Dr. David Edward Marcinko MBA MEd CMP™

IRS Offers New Simplified Home-Office Deduction

Posted on August 26, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Effective January 1, 2013

By Andrew D. Schwartz CPA

The IRS has introduced a simplified option for many home-based businesses and some home-based workers to use to figure their deductions for the business use of their home, effective January 1, 2013.

The new optional deduction, capped at $1,500 per year based on $5 a square foot for up to 300 square feet, will reduce the paperwork and recordkeeping burden on small businesses by an estimated 1.6 million hours annually.

An Easy Path

The new option provides eligible taxpayers an easier path to claiming the home office deduction. Currently, they are generally required to fill out a 43-line Form 8829, often with complex calculations of allocated expenses, depreciation and carryovers of unused deductions. Taxpayers claiming the optional deduction will complete a significantly simplified form.

No Allocation

Though homeowners using the new option cannot depreciate the portion of their home used in a trade or business, they can claim allowable mortgage interest, real estate taxes and casualty losses on the home as itemized deductions on Schedule A of their tax return. These deductions need not be allocated between personal and business use, as is required under the regular method.

Business expenses unrelated to the home, such as advertising, supplies and wages paid to employees are still fully deductible.

Restrictions

Current restrictions on the home office deduction, such as the requirement that a home office must be used regularly and exclusively for business and the limit tied to the income derived from the particular business, still apply under the new option.

Assessment

The new simplified option is available starting with the 2013 return which most taxpayers file early in 2014.

Conclusion

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Filed under: Taxation | Tagged: Andrew D. Schwartz CPA, Home-Office Deduction, tax | 2 Comments »

Ground Breaking Book Explains Why Accountable Care Organizations May Be the Answer the Health Care Industry Has Been Seeking!

Posted on August 23, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Book Reviews, with Testimonial, by ME-P Founding Publisher Dr. David Edward Marcinko MBA CMP®

PRESS RELEASE!

August 23, 2013 – CRC Press / Productivity Press is pleased to announce the publication of Accountable Care Organizations: Value Metrics and Capital Formation authored by nationally recognized healthcare expert, Robert James Cimasi. This dynamic book explores the historical background and evolution of the highly anticipated ACO model which is rapidly expanding since its adoption as part of the Affordable Care Act, commonly referred to as Obama Care. The book describes the basis for the development of value metrics and capital formation analyses that are foundational to assessing capacity for change in healthcare organizations considering the development of an ACO, as well as, the current efficacy of the model.

Book Reviews

“Bob Cimasi has done it again. As a thought leader in contemporary healthcare matters, his new book, Accountable Care Organizations: Value Metrics and Capital Formation, establishes and explains, in plain terms, the operational and financial DNA and genomic construct and understanding for any organization considering the development and operations of an ACO…a must read and resource for any healthcare industry executive.”

-Roger W. Logan, MS, CPA/ABV, ASA, Senior Vice President of Phoenix Children’s Hospital

“Accountable Care Organizations is the first comprehensive text on capital formation and value metrics for this new healthcare business model… I can think of no one more qualified to write it than Bob Cimasi at Health Capital Consultants … it is destined to become a classic work … read, review, refer, and profit by this valuable resource.”

-Dr. David Edward Marcinko MBA CMP® of the Institute of Medical Business Advisors, Inc Atlanta, GA

“As both a healthcare management educator and as a consultant who has worked on health and professional services transactional advisory work for many years, I applaud the ambitious undertaking of Bob Cimasi’s latest book, Accountable Care Organizations: Value Metrics and Capital Formation. Cimasi’s description of the complex history and evolution of the US health system provides a useful framework for students and professionals who may lack a detailed background in the field. This should help them better understand both how we have arrived at the ACO approach, and how it might work. This addressing capital and valuation information is also uncommon in the literature on ACOs. It should provide a valuable contribution to the field, especially given that a some surveys of healthcare leaders have pointed to access to capital and to a lesser but still important degree, agreement on valuation, as concerns as they consider acquisitions, mergers, and other affiliations towards forming/joining ACOs or similar organizations to help deal with the changing reimbursement and competitive environment.”

-R. Brooke Hollis, MBA/HHSA, Executive Director, Sloan Program in Health Administration, Cornell University and Managing Member, Hollis Associates Acquisition Advisors, LLC

The book examines the Four Pillars of Value in the Healthcare Industry: regulatory, reimbursement, competition and technology in addressing the value metrics of ACOs, including requirements for capital formation, financial feasibility, and economic returns. It focuses the discussion of non-monetary value on a review of aspects of population health within the context of such objectives as improved quality outcomes and access to care. It also examines the positive externalities of the ACO model, including results for third parties outside the basic construct of the ACO contracts shared savings payments. The potential role and opportunities for consultants in assisting their provider clients in the consideration, development, implementation, and operation of an ACO are also discussed.

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Accountable Care Organizations

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About the Author:

Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP® is CEO of Health Capital Consultants (HCC), a nationally recognized healthcare financial and economic consulting firm headquartered in St. Louis, Missouri, since 1993. Cimasi has more than 30 years of experience in serving clients in over 45 states, with a professional focus on the financial and economic aspects of healthcare service sector entities including feasibility analysis and forecasting; valuation consulting and capital formation services; healthcare industry transactions including joint ventures, mergers, acquisitions, and divestitures; certificate-of-need and other regulatory and policy planning consulting; and, litigation support and expert testimony.

Mr. Cimasi has served for many years as faculty in both an academic and professional basis for continuing education courses, and he has provided testimony before federal and state legislative committees and has served as an expert witness in numerous court cases. He is a nationally known speaker on healthcare industry topics, the author of several books, including A Guide to Consulting Services for Emerging Healthcare Organizations (John Wiley & Sons, 1999), The U.S. Healthcare Certificate of Need Sourcebook (Beard Books, 2005), The Adviser’s Guide to Healthcare (AICPA, 2010), and Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services (John Wiley & Sons, 2013), as well as numerous chapters, published articles, research papers and case studies, and is often quoted by healthcare industry press.

UPDATE:

Top Five Videos Trending in The Last Month On HealthShareTV

Source: HealthShareTV

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Filed under: Book Reviews, CMP Program, Health Economics | Tagged: Accountable Care Organizations, ACO, ACOs, certified medical planner, Cimasi, CMP™ Course, Health Capital Consultants LLC | 5 Comments »

How a Doctor’s Job Seach May Lower Taxes

Posted on August 22, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Same line-of-work Tax Tips

By Andrew D. Schwartz CPA

Summer is often a time when doctors and other people make major life decisions. Common events include buying a home, getting married or changing jobs; especially for hospitalist physicians.

If you’re looking for a new job in your same line of work, you may be able to claim a tax deduction for some of your job hunting expenses.

The Tax Tips

Here are seven things the IRS wants you to know about deducting these costs:

1. Your expenses must be for a job search in your current occupation. You may not deduct expenses related to a search for a job in a new occupation. If your employer or another party reimburses you for an expense, you may not deduct it.

2. You can deduct employment and job placement agency fees you pay while looking for a job.

3. You can deduct the cost of preparing and mailing copies of your résumé to prospective employers.

4. If you travel to look for a new job, you may be able to deduct your travel expenses. However, you can only deduct them if the trip is primarily to look for a new job.

5. You can’t deduct job search expenses if there was a substantial break between the end of your last job and the time you began looking for a new one.

6. You can’t deduct job search expenses if you’re looking for a job for the first time.

7. You usually will claim job search expenses as a miscellaneous itemized deduction. You can deduct only the amount of your total miscellaneous deductions that exceed two percent of your adjusted gross income.

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Conclusion

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Filed under: Taxation | Tagged: Andrew D. Schwartz CPA, IRS, Job Seach, Same line-of-work Tax Tips, taxes | 1 Comment »

Passive Investing with a “Steroid Twist”

Posted on August 21, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Core and Satellite Philosophy

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

“Keep your hands away from your investments and back away from the market reports.”

That pretty much sums up passive investing, the approach I have practiced for years. I’ve preached it for years, too, and did so in a recent column. The wisest way to build wealth is by investing in a variety of asset classes, setting target allocations in each asset class, and then taking your hands off except to periodically rebalance to the original target allocations.

For most of us, including doctors, the best way to invest in an asset class is to give our funds to a mutual fund manager who will purchase the appropriate investments. Mutual fund managers have a choice of actively or passively managing the money you give them to invest.

Passivity

Passive managers try to match market indexes, which are groups of companies representing a cross-section of a certain type of investment. The most popular index in the world is probably the S&P 500 index, which consists of the largest 500 companies in the United States. Another popular index is the Dow Jones Industrial Index which is made up of 30 companies. When we consider the US has almost 10,000 companies, we can quickly see that many indexes represent just a segment of the entire market.

Research indicates it is very hard to beat an index, especially with stocks, bonds, real estate investment trusts, and commodities. I prefer to keep about 80% of my investment portfolio in a broad variety of passively managed investments in these asset classes.

Timing or Strategy?

Where do I put the other 20%? In mutual funds with active managers who try to earn returns similar to stocks and bonds and that are not correlated to either.

This may seem to make me a hypocrite. I’ve been saying for years not to be a market timer, and now here I am suggesting you do just the opposite with a portion of your portfolio. Not hypocrisy at all. What I’ve preached for many years is that neither you nor I have any business timing investments. That doesn’t mean no one should ever do it.

So, is it timing or strategy?

Core and Satellite Philosophy

It can be wise to put a small portion [satellite] of our portfolios [core] into various investment strategies with active managers. The key is to find managers who have a disciplined approach that eliminates emotion and who have long-term track records of success. These strategies include managers who attempt to time markets by shorting stocks they think will decline in value and buying stocks they think will rise.

It also includes one investment strategy, managed futures, that I call “timing on steroids.”

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Rationale

My reason for including some actively managed funds is to have part of my investment portfolio that is not correlated to stocks. I want these investments to have a positive return over a long period, but also to move in opposition to other major asset classes, especially stocks. So when stocks are up, I am not fazed if my managed futures are down. And, when stocks are down, I am thankful when my managed futures are up. If both asset classes earn 6 to 9% over a long period of time, I’m happy.

So, call it … passive investing with a steroid twist.

Assessment

So I stand by my commitment to passive investing. It’s based on research suggesting that timing the markets is a loser’s game.

Yet part of passive investing is having a fully diversified portfolio. This includes having a small portion—20% or less—in mutual funds with disciplined, successful active managers. My job is to research and find those managers. Then it’s okay to let them time their hearts out. I just make sure I don’t try to time the timers.

More:

Conclusion

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Filed under: Interviews, Portfolio Management | Tagged: active investing, Core and Satellite Philosophy, passive investing, Rick Kahler CFP® | 1 Comment »

The 2013 Tax Hike Means it’s Time for Doctors to Revisit Available Tax Breaks

Posted on August 20, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Mid-Year Tax Round-Up for Medical Professionals

By Andrew D. Schwartz CPA

The American Taxpayer Relief Act of 2012 rescued the vast majority of Americans from the tax edge of the “fiscal cliff” and the steep tax increases scheduled to kick in as the Bush tax cuts expired at the end of 2012.

This legislation, however, did not entirely spare high-income earners; like some doctors and other medical professionals.

Key Provisions of ATRA 2012

Here are the key provisions of the Act passed on January 1, 2013 and strategies you can implement to minimize your tax burden under these new rules:

Threshold for 39.6% Bracket:

The American Taxpayer Relief Act raised the top federal marginal income tax rates from the 35% max in place since the Bush 2003 tax cuts to 39.6% for taxable income exceeding the following thresholds:

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Filing Status	Tax Bracket Starts (at taxable income)
Married Filing Joint	$450k
Head of Household	$425k
Single	$400k
Married Filing Separate	$225k

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Increased Tax Rate on Long-Term Capital Gains and Corporate Dividends

The top tax bracket was not the only increase to federal income taxes. For long-term capital gains and qualified corporate dividends, the tax rate increases by one-third – from 15% to 20% – based on the same taxable income thresholds as apply the 39.6% bracket, effective 1/1/13.

Higher Medicare Taxes:

There are two new increases to the Medicare tax. One upped the Medicare tax that you’ll pay on your earned income from 1.45% to 2.25% for single individuals earning more than $200k or married couples whose combined earned income exceeds $250k.

Keep in mind that your employer will match Medicare taxes withheld from your pay at a rate of 1.45%, so the federal government now gets 3.8% on your earned income that exceeds the applicable threshold.

New 3.8% Medicare Tax On Unearned Income:

The new 3.8% Medicare tax on unearned income kicks in at the $200k of Adjusted Gross Income (AGI) for single individuals and $250k of AGI for married couples. Unearned income includes interest, dividends, capital gains, annuities, royalties, and rents. This is the first time that unearned income has ever been subject to Medicare taxes.

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Strategies to minimize your tax bill in light of these new rules:

Plan Your Revenue & Expenditures

Most healthcare professionals are on the “Cash Basis” of accounting, which means that:

Income is reported when fees are collected
Deductions are claimed when bills are paid

By planning your billing and your expenditures, especially as the year winds down, you might be able to flatten out profit fluctuations from year to year, which could help minimize the portion of your income that will be taxed at higher rates.

Invest in retirement

Always a good idea, socking away money in retirement accounts is even more valuable now when it means saving 39.6% in federal income taxes and allowing your investment to grow tax-deferred. You should also consider rebalancing your portfolio, putting less tax-efficient investments in your tax-advantaged accounts while keeping index funds, ETFs, non-dividend paying stocks, and tax-exempt bonds and bond funds in your taxable accounts.

Contribute to a 529 plan

With investment income taxes higher in 2013, take the opportunity to invest in a 529 plan to begin planning for your child’s college education. All earnings in a 529 plan are tax-free, provided that the funds are used to pay for college. And many states even allow you to deduct a 529 contribution on your state tax return. The annual maximum contribution into these tax-advantaged college savings plans is $14,000 per child per year for Gift Tax purposes (or $28,000 for spouses splitting gifts), however, you can frontload five year’s worth of contributions all in one year. Don’t forget to file a Gift Tax Return if you contribute more than $14k ($28k if married) into 529 accounts in one calendar year on behalf of a child.

Purchase needed equipment and machinery for your practice

With the fate of the $500K Section 179 deduction up in the air past 2013, it might be in your best interest to buy big-ticket equipment and machinery during the year to take advantage of the immediate deduction.

Employ your spouse and children

If there’s extra work to be done at your practice, putting your children and spouse on your payroll can be a great way to shift income to a lower tax bracket (in your child’s case) and enable your spouse to put away the maximum ($17,500 for 2013) pre-tax into a 401k retirement fund. Moreover, your child can fund a Roth IRA with the money they earn, up to a maximum of $5,500 in 2013.

Establish a Health Savings Account

If you have a qualified high-deductible health insurance plan, take advantage of the opportunity to pair it with a Health Savings Account (HSA). Contributions to an HSA are tax-deductible and grow tax-deferred. Plus, HSAs allow tax-free distributions to cover your family’s health care costs and any money remaining in the HSA is available penalty-free to supplement your retirement once you reach age 65. The maximum contribution into an HSA for 2013 is $6,450 for married couples and $3,250 for single individuals.

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Accounting, Financial Planning, Retirement and Benefits, Taxation | Tagged: 3.8% Medicare Tax, 401k retirement fund, 529 plan, AGI, American Taxpayer Relief Act of 2012, Andrew D. Schwartz CPA, Cash Basis" accounting, Corporate Dividends, gift tax, health savings account, IRA, Long-Term Capital Gains, Revenue & Expenditures, Section 179 deduction | 6 Comments »

On Mentally Ill Inmates

Posted on August 19, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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New York Promised Help for Mentally Ill Inmates – But Still Sticks Many in Solitary

By Christie Thompson

[This story was co-produced with WNYC]

In New York, inmates diagnosed with “serious” disorders have been protected from solitary confinement. But, since that policy began, the number of inmates diagnosed with such disorders has dropped.

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Link: New York Promised Help for Mentally Ill Inmates – But Still Sticks Many in Solitary

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Law & Policy | Tagged: Mentally Ill Inmates | 2 Comments »

Commercial Health Plans’ Medical Loss Ratio [2nd Quarter 2013]

Posted on August 17, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

By http://www.MCOL.com

The 85% Rule

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Conclusion

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Filed under: Health Economics, Health Insurance | Tagged: Commercial Health Plans' Medical Loss Ratio, medical insurance loss ratios | 3 Comments »

The Danger of Used Health Information Technology

Posted on August 15, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Remember to destroy that hard drive!

By D. Kellus Pruitt DDS

NEWS FLASH!

“Affinity Health Plan to Pay $1.2 Million+ for HIPAA Violations -The HHS Office for Civil Rights on August 14 sent the industry a message on the importance of erasing protected health information on hardware being sold, recycled or returned,” by Joseph Goedert, HealthDataManagement.

http://www.healthdatamanagement.com/news/breach-notification-hipaa-privacy-security-affinity-46483-1.html

Talk about bad luck

A photocopier once leased by Affinity Health was purchased by CBS Evening News – which discovered that the copier’s hard drive contains 344,579 individuals’ unencrypted Protected Health Information.

The Response

In response to the federal investigation triggered by the CBS discovery, the Office of Civil Rights announced: “OCR’s investigation indicated that Affinity impermissibly disclosed the protected health information of these affected individuals when it returned multiple photocopiers to leasing agents without erasing the data contained on the copier hard drives.

Moreover ….

In addition, the investigation revealed that Affinity failed to incorporate the electronic protected information stored on photocopier hard drives in its analysis of risks and vulnerabilities as required by the Security Rule, and failed to implement policies and procedures when returning the photocopiers to its leasing agents.”

Assessment

Before disposing of used technology, remember to destroy the hard drive.

Conclusion

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Filed under: Information Technology, Pruitt's Platform | Tagged: eDRs, EHRs, health information technology, HIT | 1 Comment »

On Overspending and Overeating?

Posted on August 14, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Is there a Causal Relationship?

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

Over the years, I’ve noticed a commonality among people with money problems. Many of them are also overweight. Is there a relationship between overspending and overeating?

Behavioral science

Until now, I couldn’t be sure my experience was anything more than circumstantial. But I recently read about a 2009 study done by Dr. Eva Munster at the University of Mainz in Germany. It found that people who were in deep consumer debt were 2.5 times more likely to be overweight than those who were debt free. This confirms what I’ve observed over the past 15 years.

It isn’t possible to pinpoint one simple reason for this link. Among the causes I’ve seen suggested are overeating because of the stress of being in debt, difficulty buying healthful food with limited income, or an inability to delay gratification in both spending and eating.

Based on my work with people in financial trouble, however, I suspect a deeper root cause. Just as chronic money problems aren’t about the money, chronic weight problems probably aren’t about the food.

Evidence?

For supporting evidence, I went to an expert: my daughter. London recently took a graduate level course in previewing medicine. I asked her what the medical link between overspending and overeating might be. She explained that sugar is addictive and lights up the same part of the brain that narcotics do. It produces a euphoric response within the brain that calls for more of the substance when the euphoria subsides.

She wondered whether people addicted to sugar might overspend on junk food to feed their addiction. They might also spend money they really don’t have on diets, fitness centers, and the higher medical costs associated with being overweight.

I pointed out that I spend a lot on healthy food that costs more than junk food. I also spend money on a fitness center and medical costs to pay for the damage I do to my body compulsively working out. “Well, I guess my argument doesn’t hold much weight,” she quipped.

She pondered for a moment. “Oh, I think I got it. I’ll bet for some people spending money lights up the same part of the brain as sugar and narcotics?”

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Bingo!

That is why the key to changing any addictive behavior—eating, drinking, using drugs, or overspending—is not simply about eliminating the substance or the activity. Something else just pops up to take its place. That’s why many people who successfully stop drinking gain weight or get into serious money problems. The brain just substitutes one dopamine producer for another.

The ultimate answer is a sort of “rewiring” of the brain to create new neuropathways that do not require the harmful substance or activity to produce the same euphoric event. The latest research on the brain tells us this rewiring is completely doable.

I’ve seen that permanently changing the most entrenched damaging money behaviors takes more than knowledge about money or budgeting. Experts on obesity tell us the solution to permanently losing weight rarely lies with learning more about nutrition or finding the right diet. Making deep life changes such as these requires looking into the past. This recovery process takes time, effort, and money. It’s a path that many people are just not willing to follow.

Assessment

But there may be some good news. If the underlying causes for overeating and overspending are the same, then doing the work to recover from one is likely to help someone recover from the other, as well. It’s a sort of “two for the price of one” sale. In terms of long-term financial, physical, and emotional well-being, it seems like a bargain.

More: Are Doctors Spenders or Savers?

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Funding Basics | Tagged: kahler, obesity | 1 Comment »

How to Reach Your Career Goals Faster

Posted on August 10, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Three Step Program

By Marie Abrahms

We all have the ability to reach our career goals in everyday life.

For many people, this involves obtaining a big paycheck. While for others like FAs and allied healthcare professionals, doing what you love is important. Regardless, most of us might like a little extra aid in order to progress down our career paths.

So, if you wish to reach your goals, below are three things that that can be done in order to augment your career path.

1. Further Your Education

In order to look more inviting to prospective employers you should do things to improve your CV. One strategy is simply by continuing college. An MBA, by way of example, can make it likelier that you’ll be able to uncover a higher paying job.

Moreover, this is easier if you have use of a http://www.amerasiaconsulting.com MBA admissions consultant that will steer you from the right direction and still provide the guidance you need.

2. Promote Your Self on Networking Sites

If you wish to advance inside your career, you must create as many opportunities as you can. There are many work-at-home opportunities available online, in case you are prepared to spend some more time developing them. You’ll find popular networking sites such as LinkedIn and CareerBuilder to promote your resume.

Although they offer no guarantees, they certainly improve your chances.

3. Study the Success of Others

When you have chosen the career path you want to capture, you could take advice from others who have already managed to rise in their particular field. You’ll find books, classes and even mentoring programs where you stand to study the secrets of the pros.

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Assessment

Should you be prepared to take a positive step towards reaching your work goals, visit http://www.amerasiaconsulting.com where you will discover the assistance you’ll need to achieve the MBA degree that may help you meet your employment objectives.

Good luck!

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Filed under: Career Development | Tagged: career, MBA | 2 Comments »

A Survey on Applications in Mobile Healthcare

Posted on August 9, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

University of Delaware Research

By Thomas Martin
Doctoral Candidate
School of Public Policy and Administration
University of Delaware
412 992 1285
trm@udel.edu

Dear Dr. Marcinko,

The University of Delaware is conducting a study to assess provider attitudes towards applications “Apps” in healthcare settings. Mobile devices hold great promise for reshaping the “time and place” where an individual receives care.

Key Topics

The research tool evaluates a number of key topics emerging in the healthcare space:

Opinions on the integration of apps into the Meaningful Use program
Characteristics important to users when downloading an app
Assessing desirable pricing structures

I’d like to invite you and the ME=P readers to provide us with feedback on how you leverage Apps in the healthcare setting. The research instrument should take no more than 10 minutes to complete and all responses will remain confidential. The results may be published in a scholarly journal or industry research publication.

ME-P Respondents Should Be:

• U.S. Providers, Physicians, or Nurses
• IT Staff involved in Health IT and mobile decisions

Assessment

If you have any questions, please do not hesitate to contact (PI) at trm@Udel.edu, tmartin@himss.org or follow this link to the Survey:

Take the Survey

Or copy and paste the URL below into your internet browser:
https://delaware.qualtrics.com/WRQualtricsSurveyEngine/?Q_SS=6GwUOhdbw9Z193f_1Te8TH0W0ZEYMGF&_=1

Conclusion

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko
Practice Management: http://www.springerpub.com/product/9780826105752
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: http://www.CertifiedMedicalPlanner.org

Filed under: Information Technology, Surveys and Voting | Tagged: mobile devices, Mobile Healthcare Applications, Thomas Martin, University of Delaware Research | 8 Comments »

Is Passive Investing Right for You?

Posted on August 7, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

On the “Buy low and Sell high” Strategy

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

“Buy low and sell high.” That was my simple approach when I was a smart young investment advisor. I poured over a company’s balance sheet, earnings statements, and forecasted returns. Then I bought those companies that were bargains and waited for my gains to roll in. More times than not, they did—eventually.

The problem came with the “not” and “eventually.” A majority of my picks did go up in value, but the minority that were “nots” still lost enough to have a negative impact on my bottom line. Even more frustrating, some of my “nots” turned into gains “eventually” after I sold them.

My investment returns were similar to findings from Dalbar, Inc., a financial services research firm. Dalbar’s studies have shown that average active investors barely beat inflation over the long term. They significantly underperform investors who put their money in an index fund of stocks and leave it alone.

So much for my early investment brilliance! Over the past 40 years, I’ve learned that with every passing year I know less than I thought I did the year before. I’ve proven to myself I have no idea where any market is going tomorrow, next month, next year, or in the next 10 years.

This awareness has led me to become increasingly passive in my investments. In passive investing, rather than trying to time the buying and selling of winners and losers, you instead buy a representative sample of the entire market. This is possible in any market: bonds, stocks, real estate investment trusts, or commodities. You simply buy mutual funds and exchange-traded funds (ETF’s) called index funds.

Benefits

The two biggest benefits of passive investing are cost and diversification.

Costs

Index funds have incredibly low costs, with annual fees as low as 0.1%. Contrast that with the average equity fund that costs 1.5%, fifteen times more. According to research, 97% of active mutual fund managers don’t beat the index over 20 years. Even the 3% who do must beat the index by more than the 1.5% fee they charge, in order for their investors to come out ahead.

Diversification

The smaller number of stocks owned – the more my fortunes are tied to those few companies. It’s the old adage, “don’t put all your eggs in one basket.” By owning index funds, I own hundreds or thousands of securities. While I will never hit a home run, I also will never strike out. My returns will be “average.” Investing may be one of the few professions where being average puts you in the 97th percentile of all investment managers.

The NaySayers

Not all of my peers agree with this philosophy. Many very smart investment advisors jumped off the passive investing bandwagon after 2008 and returned to tactical asset allocation, which is another name for timing the markets.

###

Harold’ Strategy

A noted investment advisor, Harold Evensky MBA CFP® of Evensky & Katz, addressed this issue at a conference last year. After the 2008 crisis, his firm hired researchers to evaluate whether they could find any tactical strategies that would have avoided the crisis. They found some that, in hindsight, would have worked. Yet he didn’t feel those strategies could be comfortably applied looking forward. Instead, the firm decided to add a 20% allocation to non-correlated alternative investments, something I’ve done since the late 90’s. In other words, they increased their clients’ diversification.

Assessment

The bottom line is that passive investing actually gives you more control. It allows you to focus on reducing costs and taxes, the aspects of investing you can control. It frees you from trying to beat the market and worrying over what you can’t control.

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Investing, Portfolio Management | Tagged: active investing, Dalbar, diversified porfolios, ETFs, Evensky & Katz, exchange-traded funds, Inc., Mutual Funds, passive investing, Rick Kahler CFP® | 1 Comment »

On Medicare Part D Savings?

Posted on August 6, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

An infographic

By www.MCOL.com

###

More

Conclusion

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Filed under: Drugs and Pharma | Tagged: Medicare drugs, Medicare Part D | 7 Comments »

About the ICD-10 Hub

Posted on August 5, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Free Transition Information and News

[By Staff Reporters]

ICD-10 Hub is a leading source of information about ICD-10 news and events.

Sponsored by the AAPC and Navicure, this website is dedicated to being an essential resource to help practices and HIT vendors understand how this transition will impact the entire industry and how every organization can properly prepare.

Assessment

So, give em’ a click, and tell us what you think?

http://icd10hub.com/

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Health Dictionary Series: http://www.springerpub.com/Search/marcinko
Practice Management: http://www.springerpub.com/product/9780826105752
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: http://www.CertifiedMedicalPlanner.org

Filed under: Information Technology, Practice Management | Tagged: AAPC, ICD-10, ICD-10 Club, Navicure | 6 Comments »

Doctors as Private Financiers?

Posted on August 2, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Doctors Acting as Lenders, White-Knights and Venture Capitalists

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

Every now and then I get a call from a doctor client wanting my opinion about starting a business with a friend, investing money in a business owned by a family member, or co-signing a loan to help a family member buy a business. Being in business with family is something I know a little bit about, having been in partnership with my father and brother for 40 years. Going into business with family members or close friends can carry a high degree of risk, both financially and emotionally.

In part this is because it is uncomfortable or difficult to ask the necessary dollars-and-cents questions. We don’t want to seem uncaring, unsupportive, or untrusting. We are concerned about damaging the relationship. Yet the relationship is far more likely to suffer if we don’t ask those questions and the venture fails.

My Rules

The following are some things to consider before you invest or go into business with someone close to you:

1. Don’t even consider putting money into a business without seeing a detailed business plan. Ask the same questions about risks, costs, and potential profits that you would ask if this person were not a family member.

2. Insist that the person at least talk to other possible investors who aren’t emotionally involved. This will give both of you some feedback from neutral third parties about the validity of the opportunity. A banker or a potential investor who isn’t a family member will ask questions you may not even think of asking.

3. Do your own research and seek out some independent advice. A financial advisor or someone with a lot of business experience can be a valuable source of questions, information, and alternatives.

4. Ask yourself whether you want to be involved in this business. Does it support your own goals? Do you know anything about this field or have any interest in it? Sometimes people invest on behalf of family members because they feel they “should.” Yet, had those same proposals come from acquaintances or business colleagues, they would almost certainly have said no without a second thought.

5. Try to think of other ways you might be supportive without putting money into the venture. Maybe you can think of lower-risk alternatives or other possible sources of funding. Remember, too, that if your wish is to support and encourage family members, helping them jump into an unacceptably risky investment isn’t exactly doing them any favors.

6. Pay close attention to any difficult feeling you are experiencing when considering investing in this enterprise. Explore any feelings like fear, anxiety, or sadness to determine if there is further wisdom to be gleaned. Perhaps you may be unconsciously ignoring some crucial warning signs.

7. Communicate clearly. Emphasize from the beginning that protecting the relationship is your most important consideration. If you decide not to get involved, be direct about it. Saying no right away is more respectful than is stringing the person along because you don’t want to hurt someone’s feelings. Yes, choosing not to invest in a family member’s project may cause some tension in the relationship. That’s minor compared to the damage the relationship could incur if you invest and the business fails.

###

Assessment

Sometimes, the best way for a successful doctor to support a family member’s financial well-being is to turn down an investment request. If outside parties are not willing to commit funds to a project, maybe there’s a message there that both of you need to hear. If you wouldn’t make an investment on its own merits, you almost certainly shouldn’t make it just because it involves a friend or family member.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: "Doctors Only", Funding Basics, Risk Management | Tagged: funding, lenders, Rick Kahler CFP®, venture capitalists, White-Knights | 2 Comments »

Will Healthcare Reform Impact a Spine Surgeon’s Retirement Plan?

Posted on August 1, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Q&A With Dr. Brian Knabe of Savant Capital Management

By Ann Miller RN MHA

Brian Knabe MD CFP® CMP® is a former medical physician turned financial advisor at Savant Capital Management, a fee-only wealth management firm.

Here, he discusses the smartest moves for spine surgeons at various stages in their careers to ensure an enjoyable retirement.

###

retirement

LINK: Will Healthcare Reform Impact a Spine Surgeon’s Retirement Plan? Q&A With Dr. Brian Knabe of Savant Capital Management

More

Conclusion

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Filed under: "Ask-an-Advisor", Breaking News, CMP Program, Retirement and Benefits | Tagged: "Ask-an-Advisor", brian knabe, healthcare reform, retirement plan, retirement planning, savant capital management, spinal surgeon, spine surgery | 2 Comments »

A New Physician Compensation Report

Posted on July 31, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Physician Compensation Infographic and Review

Doctors saw a small salary increases in 2012 but they were smaller than those in 2011, according to a physician compensation survey released this week by global consulting firm, the Hay Group.

For example, in 2011, physician salaries increased by 2.7 percent but 2012 saw they increased only by 2.5 percent.

####

More

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Career Development | Tagged: doctor pay, doctor paychecks, doctor salary, Hay Group., More on the Doctor Salary Conundrum, Physician Compensation Report | Leave a comment »

Medical Director Needed for NovaSys Health

Posted on July 30, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Physician Career Opportunity

By Paul Esselman

[Executive Vice President, and Managing Principal]

Cejka Executive Search

Dear Dr. Marcinko,

Centene Corporation is seeking a Medical Director for NovaSys Health, a full-service managed care company and health plan administrator based in Little Rock. This newly created position will be responsible for assisting in the development of a medical management infrastructure for the health plan as NovaSys expands their member base through the participation in the Arkansas Healthcare Exchange.

A Fortune 500 company, Centene is a national leader in low-cost solutions for high quality healthcare services for uninsured and underinsured patients. Centene’s subsidiary health plans bring better health outcomes to their 1.5 million members. Centene’s core philosophy is that quality healthcare is best delivered locally. This local approach enables them to provide accessible, high quality and culturally sensitive healthcare services to their members in their own communities.

The Medical Director will perform utilization review, quality assurance and medical review of services; oversee the activities of physician advisors; assist in provider network development and expansion; and participate in strategic program developments for improving quality of care while lowering costs. The Medical Director will also work closely with the Plan President and Vice President, Medical Management (RN) in establishing and carrying out the strategic vision of the organization working closely with external constituents as appropriate.

Successful candidates will be physician leaders with knowledge of quality improvement practices and familiarity with medical information systems, medical claims payment processing and coding. Knowledge of managed care, Medicaid and case management programs are preferred. Board certification in a recognized medical specialty, preferably in internal medicine, family practice, pediatrics or emergency medicine, and an active medical license are required.

###

Assessment

Qualified candidates should submit their resumes for consideration to me:

Thank you.

Paul Esselman Executive Vice President, Managing Principal Cejka Executive Search 4 CityPlace Dr., Ste. 300 St. Louis, MO 63141 314.236.4588 Office pesselman@cejkasearch.com http://www.cejkaexecutivesearch.com

Conclusion

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PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Career Development, iMBA, Inc. | Leave a comment »

Do Nurses like EHRs?

Posted on July 27, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Do RNs like using electronic health records?

[A seldom considered POV]

BY Darrell K. Pruitt DDS

Some Facebook comments:

Big problems when you have unexpected “downtimes”.

July 15 at 3:10pm · Like · 4

It is an absolute train wreck. I haven’t seen one record of mine that is not riddled with mistakes. Especially the allergies, they show me taking meds I’m allergic to and not taking meds I’m actually on. A true mess!! And now the records are all intertwined. I don’t like it at all!!

July 15 at 3:10pm · Like · 2

It is a nightmare!

July 15 at 3:18pm · Like

I retired just in time so I don’t have to deal with this fiasco.

July 15 at 3:19pm via mobile · Like · 2

IT SUCKS

July 15 at 3:19pm · Like

I don’t like them; my doctors don’t like them; how it will affect patient care is still a ‘jury out’ matter, but we can guess it will NOT help.

July 15 at 3:30pm · Like

Our Rural Community Healthcare system is just now switching over to this .. along with our hospital switching over to a totally new computer system .. the 2 systems do not talk to each other..In my personal experience I find that the “computer” world takes us away from Direct Patient Care (to busy playing “ring around the Rosie” on the computer).

July 15 at 3:40pm · Like · 4

I like them, but it is frustrating having “downtime.”

July 15 at 3:41pm · Like

I hear patients stating things like “my doctors don’t know who I am because they don’t look at me they are glued to the computer”. It saddens me patients feel less valued. I’ve worked in places where they’ve had paper charts and places computerized. Seems the computers are redundant and I personally prefer paper charts. Chart one assessment not one assessment 4 different places.

July 15 at 3:44pm via mobile · Like · 3

It looks to me like physicians are cutting and pasting old histories and physicals, complete with the errors. Doctors in a local ER charted complete physicals on me when they did not get closer than 5 feet away. The records are difficult to read, difficult to find information; and it is not number in chronological order.

July 15 at 3:47pm · Like

I dislike it. Besides the down time, I find it very impersonal. I don’t feel as if I am giving my full attention to my pt, nor do I feel my PCP is hearing what I’m saying . They are too busy putting in info on the computer. As for the down time you then have to work late to put in the info gathered while the system is down.

July 15 at 3:47pm via mobile · Like · 2

Assessment

https://www.facebook.com/friendanurse/posts/654085127954821

More: On DIgital Deaths

http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html

(50+ other comments)

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, Pruitt's Platform | Tagged: Darrell Pruitt DDS, EHRs, electronic health records, electronic medical records, EMRs | 7 Comments »

Should Doctors Collect Treasures?

Posted on July 26, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

On Investing in Art and Collectibles

By Rick Kahler CFP®

Almost everyone has a story about a cousin or an aunt who bought a box of junk at an auction and found in it a diamond ring worth several hundred dollars. Every once in a while a valuable painting by a famous artist turns up in someone’s attic. “Antiques Roadshow” sometimes features odd items that have been sitting around in someone’s house for years and that are appraised for thousands of dollars.

This doesn’t mean buying and selling art or collectibles is a good way to make money.

Collectibles

Buying art, antiques, or collectibles is extremely speculative, in part because values are so subjective. What a given item is worth depends entirely on what a collector might be willing to pay at any given time. A piece of pottery or jewelry might fluctuate considerably in value as trends come and go. Yesterday’s hot collectible (think Beanie Babies or Jim Beam bottles) might be tomorrow’s overpriced embarrassment.

Does this mean you should never buy art or antiques in hopes that they’ll increase in value? Not necessarily. I am suggesting, though, that investment shouldn’t be the primary reason for your purchase.

If you’re going to collect Art Deco jewelry or decorate your home with original artwork, do so because you like those things. Choose a painting because you want it hanging on your wall. Buy a carving or a pot because you want it. Collect iron toys or old books because you have fun searching for them at antique stores and garage sales. If your art or collectibles increase in value, consider it a nice bonus.

If you’re hanging onto a piece of art or an antique that you don’t like because you think it’s valuable and you think of it as an investment, why keep it? You could sell it and put the proceeds into your retirement portfolio. Then your investment wouldn’t be taking up space in your house, and you wouldn’t need to worry about maintaining it or insuring it. Another option would be to use the money to buy something you would enjoy owning.

Do the Research

If you do decide to sell an item, do some serious research and try to find out what it’s really worth. Don’t just stick a price on it for a garage sale or walk into an antiques store and take whatever they offer you. Get at least two or three estimates from dealers or other qualified experts. For something that’s potentially quite valuable, paying for an appraisal might be money well spent.

Finding valuable collectibles at rummage-sale prices is almost always sheer luck. Anyone who consistently makes money buying and selling art or collectibles has invested the time and effort to become an expert. Unless you’re willing to do the same—and you would enjoy it—don’t try to fund your retirement this way.

Making Memories

In the interests of full disclosure, I should confess that not all of my own purchases turn out perfectly. One of my travel memories is of the time I bought two hand-woven carpets at bargain prices. What made the purchase memorable was the experience of stuffing the bulky rolled-up rugs into a taxi and hauling them to the airport, only to find that the baggage handlers had gone on strike.

Those carpets still decorate the floors in our house. Are they worth more than I paid for them? After all the effort it took to get them home, I certainly hope so. But I bought them because I liked them and wanted them in my home.

Assessment

But, if my primary goal had been investing, I would have put the purchase price into several well-diversified mutual funds instead.

Conclusion

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***

Filed under: Investing | Tagged: Art, collectibles, Investing, Rick Kahler CFP® | 1 Comment »

Should You Comparison Shop for an Investment Advisor?

Posted on July 25, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Consumer’s Repot Not Available

By Rick Kahler CFP® www.KahlerFinancial.com

You can spot comparison shoppers a few aisles away at any retail store. They are the ones carrying articles from Consumer Reports, badgering the salesperson with a million and one questions. People who manage money well are usually big fans of comparison shopping.

If comparison shopping is important before choosing a new refrigerator or lawn mower, it’s even more essential before choosing an investment advisor. Unfortunately, there is no easily available consumer’s report on advisors. Even more frustrating, those selling financial products often have incentives not to be forthcoming with the information that is crucial for comparing advisors.

A Focus on Investment Returns

One aspect of shopping for an investment advisor is to know what questions to ask. One common mistake is to focus on investment returns. Shoppers may ask for the average recent returns of the advisor’s portfolios or may want to know whether the advisor’s returns beat the market averages.

Problems:

There are several problems with focusing on returns.

First, the numbers mean nothing without also knowing how much risk the advisor took to produce the return. It’s like someone on a diet focusing only on fat grams without regard to total calories. Consuming ten soft drinks in a day may give you zero fat grams, but you could easily exceed your daily calorie limit before eating one bit of food.

Second, any unscrupulous advisor can put together a portfolio consisting of the hottest investment classes over the past 10 years and show you how fantastically they did.

Third, whether an advisor beats the market is overrated. Why? A whopping 97 percent of all mutual fund managers don’t generate an “average return” over 20 years. Just finding an advisor who has done so means you found someone in the top three percent.

Fourth, some financial advisors may show you a phenomenal track record for the short term (under 10 years). Since wise investing focuses on the long term, beating the averages over a short term isn’t necessarily significant.

Gamesmanship

If so many games can be played around returns, what questions should a savvy comparison shopper ask? Focus on one word: transparency. You want to find out if the returns, costs, and risk (standard deviation) of your portfolio will be clearly displayed and contrasted against appropriate benchmarks.

Transparency

Here is how to accomplish that goal. Most advisors have model portfolios. Ask them to show you the standard deviation and the expense ratio of their model over five and ten years. Ask them to contrast the return of the portfolio against a similar benchmark.

For example, if the portfolio has US stocks, US bonds, and foreign stocks, have them compare it to a benchmark of indexes proportionate to those asset classes.

Next, either ask the advisor to run a similar analysis on your existing portfolio or have one done independently. You may even have done better than the advisor’s model.

Ask the advisor to disclose all fees in addition to the expense ratios charged by mutual fund or sub-account managers. You need to find out how the advisor is paid and how much. Ask whether there are any wrap fees, transaction costs, administrative fees, mortality fees, redemption fees, annual 12b(1) fees, surrender charges, or up-front sales charges.

Assessment

Don’t be surprised if you get a bit of resistance when you ask for all this information. Brokerage firms, life insurance companies, and many commission-based advisors don’t have much incentive to give you this data and may not even be able to.

If you don’t get clear disclosure on fees and costs, keep asking. If you persist and still don’t get understandable answers, you may need to do more comparison shopping before you choose an advisor.

Conclusion

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Filed under: Financial Planning, Investing | Tagged: investment advisor, Rick Kahler CFP® | 1 Comment »

Why Hospitals Should Use Financial Management Checklists

Posted on July 24, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Financial Management Strategies for Hospital and Healthcare Organizations [Tools, Techniques, Checklists and Case Studies]

By Neil H. Baum MD

It is fitting that ME-P Editor Dr. David Edward Marcinko MBA CMP™ and his fellow experts, have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies that physicians, nurse-executives, administrators and institutional Chief Executive Officers, Chief Financial Officers, MBAs, lawyers and healthcare accountants can follow to help move healthcare financial fitness forward during these unchartered waters.

In medicine – It all began with Dr. Atul Gawande, a surgeon at Massachusetts General Hospital, who reviewed the airline industry and their use of checklists prior to take off of an airplane.

The history of aviation checklists began in 1934 when Boeing was in the final process of testing a U.S. Army fighter plane with a potential contract of nearly 200 planes riding on the final test of the plane. The test aircraft made a normal taxi and takeoff. It began a smooth climb, but then suddenly stalled. The aircraft turned on one wing and fell, bursting into flames upon impact killing two of the test pilots. The investigation found pilot error as the cause. One of the pilots who was unfamiliar with the aircraft had neglected to release the elevator lock prior to take off. The contract with Boeing was in jeopardy.

Thus, the pilots sat down and put their heads together. What was needed was some way of making sure that everything to prevent crashes was being done; that nothing was overlooked. What resulted was a pilot’s checklist developed before takeoff, during flight, before landing, and after landing. These checklists for the pilot and co-pilot made sure that nothing was forgotten and safety of the planes was insured.

Medical Care and Hospitals

So, what does airline safety have to with medical care and hospitals?

There are so many activities that take place in medicine such as the operating room, that are far too complicated to be left to memory of doctors, nurses, anesthesiologists, and others involved in the surgical care of patients. Dr. Gawande identified the key components of a surgical procedure which include the name of the patient, the procedure to be performed, the estimated length of the procedure, whether the right or left side is the surgical target, how much blood loss is anticipated, whether antibiotics have been given prior to making the incision, and the anesthetic risk of the patient. This use of a checklist which takes approximately 30 seconds has not only prevented wrong side surgery but also instills a discipline of higher performance.

###

Financial Management Strategies for Hospitals and Healthcare Organizations

Financial Management Strategies for Hospitals and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies

###

From the Clinic to the Boardroom

And so, should [can] we port the clinical checklist example of Atul Gawande for use with non-clinical topics like hospital financial management and administration?

Assessment

Yes – We have a challenge and the Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies is a step in the direction to make all of the stakeholders in the healthcare arena become sensitive to reducing and controlling costs and at the same time preserve quality of care.

This can be done. I suggest you start by reading, using and referring to this excellent book.

And so, what is my final advice? Read the Book!

Some of you who will read this book are CXOs COOs, Chief Medical Officers and maybe even COS. (Chiefs of Staff). But, all of you should become CLOs (Chief Life Officers)! Read this book and the initials CLO will appear after your name!

Note:

Neil H. Baum MD is a Clinical Associate Professor of Urology at the Tulane Medical School, New Orleans, LA. He is also a thought-leader for this ME-P.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Book Reviews, Health Economics, Healthcare Finance, iMBA, Inc., Practice Management, Recommended Books, Research & Development | Tagged: Dr. Atul Gawande, Dr. David Edward Marcinko MBA, Financial Management Strategies for Hospital, Neil H. Baum MD, Should Hospitals Use Checklists? | 8 Comments »

Fake Sandwich Drug Concealment

Posted on July 23, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Hiding illegal drugs in a plastic “sandwich”

By Anonymous

[Click to View]

Fake Sandwich Concealment

Conclusion

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PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Drugs and Pharma | Tagged: "Illegal" Drugs, DEA, drug concealment, drug wars, Fake Sandwich Drug | 1 Comment »

The High Deductible Health Plan Option?

Posted on July 22, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

As the Only Employer Health Benefit Choice!

By www.MCOL.com

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More

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Insurance | Tagged: Employer Health Benefit Choices, HDHPs, high deductible health plans, www.MCOL.com | 8 Comments »

Are Doctors Spenders or Savers?

Posted on July 19, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Or … Just Delusional like the Rest of Us!

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

According to Scarborough, a market research firm, only 9% of adults in the U.S. label themselves as spenders. This is the percentage that “mostly agrees” with the statement, “I am a spender rather than a saver.” On the opposite side, 29% “mostly disagree” with the statement and are considered savers. Presumably, the 62% in between consider themselves to have well-balanced financial habits that include both spending and saving.

Given these numbers, it would seem that most of the adults in this country ought to have healthy savings accounts. Unfortunately, that’s not the case.

Employee Benefit Research Institute

According to a report released in March 2013 by the Employee Benefit Research Institute, 57% of U.S. workers have less than $25,000 in total household investments and savings, not including the value of their homes. The Social Security Administration’s current figures show 34% of American workers have no savings set aside specifically for retirement.

Something doesn’t quite add up. Either a lot of Americans aren’t willing to admit that they are spenders, a lot of Americans are so poor that they can’t afford to save, or a lot of Americans are delusional.

Habits of Savors

Or maybe a lot of us just have different definitions of “saving.” Here are a few money habits that might encourage people to think of themselves as savers, but that don’t necessarily add up to being successful savers:

1. Buying things on sale. Waiting for discounts on items you need and want is a wise and standard practice for frugal shoppers. But you aren’t a saver if you buy bargains that you don’t need, might not even really want, or can’t afford. Maybe that $150 pair of shoes is half price. Yet if they will just sit in your closet, you haven’t saved $75. You’ve spent $75.

2. Having money in the bank. Yes, putting money into a savings account is the first place to start saving and a great habit to teach your kids. But once you have accumulated an emergency fund, keeping your money in the bank isn’t a good savings habit. Over time, savings accounts and CD’s don’t pay enough to keep pace with inflation. Money in the bank may be safe, but it isn’t really an investment because it isn’t growing. Mutual funds that include a well-diversified range of investments are far better places for your long-term retirement savings.

3. Not spending anything. There are times when choosing not to spend money now will only cost you more money later. Failing to maintain your car or do home repairs are two common non-spending habits that may seem like saving but actually turn into spending.

4. Saving for someone else. The time-tested advice to “pay yourself first” usually means taking money off the top for savings before you spend anything. Yet this has another application, as well. Make saving and investing for your own retirement your first priority. It needs to come ahead of saving for your kids’ college educations, weddings, or first homes. This may seem selfish or greedy, but in fact it’s the opposite. When you provide for your own financial well-being in retirement, your kids won’t end up having to help pay your bills.

###

Assessment

When we’re asked to label ourselves, it’s normal to tend to choose answers that fit the way we would like to think of ourselves. I’m sure most of us would prefer to think of ourselves as savers rather than spenders.

But, if we really want to become successful savers, we can’t settle for the money habits we wish we had. We need to look at the money habits we actually practice.

Psychologists and psychiatrists, please comment. Are doctors the same as the rest of us, or not?

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Experts Invited, Financial Planning | Leave a comment »

On Doctors Passing Wealth to Children

Posted on July 17, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Limiting your kid’s ability to tap principal

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

When passing wealth to your kids, some medical professionals should consider creating a trust to limit the later generation’s ability to tap into the principal. Several astute readers suggested this strategy after my recent column citing research that shows 90% of inherited wealth is gone by the third generation.

Preserving Wealth

There is no question that a trust, done correctly, can go a long way to preserve wealth after the death of the wealth accumulator. Let’s explore what “done correctly” means.

1. Trust law is complex. Engage an accountant and attorney with strong skills and expertise in trusts.

2. Be sure the assets you intend to go into the trust will actually transfer.

Retirement plans like IRA’s, 401(k)’s, and profit sharing plans will pass to whomever you listed as the beneficiary. This must be the trust. In addition, the trust must include a number of special provisions in order for a retirement plan to be distributed according to your wishes and not as a fully taxable lump sum.

Annuities, insurance policies, and accounts with a TOD (transfer on death) clause will also pass to the named beneficiary.

Assets held in joint tenancy will not pass to the trust. Many married couples jointly own most of their major assets, such as the family home, investment real estate, brokerage accounts, or bank accounts.

3. Be sure there are enough assets in the trust to justify the trustee fees. Most professional corporate trustees charge $3,500 to $10,000 annually, or up to 1% of the trust assets. If a trust with $100,000 incurs an annual fee of $3,500, your hard-earned estate will benefit the trustee as much as your heirs. A trust probably doesn’t make financial sense if the total fees will exceed 2%.

4. If a trust still seems like a good strategy after the above caveats, the next question is how much to limit heirs’ ability to withdraw money. From an actuarial standpoint it’s fairly simple. If you limit annual withdrawals to 3% of the principal, there’s a strong probability of the money lasting several generations with its buying power intact. Provided, that is, the trustees pay close attention to the next point.

5. To generate sufficient returns to pay out up to 3% annually to heirs and also keep up with inflation, the majority of the portfolio must be invested in assets that will grow over time, such as stocks, real estate, and commodities. It needs to be broadly diversified among many asset classes and countries. The trustees must also limit the fees paid to manage the investments. Many corporate trustees have an inherent incentive to use their own bank’s mutual funds, which can have annual fees as high as 1.5%. One way to avoid this conflict of interest is to instruct the trustee to place the funds with a fee-only investment advisor who has a largely passive approach to managing money. This could cut the portfolio fees by 50% or more.

6. Finally, before setting up any trust, pay close attention to taxes. Congress recently increased the top income tax bracket to 39.6% on wealthy taxpayers. Any trust which keeps more than $11,950 of annual income is considered “wealthy.” So here is the problem. If the trust retains enough earnings to increase the principal to offset inflation, it will have to pay substantial income tax and will probably need to restrict withdrawals to 1 or 2%. All of a sudden a multi-million dollar inheritance becomes simply a source of secondary income similar to Social Security.

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Assessment

Trusts are valuable estate planning tools. But like any other powerful tools, they are best employed by someone with the skills to use them well.

More:

Conclusion

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Filed under: Estate Planning, Retirement and Benefits | Tagged: Estate Planning, Passing Wealth to Children, Rick Kahler CFP®, transfer on death, trusts | 1 Comment »

Example Total Expenditures on Health

Posted on July 16, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

International Per Capita Total Spending

By: http://www.MCOL.com

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More:

Health gap: Americans sicker than rich peers

Conclusion

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Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Glossary Terms, Health Economics | Tagged: healthcare costs, healthcare spending, Total Expenditures on Health | Leave a comment »

Ramadan Greetings 2013

Posted on July 13, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Ramadan 2013 In Pictures: Muslims Celebrate Around The Globe (PHOTOS)

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[Tuesday July 9th to Wednesday August 7th 2013]

Filed under: LifeStyle | Tagged: muslims, Ramadan | Leave a comment »

The Doctor’s Path to Wealth?

Posted on July 11, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

And … for us all

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

After three decades as a financial planner, working with successful wealth-builders, you’d think I would have a clear idea of the right path for creating wealth.

Instead, what I’ve learned is that there is no such thing. Here are just a few of the paths that aren’t the sure routes to wealth they might seem to be:

Several Paths

1. Education and career choices. Going into a field like law or medicine might seem to guarantee financial success. Not necessarily. I’ve seen many physicians, for example, who have accumulated significant wealth. I’ve seen just as many who live paycheck to paycheck.

2. High earnings. Again, this isn’t the reliable predictor of wealth it would seem to be. True, someone who spends decades in low-wage jobs is unlikely to be able to accumulate much financial security. But a person earning $1 million a year will not necessarily have a larger net worth than someone earning $75,000. I’ve seen people who worked as janitors, nurses, and mechanics become millionaires. I’ve worked with others, earning a hundred times more in careers like sales or entertainment, who reach retirement age with absolutely nothing.

3. Owning your own business. Many hard-working, creative entrepreneurs build successful businesses that provide wealth, not just for themselves, but for their children and grandchildren. Others might see a business or even a series of businesses fail. Still others might work hard all their lives but never achieve more than the equivalent of an average salary in their field.

4. Investment choices. Some people have had great success investing in various types of real estate, businesses, and commodities. Others have lost everything they ever owned investing in those same vehicles.

Some Commonalities

So, sorry, I can’t give you a simple list of the top ways to build wealth. There’s little commonality in how my successful clients have made their money. What I can suggest are a few ways to help you find your own path to accumulating wealth.

1. Define “wealth” in your own way. Maybe you’re willing to live frugally in order to accumulate enough money to feel secure that your needs will be met even if you live to be 100. Maybe wealth to you is living a lavish lifestyle and being willing to work hard to pay for it. You might see wealth as the satisfaction and responsibility of having your own business. Maybe it means being able to give generously. Or perhaps you define wealth as the freedom of owning little and traveling around the world on a bicycle.

2. Know what you are willing to sacrifice—and what you are not—in order to accumulate wealth. There’s nothing wrong with earning a high salary doing work you hate for a time, as part of an overall strategy to get you to doing something you love. But doing so for a lifetime is hardly the road to either happiness or wealth.

3. Think long term. The most reliable way to build lifetime wealth, with the lowest risk, is through a long-term commitment to diversified investing. Yet even those who are successful on riskier paths to wealth take the long view. Business owners may fail more than once before they succeed. And those who have made fortunes in high-risk investments have also lost fortunes. They understand that success is about taking calculated risks.

4. Learn to make conscious financial decisions. I’ve seen many intelligent, capable people stuck in financial chaos and poverty because of emotional pain and dysfunction. Emotional health may not be essential for building financial wealth. It is, however, essential if you want to use that wealth to support a rich and satisfying life.

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More:

Conclusion

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Invite Dr. Marcinko

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Filed under: Financial Planning, Investing, Touring with Marcinko | Tagged: doctor wealth, Marcinko, Path to Wealth, rick kahler, Wealth, wealth-builders | 2 Comments »

Some Out-Sourced Medical Humor

Posted on July 9, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Introducing The Health Scout

By Staff Reporters

We are delighted to refer our ME-P readers to Dalya Munves over at the Wing of Zock.

Dalya is a medical student at The University of Texas at Houston, where she just completed her first year. Before medical school, she earned a B.A. in Literary Studies with a Minor in Philosophy from The University of Texas at Dallas.

Sample

Assessment

Dalya is currently interested in specializing in Internal Medicine or Obstetrics and Gynecology. She blogs at The Health Scout and you can follow her on Twitter @HealthScoutBlog.

So; when you need a chuckle – just give her site a click!

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: LifeStyle | Tagged: Dalya Munves, The Health Scout, Wing of Zock | 3 Comments »

Twelve Steps of Financial Independence for Doctors

Posted on July 8, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Basic Guide

By Lon Jefferies MBA CFP® CMP®

Want to get your finances in order? Consider this comprehensive 12-step guide to address each element of your personal financial situation. In most cases, you should not address a step until all previous steps are satisfied.

1. 401(k) 403(b) Match: Without exception, if your employer matches 401(k) contributions, you should maximize whatever they’re offering. If it’s a dollar-for-dollar match, that’s an instant 100 percent return! Even the 50 percent return of a two-for-one match is irresistible.

2. Consumer Debt: Pay off your credit cards and all other unsecured loans, prioritizing the debts with the highest interest rates. Credit cards frequently charge rates as high as 30 percent. Paying off a card with 30 percent APR is comparable to getting a 30 percent investment return. Not completing this step will hamper your entire financial plan.

3. Cash Flow: You can’t develop wealth if you spend more than you make. Construct and follow a written budget to ensure you are living within your means. Your budget should include saving at least 10 percent of your gross income for retirement. Constantly compare actual spending with your budget and hold yourself accountable! Mint.com is an excellent free tool for this step.

4. Emergency Reserve: Develop a liquid savings account consisting of enough money to cover three to six months of expenses. These funds should only be utilized in crisis such as a job loss or medical emergency.

5. Life Insurance: If you have dependent children, you likely need life insurance. Cost-efficient coverage can frequently be obtained via your employer. To calculate the amount of coverage to purchase, first determine how much money your survivors would need to maintain a comfortable lifestyle, and then subtract any income they will generate as well as any savings you’ve accumulated. Alternatively, if you don’t have children in your household and your spouse is self-sufficient, you may not need life insurance coverage.

6. Disability Insurance: Getting hurt can completely derail your financial planning. A loss of income halts your savings and likely leads to increased debt. Obtain enough disability coverage to bridge the gap between earnings and expenses in the event of an injury. Coverage can frequently be purchased through your employer.

7. Estate Planning: Obtain a power of attorney, medical directive and living will. These documents allow you to designate the person you would like to make decisions for you if you become incapacitated. They also specify your preferences regarding life-prolonging medical treatments. Ensure both primary and contingent beneficiaries are assigned to your retirement accounts. Finally, develop a will or trust to ensure all other assets are distributed as you desire when you die.

8. Retirement Contributions: With risk exposures covered, it’s time to return to retirement planning efforts. Again, a 401(k) is an attractive retirement vehicle because it frequently offers an employer match and allows large annual contributions ($18,500 or $25,000 for individuals over age 50). If your employer doesn’t offer a 401(k), you can still contribute up to $6,500 (or $7,000 if over age 50) to an IRA. IRA contributions can be made on behalf of both spouses, even if only one is employed.

9. Traditional or Roth: The type of account that is best for you depends on when you want to pay taxes. A traditional retirement account allows an immediate tax deduction, the investments grow tax deferred, and the money isn’t taxed until the funds are withdrawn from the account. Alternatively, taxes are paid on Roth contributions immediately, but both contributions and growth are completely tax free when withdrawn during retirement. Put simply: will you be in a higher tax bracket now or when you withdraw the funds?

10. Asset Allocation: The most important investment decision you can make is how much of your portfolio will be invested in stocks versus bonds. A higher proportion of stocks leads to increased risk, but the potential for greater returns. The more time you have until the funds are needed, the more risk you can usually afford to take. Consequently, you should reduce the proportion of stocks in your portfolio as you approach retirement in order to minimize your risk factor. Identify an asset allocation that is aggressive enough to accomplish your investment goals while exposing you to an acceptable level of risk.

11. Get Caught Up: According to a recent Fidelity study, your nest egg should be one times your salary by age 35, three times your salary by 45, five times your salary by 55 and seven times your salary by 67.

12. Education Planning: Only after your retirement savings is where it should be can you focus on your children’s college education. At this point, explore a Utah Educational Savings Plan 529 (uesp.org) or a Coverdell Education Savings Account, both of which offer tax advantages if used for schooling.

Assessment

Does this mean you don’t need a financial advisor? Of course not! A qualified, comprehensive financial planner can add value, address shortcomings, and answer questions in each of these areas. Once you have completed each of these steps, you can be confident you have your financial ducks in a row.

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Conclusion

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Filed under: Financial Planning, Insurance Matters, Portfolio Management | Tagged: cash flow, Consumer Debt, disability insurance, financial advisors, Financial Planning, Independence for Doctors, life insurance, Lon Jefferies, www.NewWorthAdvice.com | 1 Comment »

PP-ACA Physician Ownership Provisions

Posted on July 5, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding the “whole hospital exception” to the Stark laws

By Dr. David Edward Marcinko MBA CMP®

www.CertifiedMedicalPlanner.org

This was a big week for healthcare reform, wasn’t it? Some provisions of the PP-ACA requiring the employer mandates were delayed another year; until January 1, 2015.

But, before passage of the ACA in 2010, the “whole hospital exception” to the Stark law allowed physicians to have an ownership interest in a hospital to which those physicians refer patients, provided the physician is invested in the whole hospital and not a subdivision of the hospital, with no limitations as to the amount or extent of physician ownership, on either an aggregate or individual basis.

Prohibitions

Now, according to colleague Robert James Cimasi MHA, AVA, ASA, MCBA, CMP®, of www.HealthCapital.com, The ACA completely prohibits physician-owned hospitals which were not Medicare-certified by December 31, 2010.

[1] The ACA allows hospitals with a provider agreement prior to December 31, 2010 to continue Medicare participation if they meet the following four criteria: (1) located in a county with a population growth rate of at least150% the state’s population growth over the last 5 years; (2) have Medicaid inpatient admission percentage of at least the average of all hospitals in the county; (3) located in a state with below-national-average bed capacity; and, (4) have bed occupancy rate greater than state average. [2]

Grandfathered

A very limited number of physician-owned hospital existing in 2010 met or were close to meeting all 4 of criteria.[3] The Reconciliation Act provided a limited exception to the ACA growth restrictions for grandfathered physician owned hospitals that treat the highest percentage of Medicaid patients in their county (and are not the sole hospital in a county).[4]

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Financial Management Strategies for Hospitals and Healthcare Organizations: Tools, Techniques, Checklists and…

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Assessment

Based on these provisions, the 2010 healthcare reform legislation will likely have a considerable negative impact on physician-owned hospitals, in terms of impeding development of new hospitals and expansion of existing hospitals.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

[1] “Section-by-Section Analysis with Changes Made by Title X and Reconciliation included within Titles I-IX,” Democratic Policy Committee, http://dpc.senate.gov/healthreformbill/healthbill96.pdf (Accessed 5/24/2010).

[2] “Section-by-Section Analysis with Changes Made by Title X and Reconciliation included within Titles I-IX,” Democratic Policy Committee, http://dpc.senate.gov/healthreformbill/healthbill96.pdf (Accessed 5/24/2010).

[3] “Healthcare Reform: A Brief Analysis on How it Impacts ASCs and Physician-OwnedHospitals – 10 Observations”, By Scott Becker, Leigh Page, and Rob Kurtz, Becker’s Hospital Review, http://www.beckersorthopedicandspine.com/news-a-analysis/legal-a-regulatory/1193-healthcare-reform-abrief- analysis-on-how-it-impacts-ascs-and-physician-owned-hospitals-10-observations (Accessed 5/20/10).

[4] “Section-by-Section Analysis with Changes Made by Title X and Reconciliation included within Titles I-IX,” Democratic Policy Committee, http://dpc.senate.gov/healthreformbill/healthbill96.pdf (Accessed 5/24/2010).

Filed under: CMP Program, Health Economics, Practice Management | Tagged: ACA, CMP, Dr. David Marcinko, physician owned hospitals, Reconciliation Act, robert james cimasi, Stark law, www.CertifiedfMedicalPlanner.org | 2 Comments »

The Most Common Sites of Automobile Accidents

Posted on July 3, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Doctors Be Aware

[By Dr. David Edward Marcinko MBA]

By Nalley Collision Center

Even with the latest safety features, the risk of an automobile crash or collision is never far away from the minds of most drivers. This is especially the case for some doctors who may have a proclivity to drive expensive automobiles.

But, where are the most common sites for automobile accidents? With the summer upon us – and the long Independence Day weekend – we may have the answers.

The Sites

One popular old statistic suggested that most accidents occur near the home, and numerous road safety campaigns have encouraged drivers not to be complacent as they drive along the streets in their local neighborhood. But, there are also several more specific places where automobile accidents are most common.

Car Parks

Car parks and lots are confined spaces full of motorists engaging in difficult maneuvers around other vehicles, while pedestrians walk around them. In general, the accidents are minor scrapes and dents, but they are very common indeed.

Junctions

It’s not surprising that intersections between roads are likely to produce more than their fair share of accidents. Whether it’s a rear end crunch for the driver suddenly forced to stop while turning, or a side-impact caused by a momentary loss of concentration, junctions are common crash locations.

The good news is that traffic should normally be moving relatively slowly at intersections, so damage is often limited to little more than scratched paintwork and injured pride.

Stoplights

Although unregulated intersections can pose safety problems for drivers, stoplights themselves bring their own challenges. They regulate traffic flow, and can lead to rear end collisions when drivers have to stop suddenly. Sometimes one rear end impact can result in a pile-up as the cars behind also fail to stop in time in a chain reaction. As many stoplights are associated with pedestrian crossings, these accidents have the potential to be serious.

Country Roads

Driving along an empty country road, a driver could be forgiven for thinking that the risk of auto accidents would be low. Unfortunately this appears not to be the case. Country roads are common accident sites for two reasons.

The fact that they are so quiet, and often straight with little variety in the landscape, means that motorists can find themselves losing concentration (often even falling asleep) for just a couple of moments, which is all it takes for a car to end up in a ditch by the side of the road.

Also, of course, rural highways tend not to be as well maintained as busy urban routes, and potholes and other debris also contribute to accidents.

Busy Roads

But, if quiet country roads are common accident sites, so are busy two (or more) lane roads. The reason why busy roads are dangerous is that with several lanes of traffic in each direction, sometimes with no barrier, drivers have no way of avoiding a head-on collision if, for example, a vehicle drifts towards the road’s center, or if a car pulls out into oncoming traffic to overtake the vehicle in front without checking the road ahead.

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More:

Assessment

Doctors, medical professionals and all motorists, have their work cut out, with quiet roads, busy roads, unregulated junctions, stoplights and car parks all providing rich scope for accidents. What this really illustrates, however, is the extent to which drivers cannot afford to let their attention slip for an instant when behind the wheel.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Insurance Matters, LifeStyle, Risk Management | Tagged: Automobile Accidents, Most Common Sites of Auto Accidents | 2 Comments »

Some Vital Survival Tools for Physicians and their Consulting Advisors

Posted on July 1, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

OUR BOOKS, TEXTS AND DICTIONARIES ARE VITAL SURVIVAL TOOLS FOR ALL PHYSICIANS … AND THEIR CONSULTING ADVISORS

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Filed under: Book Reviews, Financial Planning, Health Insurance, Practice Management, Risk Management | Tagged: financial advisors, physicians, Survival Tools for Physicians | Leave a comment »

Events Planner: July 2013

Posted on July 1, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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Events-Planner: JULY 2013

By Staff Writers
“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.

First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 500,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions. As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention.

So, enjoy the Medical Executive-Post and this monthly Events-Planner with our compliments.

A Look Ahead this Month – And now, the important dates:

July 21-24: ASHE Conference. Atlanta, GA
July 28-31: AHRMM Conference. San Diego, CA

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Filed under: Breaking News | Tagged: Events-Planner | Leave a comment »

Safe Driving Tips all Doctor’s May Learn from Bus Drivers

Posted on June 26, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

On Physicians Driving Safely

By Dr. David Edward Marcinko MBA

By Nalley Collision Center

Bus drivers take their lives into their hands every day on city streets and interstate highways. Despite challenging traffic conditions and the responsibility of a large vehicle and numerous passengers, bus drivers find ways to stay safe while keeping up with demanding routes and schedules. These unsung heroes of the road universally command respect, but they also offer important lessons to ordinary drivers who share busy roads with buses every day.

So – as summer is upon us – and in the spirit of safe driving – allow our ME-P team at to share a few bus-driver inspired driving tips with you.

Distracted Driving

Modern technology has caused an addiction for many bus drivers as they struggle to communicate while safely driving a bus.

An Italian bus driver was caught on video simultaneously using two cell phones while steering his bus with his elbows. This talent showed the world that cell phone use behind the wheel might not present the extreme danger most people expect.

Seriously, bus drivers can provide some good examples of how not to drive. Although many states have laws in place restricting the use of electronic devices while driving, many states do not. All drivers, and every doctor, should avoid risking their lives and the lives of passengers by reserving cell phone use to emergencies while driving.

Road Rage

A New York City school bus driver named Juan DelValle side-swiped a car on a crowded city street and was subsequently attacked by the offended driver. DelValle was within days of his long-awaited retirement and died from severe injuries to his brain.

This one example shows how a minor traffic incident can quickly escalate into a life-changing event for unprepared drivers. Drivers should exercise extreme caution every time they have an incident with another driver. After an accident, drivers who feel threatened can call police and wait in their cars until help arrives.

Rest

Bus drivers illustrate why no one should sit behind the wheel of a vehicle when fatigued.

Investigators determined that a tour bus crash in New York that killed 15 passengers was caused by a sleepy driver. The bus driver, Ophadell Williams, was charged with criminally negligent homicide. His life might never return to its previous state.

Drivers who spend time getting the sleep they need might arrive late at their destination, but they also arrive with a clear conscience, an alert mind, and living passengers.

Defensive Driving

A Transit bus in Los Osos, California rolled down an embankment after colliding with a car on a dark and wet stretch of road. Bus drivers know they cannot count on the driving skills of other motorists for safety, so they drive defensively. In the Los Osos case, the bus driver managed to stay alive after the Mercedes crossed the center line.

Although the driver of the automobile died in the wreck, all the bus passengers lived.

More

Assessment

Every driver should periodically take time to review defensive-driving tactics or to attend a defensive driving class to improve their ability to respond to unexpected circumstances on the highway.

Conclusion

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Filed under: Insurance Matters, Risk Management | Tagged: David Edward Marcinko, Defensive Driving, Distracted Driving, Driving Tips, Road Rage | Leave a comment »

On Inherited Money

Posted on June 25, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

The “money scripts” of inheritances

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

“I’ve never seen money passed from one generation to another in a manner that actually benefited the recipient.”

When a psychologist said this to me several years ago, I was dumbfounded.

Many parents, like some doctors, scrimp, save, and sacrifice so they can “leave something to the kids” with the intention of doing them good. It’s hard to accept that inheritances may actually do harm instead. Most of us have money scripts that don’t support this idea.

Money Scripts

Typically, I used to hold several money scripts around inheritances. One was that leaving money to your children is a loving thing to do. Another was that parents should always leave their money to their children. A third was that anyone who received an inheritance would invest it wisely, using only the earnings to improve their lives.

Today I know those money scripts were not universal truths. I have more understanding of the problems involved in giving money away in a manner that is beneficial to the receiver. It isn’t as easy as I once thought.

Seed Money?

Many parents envision inheritances for their kids as “seed money” that will be used for the health, education, and welfare of their offspring for many generations. Research shows that is rarely the case; instead, inherited wealth does not last long. Missy Sullivan summarizes some of the research in “Lost Inheritances,” a Wall Street Journal article published online March 7, 2013. According to this article, 70 percent of those who receive an inheritance of any size spend it all in their lifetimes.

http://online.wsj.com/article/SB10001424127887324662404578334663271139552.html

For the 30 percent that do have something left to pass on, 70 percent of their kids also blow everything they get. That means by the end of the third generation, 90% of the money originally passed down is gone.

While it’s easy to understand how an inheritance of $10,000 may evaporate, it’s difficult to understand that inheritances in the hundreds of millions evaporate just as quickly. How is that possible? Is the average American just incompetent at managing money?

The Research

According to Sullivan, a study done by the Williams Group found that poor investment decisions were not the culprit. About 60 percent of large inheritances disappeared because of a lack of trust and communication between family members. Another 25 percent of the time, money evaporated because the parents failed to prepare the next generation to handle their impending inheritance. Poor investment advice and high fees were the cause in less than 15% of cases.

###

Options

If more high net worth parents knew that only 10% of their hard-earned estates would be around at the end of their grandchildren’s lives, I wonder if they might do a few things differently.

One option would be to address the two biggest issues—lack of communication and preparation for heirs—head-on during their lives. Parents wanting their money to benefit their kids could engage the services of a financial therapist who could help the family address their communication and trust issues long before they pass on their wealth. Preparing their children to manage wealth and use it wisely would be the best way to increase the odds of making an inheritance a blessing rather than a burden.

Another option would be to secure their own retirement, then forget all the scrimping and saving and just have fun blowing the money on themselves.

Still another option would be to give their wealth to worthy causes during their lifetimes or upon their deaths.

Assessment

This would leave the kids to make their money by ingenuity, hard work, wise money management, frugality, and a little bit of luck. The same way, in fact, their parents did. Are medical professionals any different?

More:

Conclusion

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Filed under: Retirement and Benefits | Tagged: inheritance, Rick Kahler CFP®, sudden money | 2 Comments »

On the Future of Dentistry?

Posted on June 24, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Not good for the profession … as we know it!

By D. Kellus Pruitt DDS

If you have not yet noticed, the future doesn’t look good for the dental profession as we know it.

Like far too many neighborhood primary care physicians who can no longer make a profit on their own, managed care is having its way with dentists as well.

Unfortunately, our patients remain clueless about downsides to discounted care sold by huge, insensitive corporations manned by executives who cannot be held accountable for their favorite providers’ level of care.

Since as a dentist I am somewhat transparent anyway, I would like to share some feelings with friends about an awkward subject that is on the minds of more dentists than one might expect, yet (almost) none feel comfortable revealing it: Regardless of the public’s perception of dentists’ wealth for the last few decades, it does not look like the anticipated economic recovery is likely to include the small dental practice down the street.

Schadenfreud

Not unlike Schadenfreude, I am certain at least some of dentistry’s disappointed customers may find this news addictingly pleasing to savor – up until one needs a dentist for a problem that cannot be handled safely by their designated dental therapist preferred by insurance MBAs.

I watch the dental news closer than most dentists, and sadly, my studied predictions have always proven to be very accurate, even if unpopular. Today I confidently predict that the profitability most dentists enjoyed for decades will not return for years – perhaps a decade or more.

On the other hand, as it becomes increasingly difficult to find dentists who allow time for gentle injections, patients should expect to pay them better than most. When an imbalance in the free market becomes unsustainable by artificial means such as managed care’s pay-for-performance algorithms, this is the way competition regulates quality in a natural way.

Personally, I’ve dealt with the downturn by working part time as an associate of another practice to make ends meet, and I feel fortunate to have found such a wonderful opportunity with a wonderful, patient-centered team. Marci, my wife, seems to be happier as well.

Assessment

Sorry if today’s news was a bummer, Doc. Maybe it is time others spoke up as well. Our leaders’ obvious lack of interaction on the internet exposes a tremendous vacuum, and they are incapable of rescuing the profession with silence… and neither will rushed therapists in huge dental clinics.

It’s up to you and me, Doctor. Come on out. The air is fine.

Conclusion

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Filed under: Practice Management, Pruitt's Platform, Risk Management | Tagged: D. Kellus Pruitt DDS, dentistry | 3 Comments »

Will Future Doctors Need a Medical License?

Posted on June 21, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Licensing Doctors – Do Economists Agree?

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Challenging conventional wisdom is something I like to think … that I do.

After all, I am considered a healthcare ‘thought-leader”, and to the extent possible, we publish outside traditional box thinking on this Medical Executive-Post.

It’s all Relative

But, I am a piker compared to Shirley Svorny PhD.

Who is she?

Dr. Shirley Svorny is chair of the economics department at California State University, Northridge, and she holds a PhD in economics from UCLA

Medical Licensure Issues

Now, remember the old saying, “if everyone is thinking alike, then nobody is thinking”.

Well, a while back, Dr. Svorny wondered if a medical degree is a barrier – rather than enabler – of affordable healthcare. Enter the PP-ACA of 2010.

As an expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argued that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today. Malpractice attorneys, and monetary gain motives, too!

Her Published Abstract

“Despite the wide reach of medical licensing in health care production through its impact on the nature and cost of care, it has been all but ignored in debates over health care reform.

This paper pulls together statements made by economists whose expertise is in the area of health economics or, more specifically, medical licensure and discipline. Economists who have examined the market for physician services in the United States generally view state licensing as a means by which to enforce cartel-like restrictions on entry that benefit physicians at the expense of consumers. Medical licensing is seen as a constraint on the efficient combination of inputs, a drag on innovations in health care and medical education, and a significant barrier to effective, cost efficient health care.”

Full paper link: 2004-08-svorny-reach_concl

Am I Thought-Leader?

Am I a thought leader? Well, I don’t rightly know; that’s for others to decide. But, I do know that this essay was published a decade ago; in 2004, and at a time before the ME-P’s existence.

And so, based on this essay, Dr. Svorny is surely a “thought-leader” in my opinion

More about Dr. Svorny

In 1986-87, Dr. Svorny managed an industry risk group at Security Pacific Bank. She was a Milken Institute Affiliated Scholar and served as director of the San Fernando Valley Economic Research Center at Cal State Northridge. She has published articles in Economics of Education Review, Contemporary Economic Policy, Urban Affairs Review, Public Choice, Regional Science and Urban Economics, Cato Journal, Applied Economics, The Journal of Medical Licensure and Discipline, The Energy Journal, Economic Inquiry, and the Journal of Labor Research. Her opinion articles have appeared in the Los Angeles Times and the Los Angeles Daily News. Her research interests are in the areas of urban, labor, and health economics.

Assessment

Do traditionalists or collective healthcare reform advocates and health economists react rationally; or irrationally on this issue? What do you think?

Conclusion

***

Filed under: Career Development, Ethics, Health Economics, Practice Management | Tagged: david marcinko, Licensing Doctors, Shirley Svorny PhD, UCLA, Will Future Doctors Need a Medical License? | 15 Comments »

Understanding the Impact of Regulations, Laws, and Healthcare Reform

Posted on June 17, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Consequences of the Accountable Care Act [PP-ACA]

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

There is a fair amount of activity that will take place in the next 24 months in response to ICD-10 transition, healthcare reform, Accountable Care Act (ACA), meaningful use compliance and its financial incentives, and other regulatory issues that will require system or software upgrades to support the new efforts.

Some ACA Examples

As an example, The Affordable Care Act is sure to significantly alter reimbursement structures and delivery of care.

Below are several areas that will be affected:

With the projected increase in patient volumes, the associated cost of about 62% will emanate from Medicare cuts: $162 Billion through reducing fee-for-service Medicare payments; $136 Billion from setting Medicare Advantage rates based on Fee-for-Service payments; and $36 Billion from cutting hospital Medicare/Medicaid disproportionate share.
Compliance reviews will be increased through the Recovery Audit Contractors (RACs) where Centers for Medicare and Medicaid Services (CMS) expect to obtain $2.9 Billion in additional savings. With the RAC in place, hospitals and providers need to increase their focus and attention in improving documentation quality and validating medical necessity to substantiate their reviews.
Reduced payments for readmissions and Medicare penalties for poor outcomes can and will affect the bottom line for both hospitals and providers in the future.
By 2015, more than 19 million uninsured will receive coverage and in 2016, another 11 Million uninsured will be insured. This will create more patients per hospital/provider and will require more full-time equivalents to support the revenue cycle process of registration, documentation, billing and collection.
With the ICD-10 conversion will create a more complex requirement for documenting diagnoses and will require software modifications for hospitals and providers as well as significant training.

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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, Health Insurance, Health Law & Policy | 2 Comments »

Events Planner: June 2013

Posted on June 15, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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Events-Planner: JUNE 2013

By Staff Writers
“Keeping track of important health economics and financial industry meetings, conferences and summits”

First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 175,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions. As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention.

So, enjoy the Medical Executive-Post and this monthly Events-Planner with our compliments.

A Look Ahead this Month – And now, the important dates:

June 16-19: HFMA Institute Meeting. Orlando, FLA
June 25-27: AHA Health Forum Summit. San Diego, CA.

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Does the U.S. Supreme Court decision resolve the gene-patenting issue?

Posted on June 14, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Human Genes are NOT Patentable

By Karen Matthias RN MBA

[Vice-President of Marketing]

Hayes, Inc kmatthias@hayesinc.com

Yesterday, the U.S. Supreme Court unanimously agreed that human genes are not patentable, making a distinction between “natural” DNA found in the human body and the laboratory-created “synthetic” DNA. This opinion reinforces those of many in the genetics community who have argued for years that genes are products of nature rather than inventions.

A Resolution?

But, does the Supreme Court decision completely resolve the gene-patenting issue?

Dr. Diane Allingham-Hawkins, Senior Director, Genetic Test Evaluation Program and Technical Editing at Hayes, Inc., doesn’t think so.

“The Justices compromised somewhat in their decision that while human genes as they exist in nature were ruled not patentable, the opinion allowed that synthetic copies – so-called complementary DNA or cDNA – may be”.

The Court did not rule, however, that cDNA meets all requirements of patent eligibility, just that cDNA would not be considered a ’product of nature’.

Issues Not Addressed

In addition, Dr. Allingham-Hawkins points out what the decision does not address.

“Notably, the opinion clearly stated that it was not ruling on any methods patents related to the two genes or on any applications regarding what Myriad had learned about the genes, leaving the door open for narrower genetic testing patents.

Nevertheless, this is a major victory for the plaintiffs in the case and for patients, who will now have choices related to who performs their genetic testing and options to seek second opinions from independent laboratories.”

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More

Our new white paper on the history of gene patenting in the United States can be an excellent resource as you search for background information on this topic.

Download a complimentary copy here: http://www.hayesinc.com/hayes/resource-center/white-papers/gene-patenting-in-the-united-states/.

Assessment

Thanks for considering.

Conclusion

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Filed under: Breaking News, Ethics, Health Law & Policy | Tagged: complementary DNA, Diane Allingham-Hawkins, DNA, gene-patenting, Karen Matthias, U.S. Supreme Court | 1 Comment »

Possible Causes of The Military Suicide Epidemic

Posted on June 13, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Erosion of Protective Factors

By Roy Miller roydotmiller@gmail.com

Hey Dr. Marcinko,

I’m one of the guys that reads you day by day. I come from a family with a military tradition, but unfortunately I couldn’t follow this path due to an eye problem. Instead, I became very passionate about army related stuff and I tend to bookmark and save as much material I can find.

I just came across this worrying material about suicide in the army and I’d like to share it with you, maybe you’ll find it interesting:

It’s quite a huge problem that unfortunately hasn’t made it on the public agenda and it’s continuously ignored, so I’m trying to create some buzz around it.

There are 3 protective factors to prevent suicide:

1. Belongingness:

The cohesion and camaraderie of a military unit can induce intense feelings of belonging for many service members. Time away from the unit, however, may result in a reduced or thwarted sense of belonging, as individuals no longer have the daily support of their units and feel separate and different from civilians. This is especially true for Guardsmen and Reservists.

2. Usefulness:

The responsibility inherent in military service, the importance of tasks assigned to relatively junior personnel and the high level of interaction among unit members establish the importance and usefulness of each unit member, particularly in an operational environment. In contrast, the experience of living in a garrison environment (for active component personnel) or returning to a civilian job (for Guardsmen, Reservists and veterans) or, worse, unemployment, can introduce feelings of uselessness.

3. Aversion to pain or death

Repeated exposure to military training as well as to violence, aggression and death dulls one’s fear of death and increases tolerance for pain. Thus, the very experience of being in the military erodes this protective factor, even for service members who have not deployed or experienced combat, in part because service members experience pain and discomfort from the beginning of their training.

Erosion of moral certainty

Moral injury: “damage to your deeply held beliefs about right and wrong. It might be caused by something that you do or fail to do, or by something that is done to you – but either way it breaks that sense of moral certainty.”

• Failing to protect their ‘brothers’
• Friendly fire
• Deaths of civilians, particularly women and children
• Discharged from the military

Assessment

It is not the fear and the terror that service members endure in the battlefield that inflicts most psychological damage, but feelings of shame and guilt related to the moral injuries they suffer.

Sources:

Conclusion

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Filed under: Ethics, Risk Management | Tagged: Army, Friendly fire, Guardsmen, Military Suicide, Reservists | 5 Comments »

Contribute to the Medical Executive-Post and Tell Us What You Think

Posted on June 11, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Call for Guest Medical Executive-Posts!

By Ann Miller RN MHA

[Executive-Director]

MarcinkoAdvisors@msn.com

Now that we’ve wrapped up our newest textbook, we thought it would be fun to keep everybody writing to share your best posts and comments with our ever-growing online community.

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We’re open to all kinds of related subjects on the business of medical practice, healthcare economics and finance, HIT and personal financial planning and investing for doctors and all medical professionals.

###

So, if you’d like to comment or be a featured guest on our blog, or know of a great post we should feature or re-print, just let us know by emailing me! BROADCAST yourself.

www.CertifiedMedicalPlanner.org

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Filed under: Book Reviews, CMP Program, iMBA, Inc. | Tagged: certified medical planner, CMP, Medical Executve-Post | 4 Comments »

On the “Selling Points” for Whole-Life and Universal-Life Insurance

Posted on June 10, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

De-Bunking Conventional Sale Wisdom

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

“You need to protect yourself and your family with life insurance that you won’t outlive.”

This is one of the common selling points for whole life or universal life rather than term life insurance. At first glance, it seems to make a lot of sense. Of course you don’t want to outlive your life insurance. Having it pay benefits upon your death is the reason you buy it.

This statement, however, misses one essential fact. Many people don’t need to worry about outliving their life insurance, because they outlive their need for life insurance.

Outliving the Need

We don’t all need life insurance throughout our entire lives, any more than we do auto or homeowners’ insurance. If you no longer drive a car, you don’t need auto insurance. If you no longer own a home, you don’t need homeowners’ insurance.

For example, in circumstances like the following, you may no longer need life insurance:

First; when you and your spouse have accumulated enough assets and income streams to independently care for yourselves.
Second; when your children are self-sufficient adults.
Third; when your estate is too small to owe estate taxes or liquid enough to pay the estate taxes.

Primary Purpose

The primary purpose of life insurance is to replace the future income of a primary breadwinner. Two groups most likely to need it are middle-aged couples saving for retirement and parents of minor children. Ideally, most young families should have over $-1 million in life insurance to provide for the children if either parent should die prematurely.

Yet many of them are unable to afford the higher premiums for this much “permanent” insurance. Their choices are to underfund their needs with a smaller permanent policy or purchase an affordable 30-year term policy.

As we age, the probability of dying becomes greater. Therefore, a $1 million life policy costs much less for a 25-year-old than a 75-year-old. It doesn’t matter if the policy is cash value, whole life, universal life, or level term, the cost of providing the life insurance component increases every year.

Psychological Aversions

Yet most human brains have a psychological aversion to price increases. In order to please their customers with life insurance premiums that didn’t increase every year, insurance companies came out with level term policies. Essentially, the premiums are averaged out by overcharging in the early years of the policy and undercharging in the later years.

Higher Premiums

Whole life and universal life insurance policies don’t have that same averaging. To be “permanent,” the premiums must be much higher in order to fund a savings account that grows over time and is often used to offset a significant portion of the death benefit in the later years of the insured’s life. Usually, if the insured cancels the policy, a portion of the premiums will be refunded.

Cash Value

A cash value policy may occasionally be a good estate planning tool, generally for those with substantial wealth. It might be used to fund an irrevocable life insurance trust upon the second spouse’s death, perhaps to pay taxes on an illiquid estate like a family farm or other property. It also can be used for those wanting to leave the bulk of an estate to charity and still provide income to their children. These strategies rarely apply to those whose primary goal is basic income replacement for their families.

Assessment

One of the ironies of insurance in general is that we all know it’s essential and we all hope never to need it. For most people, life insurance is not really an exception to this. Its primary purpose is not to provide us with investment income, but to provide our families with income if we aren’t there.

More:

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Filed under: Insurance Matters | Tagged: rick kahler, term life insurance, universal life insurance, Whole life Insurance | 1 Comment »

Celebrating “National Get Outdoors Day”

Posted on June 8, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

National Get Outdoors Day is June 8th, 2013

By Staff Reporters

National Get Outdoors Day is a new annual event to encourage healthy, active outdoor fun.

Participating partners will offer opportunities for American families to experience traditional and non-traditional types of outdoor activities.

Prime goals of the day are reaching first-time visitors to public lands and reconnecting our citizens and youth to the great outdoors.

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Assessment

So, leave the couch behind today.

More: www.NationalGetOutdoorsday.org

Conclusion

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Are Doctors Bad Investors?

Posted on June 7, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Longboard Assessment Management Study for Lay Investors

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Assessment

And so, are doctors and other medical professionals really bad investors?

More:

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Investing, Portfolio Management | Tagged: Are Doctors Bad Investors, physician investors | Leave a comment »

Physician-Investors and the “F” Word

Posted on June 6, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

“Fiduciary”

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

Okay, I did it again in a recent column. And, I got into trouble again. That’s what I get for using the F-word.

Mea Culpa

My most recent transgression was to point out the simple fact that insurance agents are compensated by commissions on the products they sell. They have no fiduciary duty to legally act in the best interests of their customers.

Every time I remind readers that sellers of financial products do not have a fiduciary duty to their customers, I get indignant responses from financial salespeople who seem to think I have accused them of being unethical.

Ethics

Not so. Someone who sells financial products may well operate with integrity. In fact, their licenses typically require that they be “fair” and “honest.” These salespeople may care about their customers and be committed to selling only products that they believe will meet their customers’ needs.

But being a fair, honest, and ethical salesperson is not the same thing as having a legal fiduciary duty to the consumer. The word “fiduciary” has a specific meaning in our legal system. It describes those in positions of trust or authority who are required by law to act in the best interests of those they represent. A fiduciary is an advocate for the consumer, who is legally termed a “client.”

Of Doctors and Attorneys

Doctors and attorneys have fiduciary relationships with their patients and clients. The executor of an estate is a fiduciary. So is a trustee, someone acting under a power of attorney, or an agent hired to represent you. Real estate agents can be fiduciaries if they are engaged to represent either buyers or sellers.

Financial planners can also be fiduciaries. Yet those who offer financial advice and services in conjunction with the sale of a financial product are not fiduciaries.

Follow the Money

How can you generally tell whether a financial professional is required by law to act in your best interests? Simple. You follow the money. Wherever the professional’s compensation comes from is most likely where the fiduciary responsibility goes.

If you hire a fee-only financial planner, you are directly paying that person for professional advice and services. The planner receives his or her income from you and others like you. You are clients, not customers, and the planner is legally obligated to act on your behalf.

This is not the case if you buy financial investment products or receive financial advice from someone who is compensated by commissions. It doesn’t matter whether this person’s business card says “financial consultant,” “financial planner,” “investment advisor,” or “broker.” Anyone can use those terms.

Commission Sales

But, if someone is paid by commissions from financial companies, he or she is a sales representative whose fiduciary responsibility is to those companies. They may call you their “client,” but in the legal sense, you are not. You are a customer who buys products from a salesperson. Just like those who sell cars, groceries, or shoes, these salespeople owe their primary loyalty to their employers. They are obliged to operate in the best interests of themselves and their companies.

This relationship has a built-in conflict of interest. Because financial salespeople make most of their money from commissions, their recommendations to customers are usually biased toward investments that will be the most profitable for themselves. Their legal responsibilities are to act fairly and honestly. Most either don’t or won’t disclose the amounts and sources of their commissions

More:

Assessment

A financial salesperson who is not a fiduciary certainly can act with integrity. I know many who do. That means they are honest people who want to thrive in business by selling legitimate products in a responsible and ethical way. It does not, however, make them fiduciaries.

Conclusion

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Understanding the Spoils of Healthcare Fraud and Abuse

Posted on June 5, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Self Explanatory – Need we say more?

By ME-P Staff Writers

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[Click on image to enlarge]

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Assessment

Conclusion

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
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FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Ethics, Health Economics, Risk Management | Tagged: healthcare abuse, healthcare fraud | 6 Comments »

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