inspire me everyday.

***

Crowdsourced Health Predictions for 2015 (download and share your free copy)

***

About the Curator

http://drgautamgulati.com/about/
Always #ThinkUnusual.

Channel Surfing the ME-P

More:

About Crowd-Med

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[Foreword Dr. Hashem MD PhD]

Filed under: Experts Invited, Research & Development | Tagged: "Gift of Wonder", Gautam Gulati MD, Health Predictions for 2015, healthcare futurists | 3 Comments »

How employees can acquire hospital securities without cash activity

Posted on January 6, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

On discounted stock-purchase programs

[By Dr. David Edward Marcinko MBA CMP™]

http://www.CertifiedMedicalPlanner.org

To alleviate cash-flow problems of their employees, hospitals who want them to take part in a discounted stock-purchase program may lend the money to the employees to pay any taxes due and any purchase price for the stock.

Full recourse liability

However, it is important that any such loan be subject to a full recourse liability; if the loan is secured by the stock on a non recourse basis, the transaction may be treated as if it were a grant of an option, and thus there would be no transfer of property until the loan is paid.

The rationale for treatment as an option is that if the property drops in value below the amount of the debt, the employee will not pay the debt and walk away from the property, as he would an option. Thus, until the note is paid, no transfer has occurred. This could negate the effect of a Section 83(b) election.

Example:

The following example demonstrates how the use of employer loans, in connection with a Section 83(b) election, can be used to great advantage to an employee.

The employer in the example on Section 83(b) election (above) lends the employee the cash necessary to meet the income tax liability of the $10,000 grant at 30%, or $3,000. The employee gives the employer a promissory note for $3,000, bearing interest at 8%.

Thus, the employee acquires $100,000 worth of employer stock ownership after five years with no out-of-pocket cost at the date of the grant and an interest cost of approximately $1,300, payable over five years.

***

Assessment

Of course, in lieu of making a loan to the employee, the employer can simply agree to give the employee, as a bonus, sufficient cash to cover the tax liability. This is obviously more costly to the employer, as it results in the employee acquiring stock at no out-of-pocket cost.

More:

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Foreword Dyken MD MBA

Filed under: Retirement and Benefits | Tagged: discounted stock-purchase programs, Dr. David Edward Marcinko MBA CMP™, Section 83(b) election | 1 Comment »

Some Academic Views of Financial “RISK” Tolerance

Posted on January 5, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

The Psychological Studies

[By Staff Reporters]

Understanding risk tolerance should not be a guessing game especially when dozens of academic studies can point us in the right direction. Below are 2 important academic studies in the field of risk tolerance.

Measuring the Perception of Financial Risk Tolerance: A Tale of Two Measures – John Gilliam, Swarn Chatterjee and John Grable – 2010

This study compares the explanatory power of a simple question about risk versus a multi-dimensional 13-item questionnaire when trying to understand someone’s risk tolerance. Unsurprisingly the multi-dimensional questionnaire showed better results. The research helps explain why advisors should not be using boilerplate questionnaires.

Link to paper

Insights from Psychology and Psychometrics on Measuring Risk Tolerance – Michael Roszkowski, Geoff Davey, John Grable – 2005

This paper re-enforces previous studies that show risk tolerance can be measured as long as the questionnaire is long enough and asks good questions (doesn’t mix in questions about risk capacity and risk needs).

Link to paper

More:

***

[RISK TOLERANCE v. RISK AVERSION]

***

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Risk Management | Tagged: Financial Risk Tolerance, Measuring Risk Tolerance | Leave a comment »

Doctor – What Do You Say When People Ask, “What Do You Do?”

Posted on January 2, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

The Lesson of Magnets?

[By Vicki Rackner MD]

http://www.CertifiedMedicalPlanner.org

Whether you’re a clinic employee or a private practitioner, you reap the greatest career satisfaction when you see more of your best-fit patients. How do you attract them?

Magnets

Magnets offer an important lesson.

Depending on the orientation, two magnets will either attract or repel each other. The strength of the magnetic force is called the magnetism.

The way you present yourself to would-be patients, referring physicians and other SENDERS–people who send you patients– will either attract them or repel them.

Your goal is to optimize your magnetism so you will attract the attention of people you want to engage.

It begins with hello. They say you only have one chance to make a first impression.

One of the first questions people ask you at a social event is, “What do you do?” To generate referrals, answer in a way that increases the chances of attracting your best-fit patients to your practice. You want your listener to say, “Wow! I know someone who needs to see you!”

***

The Three Answers

There are three ways of answering this question:

By title: You could say, “I’m a rheumatologist” or “I’m a pediatrician.”

The problem with this approach is that your title brings an image to the mind of the listener over which you have little control.

I was at a wedding when a budding Barbara Walters-type started interviewing me. This child said to me, “You’re a doctor.” I nodded. She asked , “What kind of doctor?” I told her, “I’m a surgeon.” She asked “What kind of surgeon?” I told her, “A general surgeon.” Her eyes got big as saucers as she said, “Oh, you’re the person who puts those warning labels on the cigarette packs!”

By diagnostic and therapeutic activity: You could say, “I treat orthopedic injuries.” or “I treat diseases of digestion.”

The problem with this approach is that you’re asking your listener to become a diagnostician. Is their mother’s sub-sternal burning angina or acid reflux?

By result: You could say, “I help women make a gracious transition through menopause.” Or , “I help parents set their kids up for a life of health.” This is the approach with the highest magnetism score.

The most attractive positioning statement answers these three questions:

Whom do you help?
What results do you help people get?
Why is this result important ?

Ideally you craft a simple, memorable, repeatable sound bite. You and your staff members use it. People calling your office repeat it.

Assessment

The most magnetic positioning statements are deceptively simple. Keep working at it. You’ll know when you’ve found yours. You pique the curiosity of your listener. They want to learn more

About the Author

Vicki Rackner MD, author, speaker, ME-P thought-leader and President of Targeting Doctors, helps financial advisors accelerate their practice growth by acquiring more physician clients. She calls on her experience as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and nationally-noted expert in physician engagement to offer a bridge between the world of medicine and the world of business.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Product Details

Filed under: "Doctors Only", Career Development, Practice Management | Tagged: Doctor - “What Do You Do?”, Vicki Rackner MD | 1 Comment »

Laudable Physicians and Shameful Doctors of 2014

Posted on December 31, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Physicians of the Year [Best and Worst‏]

[From Medscape]

Which physicians made us proud this year and which made us cringe? See who made the list and what they did to make the hall of fame (or shame).

Physicians of the Year

[Of Saints and Sinners]

Here is the list according to Medscape.

Link: https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5jb20vZmVhdHVyZXMvc2xpZGVzaG93L3BoeXNpY2lhbnMtb2YtdGhlLXllYXIyMDE0P3NyYz13bmxfZWRpdF9zcGVjb2w=&ac=402&uac=193200AX

More:

Anatomy of a “Best Doctors and Dentists Award” [Marketing] Scam

OIG Most Wanted Fugitives: https://oig.hhs.gov/fraud/fugitives/index.asp?ref=widget

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Ethics | Tagged: Best Physicians, Farid Fata, healthcare fraud, Joshua Baron, Medscape, Mehdi Ali Qamar, Physicians of the Year, Rita McGill, Worst Physicians | 2 Comments »

Where There’s Smoke?

Posted on December 30, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Cytisine versus Nicotine Replacement Therapy

[By staff reporters and Rena Xu]

Doctors and financial advisors know that motivation is often half the battle of behavior change. In the battle against nicotine addiction however, motivation alone may not be enough. Mass media campaigns have helped to raise awareness about the dangers of smoking. We’ve even mentioned them on this ME-P

But, for the majority of smokers who already want to quit, the question remains: how?

Where There’s Smoke: Cytisine versus Nicotine Replacement Therapy

Assessment

We thought the non-healthcare readers of this ME-P might enjoy seeing how a practicing doctor is “detailed”; or informed about a new drug or treatment. In the past, drug “reps” accomplished this task in the office; “eye-2-eye” with folders and flip-charts, etc.

Today; not so much in the digital era!

And, insightful FAs realize the similarity to “wholesalers” in the financial services industry.

More:

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Ethics, Quality Initiatives, Risk Management, Uncategorized | Tagged: Cytisine versus Nicotine Replacement Therapy, nicotine addiction, Rena Xu, smoking addiction | 1 Comment »

About Crowd-Med [Case Review Service]

Posted on December 23, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

***

DR. DAVID EDWARD MARCINKO MBA

[By ME-P Staff Reporters]

CrowdMed Company Background

CrowdMed purports to harnesses the wisdom of crowds to collaboratively solve even the world’s most difficult medical cases quickly and accurately online.

The company offers individuals, insurance providers, and self-insured corporate customers the ability to more quickly diagnose medical conditions and reduce healthcare costs without compromising care.

***

The results speak for themselves?

Since launching publicly in April 2013, CrowdMed has helped solve hundreds of medical cases for patients around the world, and this number is quickly growing as word spreads of the new service. On average, these patients had been sick for 8 years, seen 8 doctors, and incurred more than $50,000 in medical expenses. Despite the difficulty of their cases, more than half of these patients tell us that the crowd successfully brought them closer to a correct diagnosis or cure.

Anyone can submit a case on the CrowdMed website for free (with a $50 refundable deposit), or along with a cash compensation offer to draw more attention to their case. They use incentives to increase participation, and the overall quality and confidence levels of suggested diagnoses. Thousands of people with diverse backgrounds in medicine, health care, education and research have already joined the crowd, and they are continually recruiting new medical and disease experts to help solve cases.

During early testing of the CrowdMed platform, the founder [Jared] submitted his own sister’s [Carly] anonymous case information to the crowd to test the system. More than 300 people participated, evaluating the same symptoms that had been provided to Carly’s original doctors. In just three days, the crowd gave Jared their answer: Fragile X-associated primary ovarian insufficiency

Founded by veteran technology entrepreneur Jared Heyman and based in San Francisco, CA, CrowdMed has received more than $2.4 million in funding from some of Silicon Valley’s top venture capital firms including NEA, Andreessen Horowitz, Greylock Partners, SV Angel, Khosla Ventures and Y Combinator. The company’s advisors have founded and run some the world’s most successful online healthcare companies including WebMD. CrowdMed graduated from Y Combinator’s Winter 2013 class, and was officially launched during the TEDMED 2013 conference in Washington DC.

You can read more about CrowdMed’s leadership team click here.

More:

Assessment

Check em’ out today: http://blog.crowdmed.com

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Ethics, Experts Invited, iMBA, Inc., Research & Development, Touring with Marcinko | Tagged: crowd-med, david marcinko, Wisdom of Crowds | 3 Comments »

The Resurgence of Polygraph “Lie-Detection” in an age of Evidence-Based Medicine

Posted on December 22, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

On Junk-Science in the Medical Profession

A SPECIAL ME-P REPORT

By Michael Lawrence Langan MD

***

If you are ever asked to take a polygraph test–don’t do it. Those involved in the criminal justice system, including lawyers, are largely uneducated in the realm of scientific scrutiny and experimental methodology.

They may not separate science and pseudo-science, and erroneously believe that the polygraph is an accurate scientific instrument. Their interactions are with polygraph examiners who proselytize its use, and they have little or no interaction with scientists, psychologists, and physicians who refute its use.

Refuse to take the test and educate them. Cite the Frye Doctrine, go to the medical library, copy the scientific articles which belie its validity, and present them to whomever requested you to take the test. State that the principles and assumptions underlying polygraphy are not supported by our understanding of psychology, neurology, and physiology.

*** ***

Junk-Science in the Medical Profession: The Resurgence of Polygraph “Lie-Detection” in an age of Evidence-Based Medicine.

Assessment

Then, put the burden of proof on their heads. Tell them to present you with scientific evidence that corroborates the validity of the test. There is simply no rational basis for a machine to detect liars.

More:

Channel Surfing the ME-P

About the Author

Dr. Langan graduated from Oregon Health Sciences University School Of Medicine, Portland Oregon with an MD 21 years ago. He had his residency training of Geriatric Medicine-Internal Medicine at Beth Israel Deaconess Medicine Center and Internal Medicine at St Vincent Hospital Medicine Center.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Ethics, Experts Invited, Risk Management | Tagged: evidence based medicine, Michael Lawrence Langan MD, On Junk-Science in the Medical Profession | 3 Comments »

On Happiness and Discretionary Spending

Posted on December 22, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Can Money But Happiness? [The age old question]

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

Giving away money makes people happy; especially during this holiday season.

Spending money on others makes people happier than spending money on themselves. Spending money on experiences makes people happier than spending money on things.

Does that mean it’s okay to max out your credit card to take all 37 members of your extended family on a cruise for Christmas? Not exactly.

The Research

Yes, research shows that some kinds of spending are linked to happiness. Andrew Blackman cites some of that research in an excellent article, “Can Money Buy Happiness?“, published online November 10 in The Wall Street Journal.

Before you pull out the plastic and start shopping, though, there’s one important point to keep in mind: Any spending to create happiness must come from your discretionary money. This is money we have available to spend for our lifestyle, after we’ve paid all our fixed expenses like rent, loan payments, utilities, retirement contributions, building emergency reserves, insurance premiums, etc.

Discretionary spending can include luxuries or extras like eating out, vacations, gifts, entertainment, and gadgets of all types. But it also can include items that may be necessities or fixed expenses like housing, vehicles, clothing, and food. For example, owning a car is a necessity for most South Dakotans.

However, a 10-year-old Toyota Avalon with 90,000 miles on the odometer, well maintained, can transport you just as effectively as a new model. The older model costs around $10,000; the new one costs around $35,000. The $25,000 difference is discretionary spending.

So, if you want more discretionary money for happiness spending, like giving or experiences, you might choose to spend more frugally on necessities. The other option, borrowing for happiness spending, generally doesn’t work. Research finds that borrowing and debt creates unhappiness that pretty much cancels out the happiness created by the spending.

***

The Psychologist

Elizabeth Dunn, associate professor of psychology at the University of British Columbia and co-author of the book Happy Money, puts it this way in The Wall Street Journal article: “Savings are good for happiness; debt is bad for happiness. But, debt is more potently bad than savings are good.”

In a series of studies, Professor Dunn found that the spending producing the highest amount of happiness was spending on others. She found it wasn’t the dollar amount given but the perceived impact of the gift that mattered. Seeing your money make an impact in someone’s life will produce happiness, even though the gift is very small.

Life Experiences

The impact experiences have on our lives may be the reason we gain more happiness from experiences than from material things. Even though we tend to see tangible things as offering more value, the memories and learning we gain from experiences actually provide more happiness.

Creating experiences can involve the purchase of some stuff. Buying baseball equipment with the intention of playing with your children is one example. Buying a camper or a boat for shared family experiences is another. Of course, buying stuff to be used in creating experiences only creates happiness if you use it. We don’t gain much happiness from sports equipment gathering dust in the basement or a camper abandoned in the back yard.

Pro-Bono Medical Care?

More:

Assessment

After reading this research on the value of spending on giving and experiences, I came up with what might be the ultimate happiness spending scenario: Giving the gift of an experience that includes both the recipient and the giver. While I haven’t found any research validating that hypothesis, I am guessing this may be the perfect happiness two-for-one.

Maybe, if you can afford it out of discretionary money, taking the family on that cruise isn’t such a bad idea after all.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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

Filed under: Book Reviews, Financial Planning | Tagged: Andrew Blackman, Can Money But Happiness?, Elizabeth Dunn, Happy Money, Rick Kahler CFP® | 3 Comments »

Why You’re Probably Using the Wrong [Medical] Dictionary [er…ah…Tchotchkes?]

Posted on December 21, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

About the iMBA Inc, Health Glossary and Administration Dictionary Series … with Book Reviews

[By Staff Reporters]

***

The Health Dictionary Series of Administrative Terms and Definitions

According to James Somers, the way we use an ordinary [medical] dictionary is to look up words, acronyms or initialisms we’ve never heard of; or whose sense we’re unsure of, or need more clarification or spelling direction. Makes sense!

http://jsomers.net/blog/dictionary

But, you would never look up health administration industry specific words or terms in an ordinary medical dictionary — words like HL7, “meaningful-use”, “skinny networks”, managed care organization, hospital cloud computing, patient portal, stop-loss ratio, economic externality, PHO, MPT, SAR-BOX, Fama-French, US Patriot Act, the Treynor index, Asset Pricing Theory, PP-ACA, or ACOs — because all you’ll learn is nothing about what they mean.

Extreme Utility – Not just tchotchkes!

You would need an industry specific dictionary of health administration terms and definitions, right? And, preferably designated as a Doody’s Core Title for credibility, and written by leading experts.

So; try these 3 dictionaries for 10,000 health 2.0 administration terms and definitions, EACH.

Dictionary of Health Insurance and Managed Care
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security

Dictionary Forewords

More:

Forget the Paper Weights

According to Wikipedia, a tchotchke (/ˈtʃɒtʃkə/ CHOCH-ka) is a small bauble or miscellaneous item. The word has long been used by Jewish-Americans and in the regional speech of New York City and elsewhere. Tchotchkes are often given at Chanukkah as part of a game.

The word may also refer to free promotional items dispensed at financial services trade shows, medical conventions, and similar large events. They can also be sold as cheap souvenirs which are sometimes called “tchotchke shops”.

***

Not a Throw-Away

But, if you want to give your hospital, medical clinic or physician clients an advertising item that’s both useful and handy at the same time, try using these dictionaries. Make an IMPACT, and forget those paper-weights.

As a Financial Advisor [FA], or drug rep, you can represent your eagerness to be there for clients and prospects anytime they need your service by having the dictionaries engraved or placing your business card, inside. Plus, they serve as a great addition to a wonderfully decorated medical office or home library. It is an item they will refer to again and again; not just throw-away.

Give one … or all three … they are so reasonably priced.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Dictionary Health Economics and Finance://www.r2library.com/Resource/Title/082610254
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Book Reviews, Glossary Terms, iMBA, Inc. | Tagged: Dr. David Marcinko, health administration dictionaries, Health economics and finance; health insurance and managed care, health IT and security, tchotchke | Leave a comment »

Retirement Planning and Physicians [An Oxymoron]?

Posted on December 19, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Confidence Eluded

By Shikha Mittra MBA CFP® AIF® http://www.feeonlynetwork.com/Shikha-Mittra

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

Retirement Money

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

Debt

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

Shifting Demographics

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

***

***

Physician Statistics

Now, compare and contrast the above to these statistics according to a 2013 survey of physicians on financial preparedness by American Medical Association [AMA] Insurance.

The statistics are still alarming:

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

Assessment

More:

Physicians and Retirement Planning

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Retirement and Benefits | Tagged: AMA, certified medical planner, Employee Benefit Research Institute, Greenwald & Associates, Retirement Confidence Survey, retirement planning, Shikha Mittra | 3 Comments »

About Peer-to-Peer Lending [P2PL]

Posted on December 18, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – How it works?

By TIMOTHY J. McINTOSH; MBA, MPH, CFP®, CMP™ [Hon]

Similar to private equity or venture capital, peer-to-peer lending [aka person-to-person lending, peer-to-peer investing and social lending] is the practice of lending money to unrelated individuals without the benefit a traditional financial intermediary like a bank or financial institution. P2P lending takes place online using various platforms and credit checking tools.

And, it has been in existence for about a decade.

Here are some important characteristics:

P2PL offers a chance to get a lower interest rate than a bank, and gives investors a chance to receive higher returns. Of course, more rewards means more risk.
The two largest P2PL companies are Prosper.com and LendingClub.com. Prosper is older, Lending Club is bigger. Prosper allows bidding on the interest rates you’re willing to provide a loan. Lending Club sets the rates.
Initial returns on Prosper were disappointing because default rates were high; today it is better. For loans originating in the last six months of 2009, both Lending Club and Prosper have a default rate (including currently late loans) of about 13.5%. Using loans from that same time period, Prosper had overall returns of 8.3% and Lending Club had returns of 4.3%.
Since avoiding defaults is an important part of P2PL, investors should buy many lots of notes – for as little as $25 each – which make it relatively easy to achieve broad diversification. Compared to buying index funds and rebalancing once a year, P2PL is more time-consuming as you must pick the loans to invest in individually. Filtering through the offered loans is time-consuming, but can be rewarding. Some investors sell off their notes at a discount once the borrower goes late on a payment for instance, or just because they need their money out of the investment before the term is up.
No matter how closely watched there will be a drag on returns from the cash in your portfolio. It takes time to choose loans acceptable and then for them to be approved. Just as with a mutual fund, this will lower your returns, perhaps as much as 1%.
One of the real benefits of P2PL is a low correlation with other investments, as it is different than other asset classes and ought to perform differently from equity and fixed income investments.

More:

Could This New Billion-Dollar Industry Put Banks Out Of Business?

Assessment

The Author

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Experts Invited, Investing, Risk Management | Tagged: certified medical planner, Lending Club, Peer-to-Peer Lending, Prosper, SIPCO, Timothy J. McIntosh | 1 Comment »

How to Protect Your Vehicle During Long-Term Storage

Posted on December 18, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Hibernation and Your Luxury Car

[By Dr. David Edward Marcinko MBA]

[By Nalley-Lexus Roswell, GA]

An ME-P Special Winter Report

***

I was speaking at a seminar in Pittsburgh PA recently, and I realized how cold it gets there. Moreover, I just learned of an impeding Christmas Eve storm this year.

http://www.msn.com/en-us/weather/topstories/holiday-travel-forecast-major-christmas-eve-winter-storm-to-impact-millions-in-midwest-east/ar-BBgVhts?ocid=iehp

Hence this ME-P.

***

Many car drivers use their vehicle every day, but from time to time – and during the winter – it’s necessary to consider long-term storage. Some physicians however, don’t use their car over the winter months, or need to leave the country for a while on vacation, and this means that it’s time to store away that luxury automobile.

The Storage Steps:

So, if you need to put your car into long-term storage, use the following tips to make sure that your vehicle remains in excellent working order.

Find a good place to store the car

You probably won’t want to leave your car exposed to the elements if you’re not going to use it. Find a sheltered place to keep the car like a garage, shed, or outhouse that can protect the vehicle from the rain. Search local ads for reasonably priced accommodation if you don’t have your own garage. If there’s nothing available, invest in a high-quality weatherproof car cover which will at least protect your car from the weather.

Thoroughly clean the car

Dirt and debris on your car may cause damage, so give the car a thorough clean before storing it. Remove bird droppings or tree sap, which can both damage paint work, and get rid of mud or oil from the wheels and fenders. Apply a good quality wax or sealant to the exterior, as this will protect the paint from any dirt or dust that accumulates in storage.

Fill up your gas tank

Some doctors and other drivers make the mistake of emptying the gas tank when they put their cars into storage.

Follow your car dealer recommendations but use premium if you can. Topping off your gas tank stops moisture from accumulating inside the tank, and will also make sure the seals don’t dry out. Gas is cheap currently, so do not forget this step.

And, consider adding a fuel stabilizer, which may protect the engine from rust and ensure the fuel doesn’t deteriorate [debatable issue].

Charge the battery

Even though you aren’t going to drive the car for a while, it’s a good idea to make sure the battery charge doesn’t run out. If you can’t get somebody to come and visit the car, charge and disconnect the battery completely.

Otherwise, you can buy a battery tender [not trickle charger] that plugs into the electricity supply and continuously gently charges the battery. I have one for my vintage 2000 Jaguar XJ-V8-XL and they are great.

Inflate your tires

It’s always a good idea to inflate your tires to the manufacturer’s recommended pressure. While the car is stationary, the weight of the vehicle pressing on the tires can cause damage, particularly in cold temperatures.

Another solution to consider is removing all four wheels and jacking the car up on all four corners. This is hard work, but it’s worth it for cars that will be stored for a month or more.

***

Protect the car from pests

Cars give rats and mice lots of places to hide and keep warm and these creatures can cause damage if they gnaw at wires. Plug obvious places (like the exhaust pipe) where rodents could get in, and consider laying traps or poison. Make sure you close all the car windows tightly and remove any food or trash from the car that may attract pests.

Don’t cancel your insurance

Your car is a valuable asset. Even though it’s not on the road, it could still suffer damage in storage. If you cancel your insurance, you may have to pay more when you decide to start driving it again. Talk to your insurance company about the options available to you.

More:

Assessment

It’s important to prepare your car properly for long-term storage. Your vehicle is probably worth a lot of money, so protect your investment and make sure your car is just the way you left it when you come back.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: Insurance Matters, LifeStyle | Tagged: Dr. David Marcinko, jaguar XJ-V8-L, Vehicle During Long-Term Storage | 1 Comment »

A Video Presentation by Political Economic Strategist Greg R. Valliere

Posted on December 17, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Chief Political and Economic Strategist at Potomac Research Group Holdings, LLC

Video Pod-Cast Sponsored By

Sharkey, Howes & Javer
720 S Colorado Blvd – So. Tower, Suite 600
Denver, CO 80246

Dear David,

We thoroughly enjoyed our time with those of you who were able to attend our annual Client and Friends Appreciation Event.

Since then, many of you have been requesting to see Greg R. Valliere’s presentation from the event. So, we recently posted the video on our website and would like to invite you, your family and friends to view it. If you missed the event, Greg’s speech was thought provoking, insightful and is well worth a watch.

Enjoy!

SHJ

***

< Click here to watch now >

***

About Greg R. Valliere

Greg R. Valliere is a Chief Political Strategist at Potomac Research Group Holdings, LLC. He coordinates political and economic research. Mr. Valliere focuses on how Congress and the White House shape fiscal policies and monitors the Federal Reserve Board’s interest rate policies. He has over 30 years of experience in covering Washington for institutional investors.

Prior to joining the firm, Mr. Valliere served as Chief Policy Strategist for Soleil Securities Group Inc. He was also employed at Stanford Group Company, Research Division. He previously held key strategy roles at Charles Schwab’s Washington Research Group and The Washington Forum.

Mr. Valliere co-founded The Washington Forum in 1974, serving as Chief Political Analyst and Editor of the group’s publications, and ultimately as Research Director. He began his career in 1972 at F-D-C reports, monitoring the pharmaceutical industry. Mr. Valliere is an exclusive commentator for CNBC, appearing regularly on network programs such as ‘Squawk Box,’ ‘Power Lunch,’ ‘The Closing Bell,’ and ‘Kudlow & Company.’ He earned his Bachelor’s degree in Journalism from The George Washington University.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

Filed under: Investing, Portfolio Management, Videos | Tagged: Greg R. Valliere, Investing, Potomac Research Group Holdings, Sharkey Howes & Javer | Leave a comment »

Pitfalls with Health Care Provider Data

Posted on December 16, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Physician Licensure and Medical Care Quality?

By http://www.MCOL.com

More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Information Technology, Quality Initiatives | Tagged: medical data security?, Pitfalls with Health Care Provider Data, www.MCOL.com | 2 Comments »

A Frank Look at Physician Suicide

Posted on December 15, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Staring Down the Enemy

[By Staff Reporters]

We have skirted around this issue before on the ME-P; as well as our related physician-executive leadership, risk-management and career development essays in our books and print publications.

But now, we look directly into the face of the terminal demon/beast.

So, her is a powerful look at the growing problem of physician suicide by two leading physicians and expert-bloggers Michael Lawrence Langan MD; an ME-P “thought-leader” – as well as a video by Pamela Wible MD.

***

Physician Suicide

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Career Development, Ethics | Tagged: Michael Lawrence Langan, Pamela Wible, physician suicide | 6 Comments »

About the INSTITUTE OF MEDICAL BUSINESS ADVISORS, Inc.

Posted on December 14, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

About

INSTITUTE OF MEDICAL BUSINESS ADVISORS, Inc.

***

The Institute of Medical Business Advisors, Inc provides a team of experienced, senior level consultants led by iMBA Chief Executive Officer Dr. David Edward Marcinko MBA CMP™ MBBS [Hon] and President Hope Rachel Hetico RN MHA CMP™ to provide going contact with our clients throughout all phases of each project, with most of the communications between iMBA and the key client participants flowing through this Senior Team.

iMBA Inc., and its skilled staff of certified professionals have many years of significant experience, enjoy a national reputation in the healthcare consulting field, and are supported by an unsurpassed research and support staff of CPAs, MBAs, MPHs, PhDs, CMPs™, CFPs® and JDs to maintain a thorough and extensive knowledge of the healthcare environment.

The iMBA team approach emphasizes providing superior service in a timely, cost-effective manner to our clients by working together to focus on identifying and presenting solutions for our clients’ unique, individual needs.

The iMBA Inc project team’s exclusive focus on the healthcare industry provides a unique advantage for our clients. Over the years, our industry specialization has allowed iMBA to maintain instantaneous access to a comprehensive collection of healthcare industry-focused data comprised of both historically-significant resources as well as the most recent information available. iMBA Inc’s specific, in-depth knowledge and understanding of the “value drivers” in various healthcare markets, in addition to the transaction marketplace for healthcare entities, will provide you with a level of confidence unsurpassed in the public health, health economics, management, administration, and financial planning and consulting fields.

iMBA Inc’s information resources and network of healthcare industry textbook resources enhanced by our professional consultants and research staff, ensure that the iMBA project team will maintain the highest level of knowledge regarding the current and future trends of the specific specialty market related to the project, as well as the healthcare industry overall, which serves as the “foundation” for each of our client engagements.

Ann Miller RN MHA

www.MedicalBusinessAdvisors.com

Financial Advisor Education Letterhead CMP™

Solicitation Letterhead.iMBA, Inc

Sample iMBA Engagements

iMBA Seminar Topics

***

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

***

Filed under: Career Development, Financial Planning, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Investing, Portfolio Management, Professional Liability, Recommended Books, Retirement and Benefits, Risk Management | Tagged: career planning, David Edward Marcinko, Financial Planning, Health Economics, Investing, Portfolio Management, practice administration, Practice Management, practice valuation | 1 Comment »

Understanding “Meaningful Use” Attestation Numbers for 2014

Posted on December 13, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Providers versus Hospitals

By CMS

Assessment

So, what do the hospitals know – that the doctors do not?

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Information Technology | Tagged: CMS, EHRs, HIPAA, HIT, meaningful use | 6 Comments »

Introducing the International Institute of Research Against Counterfeit Medicines

Posted on December 12, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Launching an e-learning program on the counterfeiting of medicines

[By staff reporters]

Because with every passing day, men, women and children, your loved ones, even yourself, can be victims of counterfeit medicines.

Thousands of lives are at stake; especially with drugs produced in China. That is why the International Institute of Research Against Counterfeit Medicines (IRACM) is launching an electronic learning program on the counterfeiting of medicines.

***

OBJECTIVES OF THE CAMPAIGN

• To promote and support the fight against trafficking in counterfeit medicines.
• To protect the health of patients by training and informing people.

Today, to fulfil these front line health objectives, IRACM needs you and your network to disseminate this e-learning on your digital media.

Why Counterfeit Medicines?

Check out the image below; need we say more?

***

Channel Surfing the ME-P

And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Assessment

Check em’ out today.

Tell us what you think?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Drugs and Pharma, Ethics | Tagged: http://www.iracm.com/en/, IRACM, the International Institute of Research Against Counterfeit Medicines | 2 Comments »

Do You Have a Taxable Investment Account – Doctor?

Posted on December 11, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Is it Time to Harvest?

[By Lon Jefferies MBA CFP®]

Tax harvesting is the process of selling assets for the purpose of creating either long-term capital gains or losses to minimize your tax bill. This procedure is usually conducted near the end of a calendar year.

While many people are familiar with the concept of tax loss harvesting, fewer physicians or clients are familiar with the more recently developed process of tax gain harvesting. Between these two procedures, virtually everyone with a taxable (not tax-advantaged) investment account should make adjustments to their portfolio before the year ends.

Who Qualifies For the 0% Capital Gains Rate?

First, it is important to understand that capital gains (the growth on investments within a taxable, non retirement investment account) are taxed differently than ordinary income (wages, pensions, Social Security, IRA distributions, etc.). While short-term capital gains (recognized on the sale of assets held less than a year) are essentially considered ordinary income, long term capital gains, or recognized gains on assets held more than a year, are taxed at advantageous tax rates. While ordinary income tax rates range from 10% to 39.6%, capital gains tax rates range from 0% to 20%.

Second, it is crucial to understand what enables a taxpayer to qualify for the 0% capital gains rate. If a taxpayer is in the 10% or 15% ordinary income tax bracket, they qualify for the 0% long-term capital gains rate.

For a married couple filing jointly, the 15% tax bracket ends at $73,800 of taxable income ($36,900 for single taxpayers). Thus, if a married taxpayer has a taxable income (which includes long-term capital gains but is also after deductions and exemptions) of less than $73,800, all their long-term capital gains will be tax free. If the taxpayer is in a tax bracket anywhere between 25% and 35% (taxable income of $73,800 and $457,600, or between $36,900 and $406,750 for single tax filers), they will pay long-term capital gains taxes at 15%. Only those in the top tax bracket of 39.6% (married taxpayers with a taxable income over $457,600 and single taxpayers with taxable income over $406,750) will pay capital gains taxes at 20%.

Tax Loss Harvesting

During the calendar year, assets have been purchased and sold in most taxable investments accounts. The sale of an asset creates a net gain or loss, both having tax implications. Investors should have an understanding of what their long-term capital gains tax rate will be so they can determine whether a taxable gain or loss is preferable.

For instance, an individual who does not qualify for the 0% capital gains tax rate may wish to minimize the amount of taxable gains they recognize during the year, which would reduce their tax bill. If the investor currently has a net long-term capital gain (which is probable after the strong year the market had in 2013), then it is likely worthwhile to sell any assets in the portfolio that are currently worth less than the investor’s purchase price. This tax loss harvesting would reduce the net gain recognized during the year and lower the investor’s tax bill.

In some cases, by taking advantage of all potential losses within a portfolio an investor has the ability to negate all capital gains created during the year, completely eliminating their capital gains tax bill. Further, the IRS will allow investors to recognize a net capital loss of up to a -$3,000 per year. This -$3,000 loss can be used to lower the taxpayers ordinary income. This is particularly advantageous in that the capital loss reduces a type of income that is taxed at higher tax rates.

Harvesting Gains

Harvesting gains from a taxable portfolio is a more recently developed concept. Once the 0% long-term capital gains tax rate became a permanent part of the tax code with the passing of the American Taxpayer Relief Act of 2012 (signed January 2nd, 2013), in some scenarios it began making sense to recognize long-term capital gains on purpose to potentially avoid a larger tax bill in the future.

Suppose a taxpayer’s taxable income is consistently $65,000 a year. Additionally, suppose our hypothetical taxpayer won’t withdraw funds from his taxable account during the next few years, but may need a large lump sum distribution five years down the road. Recall that the 0% capital gains rate ends when a married taxpayer’s taxable income (which includes long-term capital gains) exceeds $73,800. Consequently, this hypothetical taxpayer has the ability to recognize $8,800 ($73,800 – $65,000) in long-term capital gains every year without increasing his tax bill. If this $8,800 in gains is recognized every year by simply selling and immediately repurchasing appreciated assets, he would raise the cost basis of his investment by $44,000 ($8,800 gain recognized annually for five straight years). He could then sell and withdraw that $44,000 without creating a tax liability.

Alternatively, if the investor does not harvest gains during the years when no distributions are taken, withdrawing $44,000 of gains five years down the road would create a sizable tax bill. He would still be able to recognize $8,800 of gains tax free in the year of distribution, but the remaining $35,200 of gains would cause his taxable income to be over the $73,800 limit, eliminating access to the 0% capital gains rate. That $35,200 would be taxed at the 15% capital gains rate, creating a federal tax bill of $5,280. With proper planning, this significant tax bill can be avoided.

***

The Bottom Line

Tax harvesting has no purpose in tax-advantaged retirement accounts such as IRAs and 401ks because all distributions from these accounts are taxed as ordinary income. However, taxable individual or trust investment accounts can almost certainly benefit from tax harvesting. Speak to your accountant and financial planner to understand whether capital gains or losses are desirable for you this year and determine the amount of taxable gains already recognized. This will help you determine what type of harvesting should take place.

Tax harvesting can be a difficult and confusing concept. However, a competent financial planner who utilizes this procedure within your taxable investment account can significantly lower your tax bill. Speak to your adviser to ensure you are reaping the tax benefits available to you.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

Filed under: Investing, Portfolio Management, Taxation | Tagged: capital gains, Investing, Lon Jefferies MBA CFP®, Tax harvesting | 3 Comments »

About “OOP” National Health Care Expenses

Posted on December 10, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

Detailing “Out-Of-Pocket” Expenses not included in Federal NHE Calculations

By http://www.MCOL.com

More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Health Economics, Health Insurance | Tagged: Expenses not in Federal NHE Calculations, Out-Of-Pocket Expenses | 4 Comments »

My Stock Market Forecast for 2015

Posted on December 9, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

All Forecasts Will Be Wrong

[By Lon Jefferies MBA CFP®]

The investment media is a rare industry in which professionals are rewarded for making bold projections but never punished for being wrong. The more outlandish a pundit’s forecast the more attention it receives.

Yet, surprisingly little consideration is given to how accurate the prediction turns out to be.

At the beginning of 2014, there were some widely-accepted expectations regarding the investment environment.

Let’s review those predictions and analyze how precise they really were.

Interest Rates

In a study conducted by Bloomberg at the beginning of the year, all 72 economists surveyed predicted higher interest rates and falling bonds prices in 2014. Consequently, investors were questioning whether they should reduce or eliminate the bond portion of their portfolios until the rate increase occurred.

So, have we experienced this rise in interest rates?

On January 1st, 2014, the yield on the 10-year Treasury note was 3 percent. On November 13th, the yield on the same note was 2.35 percent. That’s right — interest rates actually decreased significantly during the year. As a result, intermediate U.S. government bonds (ticker – IEF) produced a return of 7.38% during the year. Not bad for the conservative portion of your portfolio!

Quantitative Easing

The most widely promoted fear among forecasters was that the phasing out of the Federal Reserve’s quantitative easing (QE) program would diminish stock returns. Prognosticators worried that the Fed would lower the amount of loans the government would buy from commercial banks, thus reducing the amount of money available for new businesses to borrow leading to less innovation and the creation of fewer jobs.

But, was the reduction of quantitative easing a legitimate fear? In fact, this possibility came to fruition. In December of 2013, the Federal Reserve was buying $85 billion of financial assets from commercial banks each month. The Fed reduced this amount during every meeting it held this year, finally eliminating the action completely in October.

However, the elimination of Quantitative Easing did not have a negative impact on the unemployment rate, which declined from 6.7% in January to 5.8% in October. Further, the S&P 500 has gained 12.31% year-to-date (as of 11/13/14). Clearly, fading out the Quantitative Easing program didn’t have the negative impact on stocks that many pundits expected.

Increased Volatility

Another widely held viewpoint at the beginning of the year was that 2014 was likely to be more volatile than anything experienced in 2012 or 2013. There was talk about valuations and P/E ratios being too high, concern about the war in Ukraine (ISIS wasn’t even in the headlines yet), and endless noise about unfavorable weather patterns impacting the market.

So, has 2014 been a wild ride? Since 1929, the S&P 500 has experienced either a rise or a decline of more than 1% during 23% of trading days. In 2014, the S&P 500 moved more than 1% only 15% of the time. Less movement equates to less volatility, so again forecasters were inaccurate.

2015 Forecasts

Bloomberg News recently published a story titled Predictors of ’29 Crash See 65% Chance of 2015 Recession, in which the grandson of a prognosticator who luckily forecasted the Great Depression is still getting attention for a guess his grandfather made 85 years ago. If giving credence to forecasters isn’t ridiculous enough, suggesting there is a gene for forecasting is insane!

The article doesn’t mention that the same grandson made similar headlines with the same forecast in both 2010 and 2012; of course, those predictions did not work out so well. You will start hearing many 2015 projections soon, so pay no heed.

***

Ignore the Pundits

The most significant lesson inherent in these numbers is that market expectations are essentially useless. Despite their abysmal track record, the news media loves forecasters because they capture attention and fill space. Unfortunately, pundits making projections are rarely held to their inaccurate forecasts and are allowed to continue making a living showing they have no greater knowledge than the average investor.

Of course, this is not to say that interest rates will never rise, that bond values will never decline, and that the market won’t return to the roller coaster it is. In fact, all those things are certain to happen. Unfortunately, anyone who contends to know “when” likely doesn’t actually know anymore than you or me. For this reason, having and sticking to a diversified investment strategy that coincides with a detailed financial plan is the most probable path to financial success.

More:

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

Filed under: Investing, Portfolio Management | Tagged: Bloomberg News, emerging markets, great depression, Lon Jefferies MBA CFP®, market forecasting, Quantitative Easing, stock markets | 5 Comments »

2014 – A Near Record Year for IPOs

Posted on December 8, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

A 2014 Wrap-Up

[By Inside the Ticker]

***

More:

Assessment

http://www.msn.com/en-us/money/inside-the-ticker/graphic-a-very-big-year-for-ipos/ss-BBfECz7?ocid=iehp#image=2

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

***

Filed under: Investing, Portfolio Management | Tagged: Famous IPOs [Including WebMD], Initial Public Offering, IPOs | 6 Comments »

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