How Volatile Is the Stock Market Today?

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And … Is it Dangerous?

By Lon Jefferies CFP® MBA www.NetWorthAdvice.com

Lon JefferiesBased on conversations with physician and clients, I’d suggest that most investors view the market of the new millennium as more volatile and fragile than it’s been in the past.

JUNE 4, 2013

DOW 15,253.7 +138.1
NASDAQ 3,465.49 +9.58
S&P 1,640.61 +9.87

New concerns that could affect a portfolio are seemingly always coming to light – think of the near-financial collapse of the U.S. economy during the last recession, the U.S. debt downgrade, the potential bailout crises in Europe and the possible devaluation of the euro, domestic unemployment concerns, and the perennial concern about the inflation/deflation of the dollar.

Add to this the idea that the world has become a more unstable place and the reality that supercomputers make thousands of trades every second.

How Valid Are the Concerns?

To determine the validity of these perceptions, Allan Roth analyzed the performance of the Wilshire 5000 (an index of the market value of all stocks actively traded in the United States) since 1980 in the May edition of Financial Planning Magazine. Surprisingly, Mr. Roth found that market swings of more than 30% weren’t much more common during the past 10 years than they were from 1980-2002. In fact, on a monthly basis, market swings of more than 10% actually occur less these days than in the past.

On a daily basis, the mean standard deviation of returns (a measure of volatility) over the entire 32-year period was 1.01%. In other words, during 68% of trading days, the index increased or decreased by less than 1.01%. Further, on 95% of trading days the index went up or down by no more than 2.02% (or two standard deviations). While daily standard deviation hit a record in 2008 of more than 2.5%, last year actually had lower volatility than the overall average. Consequently, while volatility hit a high in 2008, it has been at a very normal level since.

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Stock_Market

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Why the Perceptions?

So why do investors perceive more uncertainty in today’s environment? Mr. Roth mentions a few hypotheses:

  • Magnitude Effect – To suffer a 2.5% decrease in 1972, the S&P 500 would have needed to decrease by 2.54 points. To endure a 2.5% decrease today, the index would need to decrease by 41.25 points. Although both represent the same investment loss, we perceive the double digit point swing as larger and more dramatic.
  • Availability Bias – Humans overestimate the probability of events associated with memorable or vivid occurrences. Memorable events are further magnified by excessive coverage in the media.  Because the market crash of 2008 was so remarkable, investors tend to overestimate the probability of a similar crash and underestimate the probability of market appreciation, which historical data says is significantly more likely.
  • Access to Information – Jason Zweig, a columnist for the Wall Street Journal, says “today between websites, Facebook, Twitter, the TV and smart phones, an investor couldn’t escape knowing about a big move in the stock market if he or she tried. Whatever you pay attention to, while you are attending to it, will always seem more significant than it really is.”
  • Simple Fear and Pessimism – Meir Statman, a finance professor at Santa Clara University, suggests “people who think the U.S. is in decline view investing as riskier now than in the past, when they believe the country was better off, and no amount of data showing actual volatility would change their minds.” Similarly, Daniel Kahneman, a Nobel laureate and Princeton professor suggests “people always think the present is more volatile than the past. Because we know that historic crises have resolved themselves, we may simply remember the past as being less volatile than we viewed it at the time.”

More:

Assessment

It’s likely beneficial for physicians and all investors to evaluate their behavior and determine if they exhibit any of these biases. History tells us that the most dominate factor leading to investment success is to keep your asset allocation steady. Being aware of tendencies that might encourage us to make rash investment decisions could save us a lot of stress during critical market movements.

Conclusion

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The Chiropractic Fad?

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Now those hieroglyphics make sense!

By Anthony Narushka DC945457_573594136020162_1396079168_nAssessment

Chiropractic, it’s no fad!

Polish Chiropractic Association

New PCA BOD Members

[2009 Polish Chiropractic Association  BOD Members]

Conclusion

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What Physician-Investors Need to Know about the Shiller PE Ratio

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What it is – How it works

By Michael Zhuang MS www.MZCap.com

This Shiller PE index is a stock market metric invented by Yale University Professor Robert Shiller, PhD.

Basically, it is the average PE ratio of all S&P 500 stocks for the last ten years. The Shiller PE is also called PE10. Professor Shiller found it to be a reasonably good measure of valuation of the whole market.

IOW: The higher the Shiller PE, the more expensive the market. So, with Shiller PE at 24, we can call this market relatively expensive.

Assessment

Here is what I know currently.

  1. The  higher the Shiller PE – the lower the one-year and three-year return propensity.
  2. Return variability is so high as to render the Shiller PE’s predictive power very weak.
  3. Only when Shiller PE is over 35 are the three-year forward returns overwhelmingly negative.

So, the market may or may not be headed for a fall immediately, but we do need to temper our expectation of future returns.

About the Author

Michael Zhuang is founder and principal of MZ Capital, a fee-only registered investment advisor firm located in the Greater Washington D.C. metropolitan area.

Conclusion

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Cell Phone Usage In Car Crashes Massively Underreported

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Are You Guilty – Doctor?

[An NSC Infographic]

COM-Cell-Phone-Crash-Underreporting

Conclusion

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Are Doctors NOW Members of the Middle Class?

In OR Out?

By Dr. David Edward Marcinko MBA CMP®

By Rick Kahler MS CFP® ChFC CCIM

Rick Kahler CFPThe middle class Marketers target it. Politicians champion it. Economists talk about it. Most of us consider ourselves part of it. FAs want to serve it.

Yet, when I’ve asked for a clear definition, I have not found anybody yet that really can tell me what “middle class” is.

Definition

I recently posted on Twitter that $90,000 was a middle-class household income and that it would take a nest egg of $3 million to generate that income in retirement.

A couple of my colleagues responded that my figures were way too high and accused me of being out of touch. As a lifelong South Dakotan, I’m used to being seen as “out of touch,” but the idea that $90,000 was beyond a middle-class income intrigued me.

I figured a few minutes with Google would point me to a definition of “middle class.” It wasn’t that simple. I soon discovered that neither politicians, nor economists, sociologists, nor financial advisors can agree on what makes someone middle class. It is a little easier to define a middle class income.

USA Today

I did find an excellent article in USA Today by Dan Horn of the Cincinnati Inquirer. He cited three surveys that attempted to define the middle class by income. The Pew Charitable Trust describes it as the middle 20%, an income range from $32,900 to $64,000. The U.S. Census Bureau disagrees.

They say a middle class income is the middle 60%, an income range of $20,600 to $102,000. The U.S. Department of Commerce begs to differ with both and says an income between $50,800 and $122,000 puts you in the middle class. Combining the income range of the three studies ($20,600 to $122,000) puts two-thirds of all income earners in the middle class.

My Personal POV

For me, defining middle class with such a broad income range just raises more questions than it answers.

First of all, the same income that will provide a comfortable middle-class lifestyle in a place like the Black Hills of South Dakota won’t necessarily do the same in San Francisco or Boston.

Second, if you want to assure yourself of a middle-class income throughout your lifetime, you apparently have to get rich.

Concept of expensive education - dollars and diploma

Case Model

Let’s assume a young couple, both allied healthcare professionals, earn $45,000 each for a household income of $90,000. Let’s assume they want to save enough to provide a similar income in retirement without counting on Social Security. To generate that income, with a 99% certainty they will never run out of money, how much will they need to save?

While financial advisors’ responses will vary, most will agree this couple would need between $2 million and $4 million in today’s dollars. Let’s settle on $3 million. If they each saved $1,000 monthly to 401k’s (about 25% of their salaries), our young couple could save $6,600,000 million ($3 million in today’s dollars adjusted for inflation) by the time they reached age 65.

However, while a couple needs $3 million to produce a middle-class income, someone with a net worth of $3 million is in the financial top 2% of Americans. That’s hardly middle class.

And to complicate things further, Gallup polls have shown that most Americans think anyone with a net worth of $1 million is rich. Yet having $1 million when you retire will generate a secure lifetime income of $30,000. So the net worth that we define as wealthy provides an income that we define as barely middle class.

More:

Assessment

Confused yet? I certainly am. There’s just one thing I’m still sure of. If you want a middle-class lifestyle after you retire, what you’d better do now is live a modest middle-class lifestyle so you can save enough to qualify as rich.

Conclusion

And so, are doctors members of the middle class – in potential retirement income under this model? Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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A Hospital Industry Outlook for 2013

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One Expert’s Opinion

By Ann Miller RN MHA

[Managing Editor]

The ME-P and nation recently celebrated National Hospital Week for 2013. And so, what better time than now to ask health economist and financial expert Robert James Cimasi MHA, ASA, AVA, CMP for his take on the industry outlook. www.HealthCapital.com

cimasiHistory Background and Overview

The U.S. Healthcare Delivery System is facing what is perhaps its greatest challenge in the expected demand for increased health services from the aging of the “baby-boom” generation, the fastest-growing segment of the population.

The enactment of healthcare reform in March 2010, requiring increased insurance coverage requirements for individuals and employers, will also increase patient demand for hospital inpatient and outpatient services in the coming years.

Hospital Industry 

The hospital industry continues to face many challenges in the changing healthcare environment, including workforce shortages, rising healthcare costs to provide care, and difficulty acquiring needed capital. With consistent financial stresses, hospitals in some areas appear to be struggling.

However, general acute-care hospitals recorded record high profits of $35.2 billion in 2006, an increase of over 20% from 2005.  Total net revenues for general acute-care hospitals were $587.1 billion, resulting in an average profit margin of 6% (the highest since 1997, when the average profit margin was 6.7%).

While the demand for healthcare continues to rise, the site of service also continues to evolve as more procedures are performed on an outpatient basis and by freestanding facilities rather than by inpatient acute care hospitals.  As evidence of this trend, the number of freestanding ambulatory care surgery centers increased from 2,864 in 2000 to 5,197 in 2006.

U.S. healthcare costs are again increasing after their rate of growth slowed in the mid-1990s.

In 2009, total national health expenditures (NHE) in the U.S. grew to $2.5 trillion, a 5.7% increase from 2008.  Meanwhile, the nation’s gross domestic product (GDP) shrank by 1.1%, and as a result, NHE increased from 16.2% to 17.3% of the GDP: the largest one-year increase-in history. Additionally, healthcare spending has been projected to grow to 19.6% by 2016. The potential impact of the 2010 healthcare reform legislation to reduce rising healthcare expenditures is yet uncertain.

According to a 2002 study conducted by the Blue Cross and Blue Shield Association (BCBSA), inpatient costs are responsive to hospital market organization.  Each 1% increase in for-profit hospital market share is associated with a 2% increase in inpatient expenditure per person.  Conversely, each 1% increase in network hospital market share corresponds to a 1% decrease in inpatient expenditures.

Risk Sharing

As healthcare costs again continue to rise faster than inflation in the overall economy in 2013, driven by advances in technology and treatment (as well as the growing baby-boomer population), pressures to reduce costs, such as those included in the ACA will result in a changed paradigm for healthcare delivery.

Reimbursement mechanisms are increasingly designed to control costs and access, and hospitals must continually adjust to deal with increasing pressure to contain reimbursement and utilization levels; ie., share financial risks.

The Marketplace

The healthcare marketplace continues to experience dramatic change as the business of healthcare becomes increasingly competitive, particularly in the outpatient ancillary services arena.  Providers and payors continue to seek to control costs and markets. Legal and regulatory issues also affect change as providers adapt to new opportunities and restrictions.

In particular, there are a wide variety of cost, operational, and regulatory pressures impacting the specialty and surgical hospital industry.

Of course, these pressures are offset by the stable and increasing demand for hospital services, particularly for those hospitals already in operation.

national-hospital-week

Assessment

Bob feels that hospitals that are operationally efficient will continue to be successful within this environment; others will not. How about you?

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

More: Arkansas Medical News Interviews Dr. Marcinko

Conclusion

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Doubting the Accountable Care Organization B-Model

New Healthcare Business Model or Edsel Model?

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By David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

Dr. Marcinko with ME-P FansDefined by Professor Michael Porter at Harvard Business School, value is defined as a function of outcomes and costs. Therefore to achieve high value we must deliver the best possible outcomes in the most efficient way, outcomes which matter from the perspective of the individual receiving healthcare and not provider process measures or targets.

Sir Muir Gray expanded on the idea of technical value (outcomes/costs) to specifically describe ‘personal value’ and ‘allocative value’, encouraging us to focus also on shared decision making, individual preferences for care and ensuring that resources are allocated for maximum value.

Healthcare Value and ACOs

According to our Medical Executive-Post Health Dictionary Series of administrative terms http://www.HealthDictionarySeries.org  and health economist and colleague Robert James Cimasi MHA, ASA, AVA CMP™ of www.HealthCapital.com; an ACO is a healthcare organization in which a set of providers, usually large physician groups and hospitals, are held accountable for the cost and quality of care delivered to a specific local population.

ACOs aim to affect provider’s patient expenditures and outcomes by integrating clinical and administrative departments to coordinate care and share financial risk.

ACO Launch

Since their four-page introduction in the PP-ACA of 2010, ACOs have been implemented in both the Federal and commercial healthcare markets, with 32 Pioneer ACOs selected (on December 19, 2011), 116 Federal applications accepted (on April 10, 2012 and July 9, 2012), and at least 160 or more Commercial ACOs in existence today.

Federal Contracts

Federal ACO contracts are established between an ACO and CMS, and are regulated under the CMS Medicare Shared Savings Program (MSSP) Final Rule, published November 2, 2011.  ACOs participating in the MSSP are accountable for the health outcomes, represented by 33 quality metrics, and Medicare beneficiary expenditures of a prospectively assigned population of Medicare beneficiaries.

If a Federal ACO achieves Medicare beneficiary expenditures below a CMS established benchmark (and meets quality targets), they are eligible to receive a portion of the achieved Medicare beneficiary expenditure savings, in the form of a shared savings payment.

Commercial Contracts

Commercial ACO contracts are not limited by any specific legislation, only by the contract between the ACO and a commercial payor.

In addition to shared savings models, Commercial ACOs may incentivize lower costs and improved patient outcomes through reimbursement models that share risk between the payor and the providers, i.e., pay for performance compensation arrangements and/or partial to full capitation.

Although commercial ACOs experience a greater degree of flexibility in their structure and reimbursement, the principals for success for both Federal ACOs and Commercial ACOs are similar.

###

Eidsel

Dr. David E. Marcinko with 1960 Ford Edsel

[© iMBA, Inc. All rights reserved, USA.]

[The Edsel was an automobile marque that was planned, developed, and manufactured by the Ford Motor Company during the 1958, 1959, and 1960 model years. With the Edsel, Ford had expected to make significant inroads into the market share of both General Motors and Chrysler and close the gap between itself and GM in the domestic American automotive market. But, contrary to Ford’s internal plans and projections, the Edsel never gained popularity with contemporary American car buyers and sold poorly. The Ford Motor Company lost millions of dollars on the Edsel’s development, manufacturing and marketing].

More:

 

Update

Junking the Merit-Based Incentive Payment System (MIPS) would undoubtedly let the proverbial air out of the MACRA balloon, dealing a significant blow to the value-based reimbursement shift; right?

Assessment

Although nearly any healthcare enterprise can integrate and become an ACO, larger enterprises, may be best suited for ACO status.

Larger organizations are more able to accommodate the significant capital requirements of ACO development, implementation, and operation (e.g., healthcare information technology), and sustain the sufficient number of beneficiaries to have a significant impact on quality and cost metrics.

Conclusion

But, will this new B-Model work? Isn’t leading doctors in a shared collaborative effort a bit like herding cats? And, what about patients, HIEs, outcomes management, data analytics and … Population Health via our colleague David B. Nash MD MBA of Thomas Jefferson University, often considered the “father” of Pop Health?

OR, what about the developing IRS scandal and full PP-ACA launch in 2014? Will it affect federal funding, full roll-out, or even repeal of the entire Act?

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Purchase ME-P Textbooks, Handbooks and Dictionaries to Thrive

 Our Library is Growing … thanks to you

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By Ann Miller RN MHA

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We have been publishing the Medical Executive-Post for more than eight years now. And, with almost 3,000 formal posts, by the nation’s brightest experts, we have a treasure trove of information available to you.

So now, for the first time, all this information – and more – has been codified, updated, copy-righted and copy-protected in print form for your purchase and use. All have been edited by our Publisher – Dr. David Edward Marcinko and Professor Hope Rachel Hetico.

Just click on an image below to order.

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Assessment

Purchase our white papers, too: https://medicalexecutivepost.com/white-papers/

Conclusion

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Finding Emotional Freedom [Access the Truth Your Brain Already Knows]

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Book Review

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

Rick Kahler CFP“It’s not about the money.” This saying has become almost a cliché among financial planners and therapists who help clients address the emotional aspects of their relationships with money.

We keep using this phrase because it is so true. Overspending, taking unreasonable risks, money conflicts that strain marriages, failing to learn from money mistakes, and a host of other problematic money patterns are not about money. They are about emotions. And since brain researchers tell us that 90% of all decisions are made emotionally, it literally “pays” to pay attention to your emotions.

Because money affects so many aspects of our lives, it’s only natural that destructive behavior around money is one of the ways people try to cope with emotional pain. Money dysfunction is really no different from other destructive behaviors like addiction or codependency. Like them, it can have high physical, emotional, relationship, and financial costs.

The more I learn about the relationship between our emotions and our money choices, the more I understand why financial knowledge alone isn’t enough to help people change unhelpful behaviors that keep them stuck. I am convinced of the value of financial therapy and other forms of counseling to help people create financial and emotional balance in their lives. It’s clear to me that psychotherapy offers clear financial benefits as well as emotional ones.

The Book

A new book by Dave Jetson, Finding Emotional Freedom: Access the Truth Your Brain Already Knows, addresses these issues in one of the more clear and succinct manners I’ve encountered.

Dave is one of the few counselors in the nation who understands and practices financial therapy. In his practice and workshops, he uses experiential therapy techniques that access both the conscious and unconscious parts of the brain to help people recover from any type of abuse and trauma, including financial. I’ve seen first-hand how effective this work is.

I also know that Dave is one of those rare guides who’s actually done and succeeded at what he teaches. He is one of those who walks the walk. Now he has written a book describing that walk.

Finding Emotional Freedom includes a clear, readable description of how our brains process emotions. This is useful, even critical information for anyone who wants to make wiser money choices.

Finding Emotional Freedom: Access the Truth Your Brain Already

Co-Dependency

Dave also describes how codependency develops and some of the patterns it takes. Many of these patterns—from addictions, to shopping as “retail therapy,” to excessive taking care of others—have financial as well as emotional costs.

Even though Dave offers financial therapy and has created a workshop on Financial Recovery, he doesn’t specifically discuss financial codependency in this book. This doesn’t mean the issue is not important. In fact, it serves to underscore the principle that that many money issues really are not about the money.

Assessment

Finally, this book explains how experiential therapy works and the deep changes it can make. Finding Emotional Freedom shows the possibilities for not only healing emotional wounds, but for increasing your emotional intelligence. It’s a powerful book, and I highly recommend it.

When I was starting out as a financial planner 30 years ago, I wouldn’t necessarily have even picked up a book like this, much less have felt comfortable recommending it to clients. Now I know better.

What I have learned over those years is that real financial planning is about much more than just the money. Providing investment advice that helps people achieve financial health is certainly important. But the larger role of a financial planner is to help clients prosper. Real prosperity includes not only financial health, but also emotional health and happiness.

Conclusion

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How the IRS’s Nonprofit Division Got So Dysfunctional

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The IRS Controversy

By Kim Barker and Justin Elliott

ProPublica, May 17, 2013, 5:14 p.m.

The IRS division responsible for flagging Tea Party groups has long been an agency afterthought, beset by mismanagement, financial constraints and an unwillingness to spell out just what it expects from social welfare nonprofits, former officials and experts say.

The controversy that erupted in the past week, leading to the ousting of the acting Internal Revenue Service commissioner, an investigation by the FBI, and congressional hearings that kicked off Friday, comes against a backdrop of dysfunction brewing for years.

Moves launched in the 1990s were designed to streamline the tax agency and make it more efficient. But they had unintended consequences for the IRS’s Exempt Organizations division.

Checks and balances once in place were taken away. Guidance frequently published by the IRS and closely read by tax lawyers and nonprofits disappeared. Even as political activity by social welfare nonprofits exploded [1] in recent election cycles, repeated requests for the IRS to clarify exactly what was permitted for the secretly funded groups were met, at least publicly, with silence.

All this combined to create an isolated office in Cincinnati, plagued by what an inspector general this week described [2] as “insufficient oversight,” of fewer than 200 low-level employees responsible for reviewing more than 60,000 nonprofit applications a year.

A Major Mistake

In the end, this contributed to what everyone from Republican lawmakers to the president says was a major mistake: The decision by the Ohio unit to flag for further review applications from groups with “Tea Party” and similar labels. This started around March 2010, with little pushback from Washington until the end of June 2011.

“It’s really no surprise that a number of these cases blew up on the IRS,” said Marcus Owens, who ran the Exempt Organizations division from 1990 to 2000. “They had eliminated the trip wires of 25 years.”

Of course, any number of structural fixes wouldn’t stop rogue employees with a partisan ax to grind. No one, including the IRS [3] and the inspector general [4], has presented evidence that political bias was a factor, although congressional and FBI investigators are taking another look.

But what is already clear is that the IRS once had a system in place to review how applications were being handled and to flag potentially problematic ones. The IRS also used to show its hand publicly, by publishing educational articles for agents, issuing many more rulings, and openly flagging which kind of nonprofit applications would get a more thorough review.

All of those checks and balances disappeared in recent years, largely the unforeseen result of an IRS restructuring in 1998, former officials and tax lawyers say.

“Until 2008, we had a dialogue, through various rulings and cases and the participation of various IRS officials at various ABA meetings, as to what is and what is not permissible campaign intervention,” said Gregory Colvin, the co-chair of the American Bar Association subcommittee that dealt with nonprofits, lobbying, and political intervention from 1991 to 2009.

“And there has been absolutely no willingness in the last five years by the IRS to engage in that discussion, at the same time the caseload has exploded at the IRS.”

IRS

Stone Walling

The IRS did not respond to requests for comment on this story.

Social welfare nonprofits, which operate under the 501(c)(4) section of the tax code, have always been a strange hybrid, a catchall category for nonprofits that don’t fall anywhere else. They can lobby. For decades, they have been allowed to advocate for the election or defeat of candidates, as long as that is not their primary purpose. They  also do not have to disclose their donors.

Social welfare nonprofits were only a small part of the exempt division’s work, considered minor when compared with charities. When the groups sought IRS recognition, the agency usually rubber-stamped them. Out of 24,196 applications for social welfare status between 1998 and 2009, the exempt organizations division rejected only 77, according to numbers compiled from annual IRS data books.

Into this loophole came the Supreme Court’s Citizens United decision in January 2010, which changed the campaign-finance game [5] by allowing corporate and union spending on elections.

Sensing an opportunity, some political consultants started creating social welfare nonprofits geared to political purposes. By 2012, more than $320 million in anonymous money poured into federal elections.

A couple of years earlier, beginning in 2010, the Cincinnati workers had flagged applications of tiny Tea Party groups, according to the inspector general, though the groups spent almost no money in federal elections.

Main Question

The main question raised by the audit is how the Cincinnati office and superiors in Washington could have gotten it so wrong. The audit shows no evidence that these workers even looked at records from the Federal Election Commission to vet much larger groups [6] that spent hundreds of thousands and even millions [7] in anonymous money to run election ads.

The IRS Exempt Organizations division, the watchdog for about 1.5 million nonprofits, has always had to deal with controversial groups. For decades, the division periodically listed red flags that would merit an application being sent to the IRS’s Washington, D.C., headquarters for review, said Owens, the former division head.

In the 1970s, that meant flagging all applications for primary and secondary schools in the south facing desegregation. In the 1980s, during the wave of consolidation in the health-care industry, all applications from health-care nonprofits needed to be sent to headquarters. The division’s different field offices had to send these applications up the chain.

“Back then, many more applications came to Washington to be worked — the idea was to have the most sensitive ones come to Washington,” said Paul Streckfus, a former IRS lawyer who screened applications at headquarters in the 1970s and founded the industry publication EO Tax Journal [8] in 1996.

Because this list was public, lawyers and nonprofits knew which cases would automatically be reviewed.

“We had a core of experts in tax law,” recalled Milton Cerny, who worked for the IRS, mainly in Exempt Organizations, from 1960 to 1987. “We had developed a broad group of tax experts to deal with these issues.”

In the 1980s, the division issued many more “revenue rulings” than issued in recent years, said Cerny, then head of the rulings process. These revenue rulings set precedents for the division. Revenue rulings along with regulations are basically the binding IRS rules for nonprofits.

“We would do a revenue ruling, so the public and agents would know,” Cerny said. “Over the years, it apparently was felt that a revenue ruling should only be published at an extraordinary time. So today you’re lucky if you get one a year. Sometimes it’s less than that. It’s amazing to me.”

Other checks and balances had existed too. Not only were certain kinds of applications publicly flagged, there was another mechanism called “post-review,” Owens said. Headquarters in Washington would pull a random sample every month from the different field offices, to see how applications were being reviewed. There was also a surprise “saturation review,” once a year, for each of the offices, where everything from a certain time period needed to be sent to Washington for another look.

So internally, the division had ways, if imperfect, to flag potential problems. It also had ways of letting the public know what exactly agents were looking at and how the division was approaching controversial topics.

For instance, there was the division’s “Continuing Professional Education,” or CPE, technical instruction program. These articles were supposed to be used for training of line agents, collecting and putting out the agency’s best information on a particular topic — on, say, political activity [9] by social welfare nonprofits in 1995.

“People in a group would write up their thoughts: ‘Here’s the law,’” said Beth Kingsley, a Washington lawyer with Harmon, Curran, Spielberg & Eisenberg who’s worked with nonprofits for almost 20 years. “It wasn’t pushing the envelope. It was, ‘This is how we see this issue.’ It told us what the IRS was thinking.”

The system began to change in the mid-1990s. The IRS was having trouble hiring people for low-level positions in field offices like New York or Atlanta — the kinds of workers that typically reviewed applications by nonprofits, Owens said.

In Cincinnati

The answer to this was simple: Cincinnati.

The city had a history of being able to hire people at low federal grades, which in 1995 paid between $19,704 and $38,814 a year — almost the same as those federal grades paid in New York City or Chicago. (Adjusted for inflation, that’s between $30,064 and $59,222 now.)

“That was well below what the prevailing rate was in the New York City area for accountants with training,” Owens said. “We had one accountant who just had gotten out of jail — that’s the sort of people who would show up for jobs. That was really the low point.”

So in 1995, the Exempt Organizations division started to centralize. Instead of field offices evaluating applications for nonprofits in each region, those applications would all be sent to one mailing address, a post-office box in Covington, Ky. Then a central office in Cincinnati would review all the applications.

Almost inadvertently, because people there were willing to work for less than elsewhere, Cincinnati became ground zero for nonprofit applications.

For the time being, the checks remained in place. The criteria for flagged nonprofits were still made public. The Continuing Professional Education text was still made public. Saturation reviews and post reviews were still in place.

But by 1998, after hearings in which Republican Senator Trent Lott accused the IRS of “Gestapo-like” tactics, a new law mandated the agency’s restructuring. In the years that followed, the agency aimed to streamline. For most of the ‘90s, the IRS had more than 100,000 employees. That number would drop every year, to slightly less than 90,000 [10] by 2012.

Change Will Come

Change also came to the Exempt Organizations division.

The IRS tried to remove discretion from lower-level employees around the country by creating rules they had to follow. While the reorganization was designed to centralize power in the agency’s Washington headquarters, it didn’t work out that way.

“The distance between Cincinnati and Washington was such that soon Cincinnati became a power center,” said Streckfus, the former IRS lawyer.

Following reorganization, many highly trained lawyers in Washington who previously handled the most sensitive nonprofit applications were reassigned to focus on special projects, he said.

Owens, who left the IRS in 2000 but stayed in touch with his old division, said the focus on efficiency meant “eliminating those steps deemed unimportant and anachronistic.”

In 2003, the saturation reviews and post reviews ended, and the public list of criteria that would get an application referred to headquarters disappeared, Owens said. Instead, agents in Cincinnati could ask to have cases reviewed, if they wanted. But they didn’t very often.

“No one really knows what kinds of cases are being sent to Washington, if any,” Owens said. “It’s all opaque now. It’s gone dark.”

By the end of 2004, the Continuing Professional Education articles stopped [11].

Recommendations [12] from an ABA task force for IRS guidelines on social welfare nonprofits and politics that same year were met with silence.

Even the IRS’s Political Activities Compliance Initiative, which investigated [13] complaints of charities engaged in politics — primarily churches — closed up shop in early 2009 after less than five years, without any explanation.

Both before and after the changes, the Exempt Organizations division has been a small part of the IRS, which is focused on collecting money and chasing delinquent taxpayers.

US capitol

IRS Employee Count in 2012

Rulings and Agreements, the division that handles applications of all nonprofits, accounted for less than 0.5 percent of all IRS employees in 2012.

Source: IRS Data Books [14], IRS Exempt Organizations Annual Report [15]

Of the 90,000 employees at the agency last year, only 876 worked in the Exempt Organizations’ division, or less than 1 in 1,000 employees.

Of those, 335 worked in the office that actually handles applications of nonprofits.

Most of those — about 300 — worked in Cincinnati, Streckfus estimates. The rest were at headquarters, in Washington D.C.

In Cincinnati, the employees’ primary job was sifting through the applications of nonprofits, making determinations as to whether a nonprofit should be recognized as tax-exempt. In a press release [16] Wednesday, the IRS said fewer than 200 employees were responsible for that work.

In 2012, these employees received 60,780 applications. The bulk of those — 51,748 — were from groups that wanted to be recognized as charities.

But the number of social welfare nonprofit applications spiked from 1,777 in 2011 to 2,774 in 2012. It’s impossible to say how many of those groups indicated whether they would engage in politics, or why the number of applications increased. The IRS said Wednesday that it “has seen an increase in the number of tax-exempt organization applications in which the organization is potentially engaged in political activity,” including both charities and social welfare nonprofits, but didn’t specify any numbers.

Total 501(c)(4) [17] Nonprofit Applications from 2002 to 2012

From 2011 to 2012, applications increased by more than 50 percent.

Source: IRS Data Books [14]

On average, one employee in Cincinnati would be responsible for going through roughly one application per day.

Some would be easy — say, a local soup kitchen. But to evaluate whether a social welfare nonprofit has social welfare as its primary purpose, the agent is supposed to use a “facts and circumstances” test. There is no checklist. Reviewing just one social welfare nonprofit could take days or weeks, to look through a group’s website, track down TV ads and so forth.

“You’ve got 60,000 applications coming through, and it’s hard to do that with the number of agents looking at them,” said Philip Hackney [18], who was in the IRS’s chief counsel office in Washington between 2006 and 2011 but said he wasn’t involved in the Tea Party controversy. “The reality is that they cannot do that, and that’s why you’re seeing them pick stuff out for review. They tried to do that here, and it burned them.”

As we have previously reported, last year the same Cincinnati office sent ProPublica [19] confidential applications from conservative groups. An IRS spokeswoman said the disclosures were inadvertent.

The Commissioner Speaks

Mark Everson, IRS commissioner for four years during the George W. Bush administration, said he believed the fact that the division is understaffed is relevant, but not an excuse for what happened. “The whole service is under-funded,” he pointed out.

And Dan Backer, a lawyer in Washington who represented six of the groups held up because of the Tea Party criteria, said he doesn’t buy the notion that low-level employees in Cincinnati were alone responsible.

“It doesn’t just strain credulity,” Backer said. “It broke credulity and left it laying on the road about a mile back. Clearly these guys were all on the same marching orders.”

The inspector general’s audit was prompted last year after members of Congress, responding to complaints by Tea Party groups, asked for it.

Like former officials interviewed by ProPublica, the audit suggests that officials at IRS headquarters in Washington were unable to manage their subordinates in Cincinnati. When Lois Lerner, the Exempt Organizations division director in Washington, learned [20] in June 2011 about the improper criteria for screening applications, she instructed that they be “immediately revised.”

But just six months later, Cincinnati employees changed [21] the revised criteria to focus on “organizations involved in limiting/expanding government” or “educating on the Constitution.” They did so “without executive approval.”

“The story people are overlooking is: Congress is complaining about underpaid, overworked employees who are not adequately trained,” said Bryan Camp, a former attorney in the IRS chief counsel’s office.

Assessment

In the end, after all the millions of anonymous money spent by some groups to elect candidates in 2012, after all [22] the groups [23] that said in their applications that they would not spend money to elect candidates before doing exactly that, after the Cincinnati office flagged conservative groups, the IRS approved almost all the new applications. Only eight applications were denied.

Source: http://www.propublica.org/article/how-irs-nonprofit-division-got-so-dysfunctional

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Need a Manager of Surgical Nurses and Operating Rooms

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Seeking A Direct Hire in Kansas

By Kathy Williams kathyw@thorgroup.com
Resource Manager
Thor Group, Inc.

Dear Dr. David E Marcinko,

Hello!  We are looking for a Manager of Surgical Nurses and Operating Rooms.

Our client has a wonderful opportunity to have a work balance life style.  If one of your ME-P readers would like the peace and quiet of a small town plus a great opportunity for your career, this opportunity is for them!

This position will manage and supervise functions related to patient care in the operating rooms; ensure effective delivery of patient care and compliance with administrative and facility policies and procedures.  This position will pay $60-75K depending in experience.  Direct Hire in Kansas.

Responsibilities:

• Guides and directs nursing staff regarding safe, effective patient care, problem-solving and decision making according to patient needs, staff capabilities and facility resources.
• Maintains up-to-date knowledge of new procedures, products and equipment used in the OR.
• Interviews, orients, assigns work schedules, conducts and reviews evaluations and disciplines personnel to manage performance.  Oversees OR staff in conducting annual performance evaluations and competency documentation.
• Ensure proper daily staffing levels in all operating rooms.
• Assist in investigating and initiating follow-up and corrective action when necessary in response to complaints and/or concerns from patients, families, physicians or employees.  Develops, implements and monitors, methods and strategies to achieve high patient satisfaction results.
• Is familiar with, and maintains compliance within the OR Department, on all regulatory agency requirements.
• Maintains compliance with accreditation/licensure requirements.
• Identify operational needs; manage appropriate level of equipment and supplies and monitors equipment maintenance.  Assess the environment and make recommendations to ensure optimal patient comfort, safety and compliance with various regulatory bodies.

Qualifications:

• Diploma from accredited nursing program.
• Current Licensure as Registered Nurse and able to obtain a Kansas license.
• Minimum of 3 years management experience in hospital setting preferred.
• Certification in area of specialization.
• Demonstrated excellent communication skills.

###

Healthcare Jobs

Assessment

THOR, Inc. is a cutting-edge business solutions firm that has been working with some of the top companies throughout the United States for nearly 40 years.

If you are interested in the Manager of Surgical Nurses and Operating Rooms position, please send your updated resume along with salary history to kathyw@thorgroup.com. If you are not interested in this opportunity, perhaps you know someone who might be, please have them forward their resume to me!

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A Red-Neck Doctor

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You know you are a red-neck doctor, when ….?

By Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

Recently, an ME-P subscriber who knows of my vintage Jaguar restoration project, sent me this photograph. We do not own it or have copyrights to it; still it is presented here in the interest of humor and collegiality.

###

Jaguar

Assessment

With all due respect to my Atlanta neighbor, and comedian, Jeff Foxworthy.

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Healthcare Promises [aka ACA]

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On the Affordable Care Act

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

Rick Kahler CFP“I’m not sure what’s wrong or what kind of surgery you need, but we have to operate right now.”

If you heard this from your doctor, you’d jump off the examination table and run for the door. Yet that’s essentially the approach the President and Congress used three years ago to pass a bill, optimistically called the Affordable Care Act, which was the largest transformation of the U.S. health care system in our lifetime.

The Debate

During the frenzied debate our elected leaders made many promises as to the amazing benefits this legislation would bestow on Americans. After listening to speeches from President Obama, Speaker of the House Nancy Pelosi, and President of the Senate Harry Reid, I recounted those promises in this blog on March 21, 2010.

The Promises

Let’s revisit those promises.

  1. All Americans will now receive affordable, or free, quality health care.
  2. No one will ever be denied coverage.
  3. No one will ever go into bankruptcy because of the costs of health care.
  4. There will be increased access to health care for 95% of Americans.
  5. There will be no decline in the quality of health care.
  6. Health care costs will go down.
  7. Health insurance coverage will be affordable to the middle class.
  8. There will be no decline in Medicare benefits.
  9. Insurance premiums will decline for the middle class.
  10. It will unleash unprecedented entrepreneurial opportunity for the economy.
  11. The deficit will decline, saving taxpayers $1.3 trillion.
  12. It will cut $500 billion of waste, fraud, and abuse out of Medicare.
  13. No government funds will be used to fund abortion.

Are these promises coming true? Many of them are pending full implementation of the act in 2014. Others have fallen flat or encountered the law of unintended consequences.

Obama Care

Business Owner’s

I’ve heard recently from several owners of small businesses about their increased health insurance costs. In addition to premium increases of nearly 50% over the past two years, they are seeing increased administrative costs from what one person called the “insanity and complexity” of the new regulations.

Businesses with fewer than 50 employees aren’t required to provide health insurance. The incentive for owners of businesses close to that threshold is to keep employee numbers below 50, which means curtailing growth or even laying people off.

Those without employer-provided insurance are supposed to be able to shop for coverage in new health care exchanges, beginning this October. However, half the states have chosen to rely on the federal government instead of setting up their own exchanges.

This has brought criticism even from former supporters like Democratic Senator Max Baucus of Montana, who helped write the health care bill. He is concerned that the exchanges will not open on time and consumers won’t have the information they need to use them. He told the Huffington Post that Obamacare is headed for a “train wreck.”

ACA Cost Estimates

The proponents said the ACA would cost $938 billion over 10 years. In addition to the promised Medicare savings, this was to be covered by a total tax increase of $562 billion over 10 years. This included a Medicare tax of 3.8% on dividends, rents, interest, and investment income on individuals and small business earning over $250,000.

The Office of Management and Budget, however, places the cost at $1.8 trillion over 10 years, resulting in a shortfall of around $900 billion.

Assessment

Whether Obamacare becomes the wild success the proponents guaranteed is yet to be seen. However, what we’ve seen so far isn’t promising. We as consumers would be well advised to pay close attention and ask tough questions before we accept this drastic surgery.

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When did you last Review your Insurance Coverage – Doctor?

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Why shopping around periodically is a smart move

By Lon Jefferies, MBA CFP™  http://www.NetWorthAdvice.com

Lon JeffriesWhen is the last time you compared rates on your home and auto insurance policies – doctors and all ME-P readers? Unfortunately, a stellar safety record doesn’t always translate into lower insurance rates. Even if you think you have a good rate, shopping around periodically is smart.

A Reader’s Query

After attempting to follow my advice of maintaining an umbrella insurance policy, one of our ME-P readers contacted his insurer to add coverage. This reader was shocked when his insurer informed him that he didn’t qualify for an umbrella policy because he didn’t carry sufficient liability insurance on his auto policy. (Minimum auto liability insurance – frequently $500,000 – is required in order to purchase umbrella coverage.) Although this individual had owned his policy for eight years, he was unaware that the policy only provided $50,000 of liability coverage. This amount was clearly insufficient for an individual approaching retirement.

In addition to realizing that he was severely under-insured, this individual discovered he was also paying excessive premiums. For only $50,000 of auto liability coverage, this person was paying $914 per year. Moreover, the individual realized he was paying $351 per year for the $350,000 of liability coverage the individual had on his condo. Consequently, in total, this person was paying $1,265 per year for $50,000 of auto liability and $350,000 of home liability coverage.

Case Model

This individual then spoke with an independent insurance agent to increase auto liability coverage to an amount that enabled him to obtain an umbrella policy. This was critical, as it dramatically decreased the individual’s liability exposure, a risk an individual with accumulated assets clearly shouldn’t have. Even better, the individual was able to obtain dramatically improved rates on his policies. For a total of $1,207 (less than he was previously paying!), the individual was able to secure $1,000,000 of auto liability coverage, $350,000 of home liability, and an additional $1,000,000 umbrella policy.

policy insurance

Assessment

Clearly, it can be beneficial to occasionally review and compare rates on your insurance policies. People tend to believe that policies that have been owned for extended periods of time are efficiently priced, but it may be the opposite. If you haven’t verified that you are adequately insured and conducted a cost comparison recently, speak to an independent insurance agent and minimize your exposure with cost-effective policies.

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ProPublica Launches Prescriber Checkup [Interactive Database]

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The Doctors and Drugs in Medicare Part D

By Jeff Larson, Jennifer LaFleur, Charles Ornstein, Tracy Weber and Lena Groeger

ProPublica, Updated at May 10, 2013

Medicare’s popular prescription-drug program now serves more than 35 million people, but the names of prescribers and the drugs they choose have never previously been public … Until now.

###

Medicare and Medicaid drug capsules
Assessment

Use this tool to find and compare doctors and other top prescribers in 2010.

Link: http://projects.propublica.org/checkup/

More:

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Seeking Director of Hospital Accounting

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For an East Coast Facility

By Kathy Williams kathyw@thorgroup.com
Resource Manager
Thor Group, Inc

Dear Dr. David E Marcinko,

Hello!  We are looking for a Director of Accounting for Hospital client located on East Coast. This is a Direct Hire position.  The position will oversee 3 Managers and 15 FTE’s.  This position will report to the VP of Accounting.

POSITION SUMMARY

The purpose of the position is to provide primary oversight, supervision and strategic direction to the General Accounting Department. This position ensures the accuracy of hospital’s consolidated financial statements in accordance with Generally Accepted Accounting Principles (GAAP) and system-wide policy.

Job Requirements

1. Previous Director / Manager experience in Hospital / Healthcare Accounting role
2. CPA or MBA required.
3. 7 to 10 years of experience.
4. The knowledge and ability to direct, control and supervise the activities of the General Accounting Department at a level generally acquired through 7 to 10 years of progressive experience in healthcare accounting
5. Experience formulating business and accounting policies and procedures
6. Extensive experience using computerized accounting systems and Microsoft Office.

###

jobs

Assessment

If any ME-P reader is interested in this Director of Accounting position, please forward their resume to me at kathyw@thorgroup.com.  If you are not interested in this opportunity, perhaps you know someone who might be … please have them forward their resume to me!

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Events Planner: May 2013

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Events-Planner: MAY 2013

By Staff Writers
Calendar Calculator“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 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:

  • NAPFA National Meeting: Paris Hotel, Las Vegas, NV.
  • FRA Advisor Forum: Harvard Club, Boston, MA.
  • May 08: Public Safety Congress: New Orleans, LA.
  • May 16: Hospital Medicine: National Harbor, MD.

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Value Focused Frugality for Medical Professionals

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Authentic versus Misguided Frugality?

By Rick Kahler MS CFP® ChFC CCIM

http://www.KahlerFinancial.com

Rick Kahler CFPMedical professionals and those who successfully build wealth have one trait in common: they understand the art of frugality.

The Millionaires Next Door

These unassuming millionaires know how to live on much less than they make, and they know how to save money. But those behaviors alone aren’t enough. Why? Because not spending money today does not always result in having more money tomorrow!

On Frugal Types

Frugality for its own sake can result in doing without things that matter to you, failing to take care of basic needs like your health, and living with a sense of deprivation. It can also lead to spending more money, not less, in the long run.

Frugality for the sake of enhancing your life, on the other hand, features an eye for value. Most people who build wealth are masters at the art of getting value.

Thinking Savings        

There are many ways we might think we are saving money, but actually the opposite is true. We end up spending more money in the long term. Here are a few of the ways we can fail to get value:

1. Not spending the money to have legal documents drawn. A poorly-worded agreement—or even worse, no written agreement at all—can cost you a bundle in future legal fees or even result in your losing a business or other asset.

2. Doing your own taxes. Unless your finances are so simple you can file the 1040-EZ, you’re better off to pay a professional who will find deductions you’re likely to miss.

3. Buying a new car to save money on repairs. An occasional repair bill for a few hundred dollars is still a lot cheaper than a monthly payment.

4. “Saving” money by spending on bargains you don’t need or want. This includes settling for what’s cheapest instead of looking for the best price on what you really want.

5. Going without insurance. At a minimum, you should have homeowner’s or renter’s insurance, car insurance with maximum liability amounts, and a high-deductible health insurance policy. A loss or liability that isn’t covered can cost you everything you have.

6. Not getting regular medical checkups. “An ounce of prevention is worth a pound of cure” is a cliché because it’s so true.

7. Looking only at the initial price tag without comparing long-term costs. A more expensive but higher-quality item, whether it’s a car or a pair of shoes, might last much longer and be a better value than something cheaper.

8. Not focusing on value for services when purchasing investments. A discount broker, for example, isn’t always a better deal than a full-service broker. For “A” shares of mutual funds, you may pay the same in commissions without getting any personalized help. If you use a discount broker, be sure to purchase “no-load” funds, which don’t have commissions.

9. Paying hidden costs for financial advice. Writing a check to a fee-only planner may seem too expensive. Yet Bob Veres, editor of Inside Information, says that investors who don’t pay directly for the financial advice they get often pay two times more in hidden costs for the “free” advice. If you buy investments products from a financial salesperson, keep asking questions until you know exactly what you’re paying in commissions and fees.

10. Paying off a low-interest loan instead of putting the money into a retirement account. If you can earn more than you pay in interest, it may be wiser to keep making loan payments.

Fiscal Cliff

Assessment

Frugality that focuses on value is an essential wealth-building tool. Those who use it well do more than just save money. They know how to get the most value for the money they do spend. Do you, doctor?

Conclusion

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Understanding the Domestic “Shadow Economy”

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Is the US Economy Strong OR Not?

By Dr. David Edward Marcinko MBA

www.CertifiedMedicalPlanner.org

Dr David E Marcinko MBARecently, new highs for the DJIA and some better than expected jobs numbers pointed an outward sign of the US  economy’s continued — though sluggish — recovery from the Great Recession.

Workers in the Shadows

But, there may be another explanation for why consumers keep spending more despite higher payroll taxes and more pain at the gas pump.

Edgar Feige PhD Speaks

That reason is a thriving shadow economy, estimated to have reached as much as $2 trillion last year, according to a study (.pdf file) co-written by Edgar Feige, an economist at the University of Wisconsin-Madison.

Assessment

A shadow economy is one where workers turn to employment that pays under-the-table. While that sometimes includes illegal activity, such as drug dealing, much of the shadow economy today appears to be in areas like service work such as babysitting; medicine, eye, foot and dental care; and working construction jobs for cash.

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Conclusion

And so, are new medical practice business models like retainer and concierge medicine, direct/private pay, or cash care more or less prone to participation in the underground healthcare economy?

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Moonlighting and Deducting Professional Expenses [video]

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For Healthcare Accountants

By Andrew Schwartz CPA

http://schwartzaccountants.com/

Andrew Schwartz

Content: Video (mp4) – 122.48MB
Title: Andrew Schwartz Webinar 1.16.13 Moonlighting and Professional Expenses

Video: http://www.screencast.com/t/Zksfdssln

Andrew D. Schwartz, CPA, received his B.S. in Accounting and Finance from the Wharton School at the University of Pennsylvania. Prior to forming Schwartz & Schwartz, P.C. in 1993, he worked at KPMG Peat Marwick, LLP.  Andrew is the author of many tax and financial articles on a variety of issues that impact healthcare professionals.  He is frequently quoted as a tax advisor on current topics in national publications, such as the Washington Post and Wall Street Journal.   Andrew is also the founder of The MDTAXES Network,  a national association of CPAs that specialize in the healthcare profession.

Conclusion

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Ten Methods of Maximizing Medical Practice Income

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On Overhead and Practice Efficiency

By Neal Baum MD

Dr. BaumAs I meet with doctors, other urologists and office managers throughout the country, I am frequently told, “Neil, we don’t need more patients. We need to increase our reimbursement, decrease our overhead, and improve the efficiency of care.”

Introducing Neil H. Baum MD

I will leave the reimbursements to the experts, but now I would like to focus on overhead and practice efficiency.

The Past

In the past we enjoyed the luxury of seeing a relatively few patients and enjoying very juicy, fat profit margins. Today, the situation is reversed. Many of us are seeing a lot more patients and we all know about those razor thin profit margins. As a result we are motivated to become more efficient.

The List

So, in this ME-P article, I will provide you with ten ideas to make your practice more efficient:

  1. Have the lab results on the patients chart or in the patients electronic medical record before the patient arrives for hisor her appointment. Nothing can slow down your patient flow than to have a patient who had a prostate biopsy in the exam room and not have the pathology report on the chart. Now your nurse or patient coordinator calls the pathologist for the report and has the report faxed to the office. This can 15-30 minutes and a very anxious patient is waiting in the exam room for the report. Or, a worst case scenario is the pathology slides have not been read and the patient makes an unnecessary visit. All of this can be solved by checking the charts the day before the patients arrive to see that all lab and x-ray reports are on the chart.
  2. Use a scribe. My accounting practice consultant advised me that all of my efforts should be dedicated to doing only what a physician can do and not any other activity that can be accomplished by someone with less training, skills, or compensated a lesser fee than a physician. With that advice, I decided I should not be taking the history of the chief complaint, the review of systems, and past medical history. I have now trained a “scribe” who does all of that for me before I conduct the physical examination. I then report to her the few findings I have found on the physical exam and what are my treatment recommendations which are carried out by the scribe or the nurse. As a result I spend far fewer minutes with each patient but the time that is spent with them is quality, eyeball to eyeball time.
  3. Effective scheduling. I don’t know of a urology practice that doesn’t have one or two emergencies or urgencies where the patients need to be seen the very  day they contact the office. Every morning or afternoon my practice receives a call from an existing patient that needs to be seen immediately or a call from a referring doctor who has a patient in their office that needs immediate urologic care. In the past the patient was told to come in and that they would be worked into the schedule. As a result, patients with scheduled appointments were delayed 15-30 minutes. Today we leave a 15 minute time slot at 10:30 A.M. and another open slot at 2:45 P.M. and these urgencies or emergencies are told to come at those designated times or at the very end of the day. These slots are referred to as “sacred time” and cannot be filled until after 8:30 A.M. on the day we are seeing patients. I have yet to encounter a patient or referring doctor that won’t accept that scheduling option. Now that late morning or late afternoon scheduled appointment is seen in a timely fashion.
  4. Answer all of  your patient’s questions at the time of their visit. It was not uncommon for me to think I was finished with a patient, close their chart, and start to walk out of the room and as soon as my hand touched the door knob, the patient would say, “Dr. Baum, I have one more question.” Frequently, I would have patients interrupt me as I was about to see another patient or they would call to take to me or my nurse after they left the office. Now patients are given a card when they check in which allows them to write down what questions they would like to ask the doctor on this visit. Patients will frequently start thinking about what they want to ask during the visit while they are in the reception (not waiting) room or when they are taken to the exam room. This now avoids the door handle questions and ensures that the patients’ most pressing concerns are answered when the chart or EMR is opened.
  5. Use videos to explain common urologic conditions and procedures. There are days when I might discuss a topic such as vasectomy three or four times. I found that I could considerably improve my efficiency by making a 5-7 minute video of me explaining the procedure, the complications, the risks, and the post-procedure caveats. After examining the patient, I tell them I would like them to view a video on vasectomy and I would like them to open the door when the video is completed and I will return to provide them with a written summary and to answer any questions that they may have on the procedure. While they are watching the video, I am able to see 1-2 patients. I also write in the chart that the patient has seen the video which makes good medical-legal documentation that patient was informed of the risks, complications, and alternatives of treatment.
  6. Educate patients before, during, and after their visit to your office. Today there is an abundance of educational materials available to your patients from pharmaceutical and device companies, the Internet, and software companies specializing in patient education. (I use DialogMedical at www.dialogmedical.com.) When a patient calls for an appointment, they are asked the purpose of their visit and they are encouraged to go to our website for educational material or we are happy to send them educational material before they come to the office on the medical condition or problem they may have. They are also provided with educational material during their visit as well as additional information in the “thanks for  being our patient” letter that they receive from our office after they have left our office. It has been my experience that an educated patient makes a better patient and less time needs to be delegated to explaining their medical condition. These educational materials are also available in other languages and usually are written at the 10th grade level.
  7. Never touch a piece of paper or mail twice. So many times I will look at the mail or reports and then place them in another pile to take action on later. It is far more efficient to look at the mail and reports and take action on the paper immediately. You can use Post-It notes if you plan to delegate the action to another staff member.
  8. Leave your office with all paper work completed. Try to avoid allowing paper work to become a mountain of charts on the back of your desk. You become more efficient if you can do the dictation real time in front of the patient or immediately after each patient encounter. Now you don’t have to rely upon your memory when you review the chart days or weeks later.
  9. Schedule time for patient call backs. Have your office tell patients that you will be calling them at a designated time at the end of your working day or ask for the number where they can reached at a time when you plan to return calls. Now you avoid playing telephone tag with your patients and avoid them waiting for extended periods of time for you to return their call.
  10. Use drive time to call patients at home. Most of us live 15+ minutes from our practices. You can make good use of this time by contacting patients that you or your office staff were not able to reach during your business day. I have my staff tell the patient that I will be calling between 6-7 P.M. and would they please be at home and keep the line free so that we avoid telephone tag. Most patients are eager to hear from their doctor and will make themselves available at a time convenient for you.

Healthcare Workers

Assessment

There you have it; a few ideas that can help make you more efficient and allow you to see more patients and improve your bottom line. By the way if you have any other ideas that you have used successfully and would like to share with your colleagues, please let me hear from you.

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Out Recent Textbook Foreword by Dr. Baum

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Conclusion

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Did You Survive the [Fleeting-Tweeting] “Flash-Crash” of 2013?

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The Day the Dow Jones Industrial Average Lost 150 Points

By Lon Jefferies, MBA CFP™  http://www.NetWorthAdvice.com

Lon JefferiesThe stock market just reached an all time high, crossing 15,000 for the first time.

But, within three minutes during last April 23, 2013, the Dow Jones Industrial Average lost nearly 150 points, and approximately $136 billion of market value was wiped out. The recovery was just as fast, and markets returned to having a profitable session (both the Dow and the S&P 500 were up over 1% for the day). The crash and recovery both happened so fast that many Americans, and physician-investors, weren’t even aware of the events.

So what happened?

On Tweeting

Believe it or not, the crash was caused by a tweet – a 140 character message posted on Twitter. The Associated Press Twitter account — which has nearly 2 million followers — was hacked and a false tweet of “Breaking: Two Explosions in the White House and Barack Obama is Injured” was posted. The message was quickly debunked by the President’s staff and markets corrected themselves. Both the crash and recovery took place in less than five minutes.

Lessons Learned

Several lessons were learned that day.

First, the power of social media is now undeniable. This was caused by a simple twelve-word lie on the internet. Further, information about the market collapse and recovery were widespread via Twitter and Facebook instantaneously, while the whole episode was over before television networks had a chance to report the events.

Second, it’s amazing how fragile our world is these days. News regarding terrorism has the potential to dramatically affect the market as well as other important aspects of our lives. It’s concerning how the world might respond if the President really was injured. (Interestingly, however, the market didn’t suffer after the Boston Marathon tragedy.)

Third, it is fascinating to examine how different asset categories responded in a time of perceived crisis. Investors build diversified portfolios hoping that when one asset category collapses, another asset class will rally. Some investors swear that gold will be the asset to own when the world struggles. Yet, when the market experienced a flash crash, gold did not rally but treasury bonds and the Japanese Yen did. Gold investors shouldn’t be as confident in their investment after this experience.

Finally, automated trading platforms have become more prevalent in the stock market. These tools execute mandatory, instant sell orders in defined market environments. When the crash occurred, algorithms read headlines and saw the initial market reaction and computers created automatic sell orders at what turned out to be the worst possible time. Traders utilizing automatic trading mechanisms with stop-loss orders suffered exaggerated losses, as they sold right after the market dip and didn’t participate in the recovery. This is a potential weakness of automatic trading that many didn’t recognize.

College Tuition Rising as Stocks are Dropping

Assessment

Why are many physician-investors unaware of this unusual market event? In reality, this drastic swing didn’t affect most investors hoping to improve their retirement. Individuals with a long-term investment strategy built around their risk tolerance don’t need to worry about these types of short-term market errors. At the end of the day, “buy-and-hold” investors had nothing to worry about and came out ahead. Perhaps we should be bragging via Twitter…

More:

Conclusion

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Seeking Vice-President of Medical Management

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Advocate BroMenn Medical Center and Advocate Eureka Hospital in Normal, Illinois

By Paul Esselman
Executive Vice President, Managing Principal
Cejka Executive Search
4 CityPlace Dr., Ste. 300
St. Louis, MO 63141
pesselman@cejkasearch.com

Dear Dr. Marcinko,

Cejka Executive Search has been retained to recruit a physician executive to be the Vice President, Medical Management of Advocate BroMenn Medical Center and Advocate Eureka Hospital.

The Opportunity

Advocate BroMenn Medical Center, a 221-bed full-service, not-for-profit, Level II trauma center and teaching facility located in Normal, Illinois, is one of the most advanced acute care facilities in central Illinois.  Last year, Advocate BroMenn opened a new 136,000 sq. ft. hospital addition housing state-of-the-art diagnostic and therapeutic services as well as opened a new 84,000 sq. ft. outpatient center, housing imaging, therapy and laboratory services and physician practices.

Advocate Eureka Hospital is a 25-bed critical access facility located 25 miles north of Normal.  With their affiliation with Advocate Health Care in 2010, Advocate BroMenn and Advocate Eureka are now part of the largest integrated healthcare system in Illinois and one of the Top 10 health systems in the country. Advocate BroMenn has been consistently recognized for high performance and awarded the Consumer Choice Award as the “Most Preferred Hospital for Overall Quality and Image” in its region.

Leadership Team

As a key member of the senior leadership team, the VPMM will serve as the clinical strategist to drive improvement in hospital-wide services and quality measures for the two hospitals.  The VPMM will be instrumental in working with the medical staffs and Advocate Health Care’s Clinical Integration division to implement its nationally-recognized approach to patient care utilizing the best practices in evidence-based medicine, advanced technology and quality improvement techniques.  The VPMM will lead the organization in achieving a high level of quality, service, and outcomes and align the culture of physician providers and the hospitals in preparation for healthcare reform.

The VPMM will also coordinate medical affairs and implement consistent policies and practices; manage and develop physician education initiatives; and oversee clinical utilization, case and risk management, and physician satisfaction at both facilities.

###

jobs

Candidates

Successful candidates will have at least five years of experience in clinical practice and at least three years of demonstrated success in a senior medical executive role within a hospital, preferably serving in a similar position.  Current board certification is required.  An MBA/ MMM degree is highly desirable.

Information Requests

For more information or to nominate candidates, kindly contact me. Thank you.

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The Cost of [Healthcare] Data Storage Through-Out the Years

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A Hard Drive History Infographic

By Mike Thomas historyofharddrives@gmail.com

425 N Prince St
Lancaster, PA 17603
7172079980

Data storage wasn’t as inexpensive as it is today. Technology is always advancing and doing bigger and better things that seemed impossible at one time. With that being said, the price of data storage has only decreased while the size of the storage overall has vastly increased.

The following infographic delves into the price of data storage throughout the years beginning with the first hard drive on the market, the RAMAC 305 that was available in 1956. Follow the timeline throughout history and read about the transformation of these data storing devices. Whether you’re a computer geek, a technology hoarder, or new to the computer world we live in, this infographic is one you will enjoy. Share this on your social media profiles, email it to the IT department at the office, or blog about these outrageously priced data storage devices to gain a new appreciation for the storage capacity we have today.

MD and financial literacy

History Of Data Storage Devices

They just don’t build things quite like they used to. This statement may seem clichéd, but it greatly applies to data – and not in a bad way. Through the years, technology becomes more and more advanced, exceeding expectations and pushing toward new and innovative products and capabilities.

In the case of this infographic, computer memory and data storage have increasingly changed since their beginnings in 1956. If we hadn’t learned how to make memory and data storage servers smaller, then we’d still have rooms solely dedicated to these large machines like the RAMAC 305 that was the size of two large refrigerators. Computers would still be gigantic and immobile, unlike our sleek and portable laptops. Nowadays, our laptops, cell phones, and desktop computers are smaller than years past but are equipped with larger memory capabilities that it once had.

Advances in Computer Data Storage Devices

To gain a better appreciation for the advances in technology, we’ve created an infographic that highlights the data storage throughout the years. Beginning with the RAMAC hard drive, we outline all types of storage devices from 1956 to present. Learn how much money these products cost at the time as well as what the price would be like with inflation factored in. It’s interesting to understand these data storage solutions, particularly how they became smaller in size yet bigger in storage capabilities. Millions of people from school students to business professionals rely on the memory in their computer to save documents, presentations, and other important information.

How crazy would it be if one megabyte of storage still cost $10,000 like in 1956? If that were still the case, laptop prices would be out of this world, and many companies and schools wouldn’t have computers to work on. Sprinkled throughout the infographic are interesting facts on how much a megabyte of storage has cost throughout the years. These amazing statistics demonstrate jut how much the price of storage has decreased since 1956.

RocklandIT Infographic

infographic on the cost of data storage

[click to enlarge]

Save, Store, and Share

Whether you’re an MD, FA, CPA, JD, student, computer geek or just interested in learning more about [medical] data storage devices, feel free to share this information with friends, family, and others. We hope that you enjoy reading this content and we encourage that you blog, tweet, pin, and share this graphic with the world.

Assessment

And, your HIT department, hospital, clinic or office coworker might appreciate viewing this infographic and possibly recollect using one of these storage devices of the past.

Conclusion

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

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
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Why President Nixon Signed the Controlled Substances Act in 1970

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The DEA History

[By Staff Reporters]

Doctors prescribe harmful and potentially addictive drugs, and they all hold a DEA license to do so.

But, did you know that one of the foundations upon which the Drug Enforcement Administration was created is the Controlled Substances Act (CSA)? It was signed into law as part of a broader set of laws called The Comprehensive Drug Abuse Prevention and Control Act of 1970.

The CSA

As all doctors and nurses know, the CSA created five schedules for controlled substances ranging from Schedule I, the most restrictive classification to Schedule V, the least so.

Schedule I drugs have a 1) High potential for abuse 2) No currently accepted medical use in treatment in the United States and c) Lack of accepted safety for use under medical supervision.

Medicare and Medicaid drug capsules

Definition of Controlled Substance Schedules

An updated and complete list  of the schedules is published annually in Title 21 Code of Federal Regulations  (C.F.R.) §§ 1308.11 through 1308.15.

Substances are placed in their respective schedules based on whether  they have a currently accepted medical use in treatment in the United States,  their relative abuse potential, and likelihood of causing dependence when  abused.  Some examples of the drugs in  each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted  medical use in the United States, a lack of accepted safety for use under  medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are:  heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote,  methaqualone, and 3,4-methylenedioxymethamphetamine (“Ecstasy”).

Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse  which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone  (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone  (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).  Other Schedule II narcotics include:  morphine, opium, and codeine.

Examples of Schedule II stimulants include: amphetamine  (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate  (Ritalin®).

Other Schedule II substances include: amobarbital,  glutethimide, and pentobarbital.

Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less  than substances in Schedules I or II and abuse may lead to moderate or low  physical dependence or high psychological dependence.

Examples of  Schedule III narcotics include: combination products containing less than 15  milligrams of hydrocodone per dosage unit (Vicodin®), products containing not  more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and  buprenorphine (Suboxone®).

Examples of Schedule III non-narcotics include:  benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such  as Depo®-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse  relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam  (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate  (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®),  temazepam (Restoril®), and triazolam (Halcion®).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse  relative to substances listed in Schedule IV and consist primarily of  preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough  preparations containing not more than 200 milligrams of codeine per 100  milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and  ezogabine.

The Nixon Connection

CSA as part of the Comprehensive Drug Abuse Prevention and Control Act was signed into law by President Richard Nixon on October 27, 1970.

RMN

[President Nixon Signs the Controlled Substances Act] 

Assessment

This picture was taken on that day at the White House. Behind the president is Attorney General John Mitchell and next to the president is BNDD Director Jack Ingersoll.

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Workers Memorial Day 2013

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Workers Celebrate on May First This Year

By Matthew Pelletier

[Director of Public Relations]

Compliance and Safety LLC

marry-harris

“Pray for the dead and fight like hell for the living”

Marry Harris “Mother” Jones

[1837 – 1930]

Dear ME-P,

We’ve just published a page for workers memorial day 2013 (falls on Sunday April 28th, 2013) that I thought you might be interested in posting on the ME-P.

Link: http://complianceandsafety.com/blog/workers-memorial-day-2013/

Assessment

You’re also more than welcome to use any of the content from our memorial page on your website.

Workers Also Celebrate on May First This Year: International Workers’ Day

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health 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

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Administrative Professionals’ Day

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Difference makers: On the job with admin

By Staff Reporters

In honor of Administrative Professionals’ Day 2013, celebrated just last week, here’s a closer look at the key roles these individuals play in order to keep medical, financial advisory and other offices everywhere – running smoothly.APD

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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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

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The DEA’s [Original] Model Paraphernalia Law

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Drug use in the 60s and 70s

By Staff Reporters

In the 1960’s and 1970’s drug use in the United States continued to grow, peaking in 1979. This was, in part, due to the wide, legal availability of drug paraphernalia like that captured in this picture of a dealer on a street corner near DEA headquarters (then located at 1405 I Street NW in Washington DC) in the late 1970’s.

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DEA

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In order to combat this trend, DEA was asked by the White House to create a model Drug Paraphernalia Law to be implemented and enforced at the state and local level, giving DEA and other partners another tool in the fight against drug abuse.

Conclusion

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More on Medical Practice Patient Scheduling Issues

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And … Waiting Room Wait-Times

By Dr. David Edward Marcinko MBA

Dr. MarcinkoRecently, I read the following post on: 8 surprising thoughts about patient wait times.

And so, I decided to offer a follow-up commentary based on my experiences, and as outlined in our newest book: www.BusinessofMedicalPractice.com

Obviating the Problem

The point here is not to “react” but to avoid the dreaded “waiting time” problem in the first place.

Now, realize that most mature doctors follow a linear (series-singular) time allocation strategy for scheduling patients (i.e., every 15 or 20 minutes). This can create bottlenecks because of emergencies, late patients, traffic jams, absent office personal, paperwork delays, etc. Therefore, as suggested by colleague Neil Baum MD, one of these three newer scheduling approaches might prove more useful.

1. Customized Scheduling

The bottleneck problem may be reduced by trying to customize, estimate or project the time needed for the patient’s next office visit. For example: CPT #99211 (5 minutes), #99212 (10 minutes), #99213 (15 minutes), #99214 (25 minutes), or #99215 (40 minutes). Occasionally, extra time is need, and can be accommodated, if the allocated times are not too tightly scheduled.

2. Wave Scheduling

Some patient populations do not mind a brief 20-30 minute wait prior to seeing the doctor. Wave scheduling assumes that no patient will wait longer than this time period, and that for every three patients; two will be on time and one will be late. This model begins by scheduling the three patients on the hour; and works like this. The first patient is seen on schedule, while the second and third wait for a few minutes. The later two patients are booked at 20 minutes past the hour and one or both may wait a brief time. One patient is scheduled for 40 minutes past the hour. The doctor then has 20 minutes to finish with the last three patients and may then get back on schedule before the end of the hour.

3. Bundle Scheduling

Bundling involves scheduling like-patient activities in blocks of time to increase efficiency.

For example, schedule minor surgical checkups on Monday morning, immunizations on Tuesday afternoon, and routine physical examinations on Wednesday evening, or make Thursday kid’s day and Friday senior citizens day. Do not be too rigid, but by scheduling similar activities together, assembly-line efficiency is achieved without assembly line mentality, and allows you to develop the most economically profitable operational flow process possible for the office.

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4. Patient Self Scheduling (Internet Based Access Management)

The traditional linear patient scheduling system is slowly being abandoned by modern medical practitioners; an all venues (medical practices, clinics, hospitals and various other healthcare entireties). New software programs, and internet cloud applications, allow patients to schedule their own appointments over the internet. The software allows solo or individual group physicians with a practice to set their own parameters of time, availability and even insurance plans. Through a series of interrogatories, the program confirms each appointment. When the patient arrives, a software tracker communicates with office staff and follows the patients from check-in, to procedures, to checkout.

Assessment 

Today, many hospitals have even abandoned the check-in or admissions, department. It has been replaced by access management systems.

Conclusion

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Recent Tax Law Changes and Basic Retirement Planning [video]

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For Healthcare Accountants

By Richard Schwartz CPA

http://schwartzaccountants.com/

Richard Schwartz CPA

Content: Video (mp4) – 105.32MB
Title: Richard Schwartz Webinar 1.23.13 Tax Changes and Retirement

Link: http://www.screencast.com/t/Huco7W8LOl

Richard S Schwartz, CPA, CVA, received a B.A. in Economics from Brandeis University in 1985 and an M.S. in Accounting from the Graduate School of Professional Accounting at Northeastern University in 1990.  Prior to joining his brother at Schwartz and Schwartz,  P.C. in 1993, he worked for the international accounting firm PricewaterhouseCoopers, LLP, in their Emerging Business Services Group.  Since joining Schwartz and Schwartz, P.C. he has worked with individuals providing tax expertise as well as small business owners providing both tax and accounting guidance to help their businesses grow.  In 2006, Rick earned the designation of Certified Valuation Analyst from the National Association of Certified Valuation Analysts (NACVA), which he uses to assist healthcare professionals in their evaluation of whether to purchase a practice.

Conclusion

In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Defining Tomorrow’s Doctor [Vote]

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What does the 21st Century Physician look like – Please tell us your vision?

Doctors

We can’t solve problems by using the same kind of thinking we used when we created them.  Tell us your vision or just view the list of visions so far.

Tomorrow’s Doctor

[This is a collective initiative lead by folks like you] 

Assessment

Why Become A Doctor?

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health 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

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Staffing Level Effects of Health Care Reform‏

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April 2013 edition of Plan Management Navigator
***
By John Park jpark@sherlockco.com
[Health Care Analyst – Sherlock Company]

Greetings:

Please find attached the April 2013 edition of Plan Management Navigator. This month’s Navigator features three estimates of employment by U.S. private health plans:

***

1. The first estimate is of staffing as it exists at present, based on Sherlock Benchmarks.

2. The second estimate calculates the effect of the new private insurance enrollment through Medicaid and through the exchanges, as estimated by the Congressional Budget Office, on health plan employment. This second estimate employs the existing Sherlock Company staffing ratio benchmarks.
3. The third estimate applies the staffing ratios of low cost health plans participating in the Sherlock Benchmarking studies to all insurers.

Estimates

We estate that the combined effect of increased health plan enrollment and heightened efficiency to be a decline of 72,000 FTEs.

new-and-improved-consult-letter-blog

Webinar

On April 17th we held a brief conference call on this topic. You may still contact us to answer any methodological questions you may have.

Assessment

April 2013 Navigator

About

Sherlock Benchmarks help to identify whether your plan has high staffing ratios and which functional area’s staffing should be targeted for a closer look. We invite you to consider participation in the 2013 survey with the nearly 50 organizations that have already committed to this valuable analysis.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health 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

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Searching for Chief Medical Director [CMD]

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Centene Corporation Seeking CMD

By Jennifer Sonneland jsonneland@cejkasearch.com

Cejka Executive Search www.cejkaexecutivesearch.com

Dear Dr. Marcinko,

I am assisting Centene Corporation in their recruitment for a Chief Medical Director for IlliniCare Health Plan, a wholly owned subsidiary and HMO for the state of Illinois.  The regional headquarters for IlliniCare is in Chicago. 

The Chief Medical Director (CMD) will be responsible for directing and coordinating the medical management, quality improvement and credentialing functions for IlliniCare. S/he will serve as a clinical advisor and educator of the medical management staff, ensuring the clinical quality and efficacy of patient care.

jobs

The CMD will also help identify trends in patient treatment data and proactively develop programs to improve patient health and wellness needs.  As an integral part of IlliniCare’s senior leadership team, the CMD will have an active role in supporting the strategic plans and vision of the organization.  

Ideal candidates will have a minimum of five years of progressive experience in healthcare enterprises and demonstrated success in establishing population health management programs and driving quality outcomes and financial performance for the underserved population. Board certification, preferably in geriatrics, and an unrestricted medical license are required. 

A post-graduate business degree (MBA/MMM) is preferred.

Assessment

More details about this opportunity upon request.

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Introducing Neil H. Baum MD

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Our Newest ME-P “Thought-Leader”

By Ann Miller RN MHA

[Executive-Director]

Dr. BaumDr. Neil Baum is Associate Clinical Professor of Urology at Tulane Medical School and Louisiana State University Medical School, both in New Orleans, LA.

He is also on the medical staff at Touro Infirmary in New Orleans, and East Jefferson General Hospital in Metairie, LA.

Medical Background

Dr. Baum received his medical degree from Ohio State University Medical School in Columbus. He completed an internship at the University of California at Los Angeles, a residency in surgery at Harbor General Hospital, Torrance, California, followed by a second residency in surgery and a residency in urology, both at Baylor College of Medicine in Texas. Dr. Baum is certified by the American Board of Urology.

ME-P Relevance

Dr. Baum often shares his extensive experience from his urologic office and regularly speaks to medical practices, hospitals, and pharmaceutical and manufacturing companies on improving communications between physicians and patients, practice management, guerilla marketing, practice promotion and motivation.

He has also several books on efficient medical marketing. In fact, he is the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically, 4th Edition (Jones-Bartlett, 2010).

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And so, we are pleased he accepted our invitation as ME-P “thought-leader.” All our readers and subscribers look forward to his essays, comments and insightful contributions.

Essential ME-P Reader Concerns

I recently caught up with Dr. Baum with these two readership questions.

Q: Why Market and Promote Your Practice in the Era of Managed Care?

A: “Often physicians will discuss the current health care situation in their community and believe that their days of practice promotion are over when they have joined all of the managed care plans in the vicinity. The reality is that noting could be farther from the truth. Now marketing and practice promotion is even more important than in the “good ol’ days” of fee-for-service”.

Q: What is the Most Common Medical Practice Disaster?

A: “Natural disasters are not the most common cause of practice failure; man-made disasters such as computer crashes, power outages, and loss of electronic data are more likely to impact a medical practice”.

Assessment

Conclusion

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

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

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[Available Now]

A New IRA Withdrawal Limit Proposal

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Capping Tax-Advantaged Retirement Plans?

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

Rick Kahler CFP“Max out your retirement plans every year” has long been standard advice I’ve given to working adults, and all medical professionals, who want to secure a reliable income when they retire.

Individual Retirement Accounts (IRAs), along with 401(k), 403(b), and profit sharing plans offered by some employers, are among the most accessible ways for middle-class workers to provide for retirement and build wealth.

If a proposal in President Obama’s budget plan is approved by Congress, however, retirement plans may no longer be the first and best stop along the road to financial independence.

The New Proposal

The proposal would limit a person’s total withdrawals from all tax-advantaged retirement plans to the amount it would cost to purchase an immediate annuity paying $205,000 a year. And, it appears to not be indexed for inflation. The articles I’ve read and my own calculations suggest this would mean capping retirement accounts at around $3 million.

From the sketchy details available so far, the proposal appears to target traditional IRAs and other tax-deferred retirement plans. Contributions to these accounts are made with pre-tax dollars, and the earnings in the account are not taxed until they are withdrawn.

Since 58% of Americans don’t have any retirement plan, my guess is they will pay little attention to this proposal. Saving $3 million dollars seems well out of reach. While that may be true in today’s dollars, it most likely will not be true in future dollars.

If inflation over the next 40 years matches that of the past 40, a $3,000,000 IRA in 2053 will be equal to $575,000 today. If today’s 25-year-old, retiring then, wanted to be sure the money would last another 40 years, the IRA would provide an income equivalent to about $1,500 a month.

Tax-Advantaged Retirement Plans

Even in today’s dollars, the $3 million maximum isn’t as unreachable as it may seem. Employees can currently contribute a maximum of $5,500 per year ($6,500 for those 50 and older) to Roth or traditional IRAs. Small business owners and the self-employed may have SIMPLE (savings incentive match plan for employees) or SEP (simplified employee pension) IRAs. The maximum annual contribution is currently $17,000 for a SIMPLE and $51,000 for a SEP. A self-employed plumber, business owner, or doctor who was a conscientious saver with a diversified portfolio could certainly accumulate $3 million over a lifetime.

Or, suppose the wife of a small business owner, or doctor, was a self-employed counselor with her own SEP plan. If he died at age 58 and she inherited his IRA, the combined totals could easily put her over the $3 million cap.

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MD Retirement planning

Unclear Options

It isn’t clear how the proposal would equate the withdrawal rate with the cap. One possibility would be to raise the required minimum distribution amount, which would erode the value of an IRA more quickly.

Another option would be to penalize excess accumulations with a hefty tax of 40% or more. Of course, the President could follow in Argentina’s footsteps and just confiscate any amount over the cap.

Any of these would add to the diminution of retirement plans as a vehicle for income during retirement.

The Caveat

The proposal includes this statement:

“But, under current rules, some wealthy individuals are able to accumulate many millions of dollars in these accounts, substantially more than is needed to fund reasonable levels of retirement saving.”

Assessment

Apparently we, as individual citizens, are not considered capable of defining “reasonable levels” of retirement saving for ourselves. The real goal of this plan appears to be wealth distribution, instead of encouraging more Americans to save and provide for their own retirement.

More:

If this proposal is passed, retirement plans will play a much smaller role in many middle class Americans’ golden years.

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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What’s the Chance a Startup Business will Fail?

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On Survival Rates

By Radel Artida (radel@staff.com

Blame it on the media when people seem to think that their hot tech startup will make them a billionaire by their mid-20s. And, doctors are not immune.

Startup

Assessment

On a lesser level, doctors and medical professionals who seek independence and their own practice should be aware of the factors that contribute to a startup’s success. So, we created this infographic on those factors, or chances, that your startup will fail or succeed.

This also includes some research on projections for the best sectors to start your new business, if you seek another industry.

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health 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

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Remembering the Boston Tragedy

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My Thoughts on the Unthinkable

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

A POEM

In memory of those who died

[Copyright by Nicholas Gordon]

In memory of those who died.

We weep and walk away.

Tears run into swollen streams.

No trace of us remains.

Even those who grieve are gone, and those that grieve who grieve, and those whose lives are ravaged by afrantic urge to be.

And those who wander silently among the empty rooms – immortality is theirs, though they must vanish, too.

We bear astonished witness to the passage of the soul.

No bridge exists that can connect our passion to the whole.

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Fenway Park Dr. Marcinko

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Assessment

Tragedy is defined as a form of drama based on human suffering that invokes in its audience an accompanying catharsis or pleasure in the viewing.

But, we shall not succumb to it; we shall not give up; we will revisit Boston and run a marathon again. And, as free Americans, we will live, love and … thrive!

Conclusion

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America’s Health Disadvantage

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A Data Analytics Infographic

By Sandy Osorno

[MPH Graduate Student]

The United States spent $2.6 trillion on health care in 2010 – more than any other country in the world. Yet based on research from a collaborative effort within the National Academy of Sciences, Americans live shorter lives and experience more injuries and illnesses than people in similar high-income countries.

THE MORTALITY GAP

Out of 17 countries surveyed (Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom), the U.S. finished dead-last (or perhaps dead first is more appropriate) in nearly every category.*

NOTE: Deaths from Disease and Injury per 100,000 people in 2008

– Japan: 349
– Switzerland: 370
– Australia: 378
– Italy: 383
– France: 397
– Spain: 398
– Canada: 401
– Sweden: 410
– Austria: 421
– Norway: 426
– Netherlands: 427
– Germany: 440
– Finland: 446
– United Kingdom: 462
– Portugal: 468
– Denmark: 500
– United States: 505

NOTE: Average Infant Mortality Rate per 1,000 Live Births in 2005-2009

– Sweden: 2.5
– Japan: 2.6
– Finland: 2.7
– Norway: 3.0
– Portugal: 3.4
– Spain: 3.5
– Italy: 3.6
– Germany: 3.7
– Austria: 3.8
– Denmark: 3.8
– France: 3.8
– Switzerland: 4.2
– Netherlands: 4.2
– Australia: 4.5
– United Kingdom: 4.8
– Canada: 5.2
– United States: 6.7

NOTE: Years of Life Expectancy at Birth in 2007

Males

– Switzerland 79.33
– Australia 79.27
– Japan 79.20
– Sweden 78.92
– Italy 78.82
– Canada 78.35
– Norway 78.25
– Netherlands 78.01
– Spain 77.62
– United Kingdom 77.43
– France 77.41
– Austria 77.33
– Germany 77.11
– Denmark 76.13
– Portugal 75.87
– Finland 75.86
– United States 75.64

Females

– Japan 85.98
– France 84.43
– Switzerland 84.09
– Italy 84.09
– Spain 84.03
– Australia 83.78
– Canada 82.95
– Sweden 82.95
– Austria 82.86
– Finland 82.86
– Norway 82.68
– Germany 82.44
– Netherlands 82.31
– Portugal 82.19
– United Kingdom 81.68
– United States 80.78
– Denmark 80.53

disadvantage

THE MORBIDITY GAP

Out of 57 health indicators (i.e. diabetes, BMI, cholesterol, BP, etc.) divided into four age groups, the U.S. scored lowest in half (28). Furthermore, when compared to its peer countries, the United States’ composite score in each of the four age groups was ranked last.

– Ages 0-4: Last (17 of 17)
– Ages 5-19: Last (17 of 17)
– Ages 20-34: Last (17 of 17)
– Ages 35-49: Last (17 of 17)

“The tragedy is not that the United States is losing a contest with other countries but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary,” said Steven Woolf, Chair, Panel on Understanding Cross-National Health Differences Among High-Income Countries

As of 2010, the United States had the highest prevalence of diabetes (for adults aged 20-79) among the 17 peer countries. Related, the United States has the highest prevalence of adult obesity among the 17 peer countries. As of 2009, the prevalence of obesity in the United States (33.8 percent) was twice the average (16.9 percent).

NOTE: Compared with the aforementioned countries, the United States fares worse in the following nine health domains:

– 1. Adverse birth outcomes. The United States continues to experience the highest infant mortality rate of high-income countries. Additionally, American children are less likely to live to age 5 than children in similar countries.

– 2. Injuries and homicides. Deaths from car accidents, injuries, and violence occur at much higher rates in the United States than in other countries.

– 3. Adolescent pregnancy and sexually transmitted infections. For nearly two decades, the U.S. maintains the highest rate of adolescent pregnancies and its teenagers are more likely to acquire sexually transmitted infections than adolescents in high-income countries.

– 4. HIV and AIDS. The United States has the second highest prevalence of HIV infection among the 17 peer countries and the highest incidence of AIDS.

– 5. Drug-related mortality. Americans lose more years of life to alcohol and other drugs than people in peer countries, even when deaths from drunk driving are excluded.

– 6. Obesity and diabetes. The United States has had the highest obesity rate among high-income countries for decades.

– 7. Heart disease. The U.S. death rate from ischemic heart disease is the second highest among the 17 peer countries.

– 8. Chronic lung disease. Lung disease is more prevalent and associated with higher mortality in the United States than in the United Kingdom and other European countries.

– 9. Disability. Older U.S. adults report a higher prevalence of arthritis and activity limitations than their counterparts in the United Kingdom, other European countries, and Japan.

WHY?

  1. – Experts at the National Research Council and Institute of Medicine posit four possible explanations for the United States’ declining health.
  2. – Health systems. Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
  3. – Health behaviors. Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
  4. – Social and economic conditions. Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
  5. – Physical environments. U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity.
  6. – *The panel did find that the U.S. outperforms its peers in some areas of health and health-related behavior. People in the U.S. over age 75 live longer, and Americans have lower death rates from stroke and cancer, better control of blood pressure and cholesterol levels, and lower rates of smoking.

SOURCE: National Research Council and Institute of Medicine. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health. Panel on Understanding Cross-National Health Differences Among High-Income Countries, Steven H. Woolf and Laudan Aron, Eds. Committee on Population, Division of Behavioral and Social Sciences and Education, and Board on Population Health and Public Health Practice, Institute of Medicine. Washington, DC: The National Academies Press.

Conclusion

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Be Your Own Banker?

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BYOB—or not

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

Rick Kahler CFPDoctors – I’m not inviting you to a “bring your own beverage” party. I’m warning you away from a get-rich scheme called “Be Your Own Banker.”

This idea has floated around the Internet and late-night television for a while now. One of the latest versions is touted on a website that I’m not going to name because I don’t want anyone getting sucked into what is essentially one step from being a scam.

Once you drill down past the initial layers of ambiguity, the basic concept seems simple enough. You buy a large whole-life insurance policy. After you pay into it for several years, it will accumulate a cash value. Then, any time you make a major purchase like a new car, you can borrow against your insurance policy instead of going to a bank.

Paying Your Self

According to the people selling this concept, you are the big winner here because you’re paying interest to yourself, not the bank.

The BYOB salespeople are incredible marketers. This must be where political campaign managers ply their trade in between elections. They blast our financial system, banks and bankers, mutual fund managers, and financial advisors. They profess to care about the customers they call “clients.”

The half-truths and misstatements from these sellers are enough to elevate the blood pressure of any fee-only financial planner. They use terms like “depositing cash into a life insurance policy” and “having control of your own banking system.”

Amid all this unbelievable double-talk, they forget to mention one little detail. All that money that you “invest” in your whole life insurance policy is paid in the form of premiums. You aren’t paying it to yourself. You’re paying it to large life insurance companies—which, by the way, are an integral part of the financial system they blast.

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good news

A Closer Look

Let’s look at some actual numbers. You pay $12,500 a year in premiums for a $125,000 whole life insurance policy. In four years, after paying in a total of $50,000, you would have $46,110 dollars in your account. Yes, this is less than you put in, as the fees and premiums add up to be more than the growth rate. You can borrow up to 90% of the net value, or $41,500.

You will pay the company 5% for borrowing your own money. Supposedly, the interest is paid to yourself and adds to the cash value of the policy. But a deeper look shows that the interest you pay yourself must be over and above the interest paid to the company, which is just another name for “premium.” The insurance company charges you interest regardless of the “interest” you pay yourself.

What happens if you don’t pay back the loan? The interest keeps compounding, adding to the amount of the loan and eating up the cash value of the policy. This could eventually leave you facing some nasty tax consequences, potentially including having to pay income taxes on phantom income.

Instead of paying that $12,500 a year in premiums, you could put it into a deductible 401(k) plan and invest the funds in a diversified portfolio. You’d even be better off to put it into a taxable account. Then if you needed a new car or water heater, you’d have cash and wouldn’t have to borrow from yourself or anyone else.

Assessment

After spending hours researching “being your own banker,” my staff and I understand what BYOB really means. It stands for “Bring Your Own Bottle”—of pain reliever. You’ll need it for the headache of trying to understand this slick advertising scheme. It makes no sense for anyone except those selling the life insurance policy.

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Events Planner: April 2013

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Events-Planner: APRIL 2013

By Staff Writers
Calendar Calculator“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 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:

  • April 25-26: South Florida FPA Conference. Westin Hotel, Ft. Lauderdale, FLA.
  • April 28-30: IMCA Conference. Washington Convention Center, Seattle, WA.

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Should You Own an Umbrella Insurance Policy?

Risk Reduction for Medical Professionals?

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By Lon Jefferies, MBA CFP™  www.NetWorthAdvice.com

Lon JeffriesAs a financial planner, a good portion of my job consists of identifying and dealing with potential risks and liabilities for which my clients are exposed. One of the most comprehensive, cost-effective tools for reducing risk exposure is an umbrella insurance policy. Quite simply, if you are reading this ME-P, the purchase of an umbrella policy would be a wise decision.

What is an Umbrella Policy?

An umbrella policy protects both your current and future assets against the cost of losing a lawsuit involving your car or real estate property. Such a policy is in addition to your auto and homeowners insurance.

For example, suppose your auto insurance pays $300k of medical expenses per accident, and you have a $1 million umbrella policy. If you are sued for $800k because of an auto accident, your auto insurance will pay the first $300k of damage. This also serves as the deductible on the umbrella policy, so the umbrella coverage would pay the remaining $500k of damages.

Additionally, umbrella policies cover legal expenses involved with a lawsuit. Even better, since it is the insurance company that will be paying any damages, they are likely to assign a strong (expensive) legal team to your case. Consequently, purchasing an umbrella policy is an indirect way of strengthening your legal defense team.

What Does an Umbrella Policy Cover?

An umbrella policy protects you in car accidents for which you are found to be at fault, as well as accidents that occur on your real estate property. Additionally, these policies protect you from personal injury lawsuits arising from slander, defamation, libel, malicious prosecution, mental anguish and more.  Even better, this coverage will protect you from accidents caused by your dependent children.

As you might imagine, certain factors increase your need for an umbrella policy. For instance, if you spend a lot of time in your car, or you own a swimming pool or a dog, the need for an umbrella policy rises.

Some people think they don’t need an umbrella policy simply because their low net worth doesn’t justify it. This is inaccurate because losing a lawsuit can result in the loss of both your current assets, and your future earnings. For this reason, I believe nearly everyone, especially medical professionals, should have an umbrella policy.

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policy insurance

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How Do I Purchase Coverage?

In most instances, an umbrella policy can be purchased through your current insurance providers. A $1 million policy usually costs approximately $200 per year, with additional coverage purchased in $1 million dollar increments and costing approximately $100 per year. At such a low cost while providing critical catastrophic coverage, there is no reason for you to not own such a policy.

Conclusion

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Health 2.0 Financial Planning for Medical Executive-Post Members

A By-Product of Health 2.0?

By Dr. David Edward Marcinko FACFAS MBA CMP*

[Founder and CEO]

www.MedicalBusinessAdvisors.com

Dr David E Marcinko MBAA decade ago, Editor Gregory J. Kelley of Physician’s MONEY DIGEST and I reported that a 47 year old-doctor with $184,000 annual income would need about $5.5 million dollars for retirement at age 65. Then came the “flash-crash’ of 2007-08, the home mortgage fiasco and the Patient Protection and Accountable Care Act [PP-ACA] of 2010; etc.

No wonder that medical provider career panic is palpable. Much like the new medical home concept, the idea of holistic life planning was born.

Life Planning

Life planning has many detractors and defenders. Formally, life planning has been defined in the following way. 

Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process.  For the client, their life becomes the axis around which financial planning develops and evolves.

But, for physicians, life planning’s quasi-professional and informal approach to the largely isolated disciplines of medically focused financial planning, was still largely inadequate.

Why? 

Today’s personal financial and practice environment is incredibly more complex than it was in 2007-08, as economic stress from HMOs, Wall Street, liability fears, criminal scrutiny from government agencies, IT mischief from hackers, economic benchmarking from hospitals and the lost confidence of patients all converged to inspire a robust new financial planning 2.0 approach for medical professionals.

Example of a financial planning mistake 

Recall the tale of Dr. Debasis Kanjilal, a pediatrician from New York who put more than $500,000 into the dot.com company, InfoSpace, upon the advice of Merrill Lynch’s star but non fiduciary analyst Henry Bloget.

Is it any wonder that when the company crashed, the analyst was sued, and Merrill settled out of court? Other analysts, such as Mary Meeker of Morgan Stanley, Dean Witter and Jack Grubman from Salomon Smith Barney, were involved in similar fiascos.

Although sad, this story is a matter of public record. Hopefully, doctors now understand that the big brokerage houses that underwrite and recommend stocks may have credibility problems, and that physicians got burned with the adrenalin rush of “self-directed” investment portfolios.

Example of a medical practice management mistake 

Just reflect a moment on colleagues willing to securitize their medical practices a few years ago, and cash out to Wall Street for perceived riches that were not rightly deserved

Where are firms such as MedPartners, Phycor, FPA and Coastal now? A recent survey of the Cain Brothers Physician Practice Management Corporation Index of publicly traded PPMCs revealed a market capital loss of more than 95%, since inception. 

Another Approach?

This disruptive narrative shift was formally noted by the Institute of Medical Business Advisors Inc [iMBA, Inc] and introduced to the medical and financial services industry. This research and corpus of work resulted in hundreds of publications in the Library of Medicine, National Institute of Health (NIH) and the Library of Congress, along with related publications, a dozen textbooks and white papers

http://www.ncbi.nlm.nih.gov/nlmcatalog?term=marcinko

The iMBA approach to financial planning, as championed by the www.CertifiedMedicalPlanner.org professional charter designation, integrates the traditional concepts of fiduciary focused financial planning, with the increasing complex business concepts of medical practice management.

The former ideas are presented in our textbook on financial planning for doctors: Financial Planning for Physicians and Advisors

The later in our companion book: Business of Medical Practice [Edition 3.0]

A textbook for hospital CXOs and physician-executives: Hospitals & Healthcare Organizations

While most issues of risk management, liability and insurance are found in Risk Management and Insurance Strategies for Physicians and Advisors

And, for the perplexed, all definitions are codified in the dictionary glossary Health Dictionary Series

Health 2.0 Paradigm Shift

And so, the ME-P community now realizes that a more integrated approach is needed.  The traditional vision of medical practice management, personal physician financial planning and how they may look in the future are rapidly changing as the retail mentality of medicine is replaced with a wholesale philosophy.

Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition.

Or, how Yale University economist Robert J Shiller warns in “The New Financial Order” [Risk in the 21st Century] that the risk for choosing the wrong healthcare profession or specialty might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. 

Physician-Executive

My Assessment

Yet, the opportunity to re-vise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the medicine, business and the meaning and purpose of life.

To allow this deeper and more realistic approach, the advisor and the doctor must build relationships based on fiduciary trust, greater self-knowledge and true medical business and financial enhancement acumen.

Are you up to the task?

Conclusion

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Understanding Vacation Time Shares

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Including Participatory Vacation Exchanges

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

Rick Kahler CFPFor residents of places like the Black Hills, where the first day of spring usually brings a snowstorm, timeshares for resorts in Florida or Mexico can have a lot of appeal. They seem like a fun idea for a vacation in the sunshine as well as a good deal financially.

My Research

Over the past 30 years I’ve researched hundreds of timeshare offers. I’ve never bought one. When you take a close look at the numbers and the restrictions, they simply don’t add up to a good value.

One of the biggest problems with timeshares in general is that they can lock you into a specific vacation. Spending a week at that resort in Mexico in February, exploring the local area and relaxing by the pool, might be wonderful for a year or even several years. But eventually you may get tired of going to the same location, doing the same things, and seeing the same people. After a while, even a rut person like me might want to do something different.

PVEs

Some timeshares mitigate this problem by participating in vacation exchanges [PVEs] like RCI, Interval International, and others. These services will add on a fee.

Not Liquid

You might think that, if you get tired of a timeshare, you can just sublease or sell it. These aren’t necessarily easy to do. There may be restrictions on subleasing, which is another good reason to read the fine print before you sign any timeshare contract. Selling is often difficult, and you certainly aren’t likely to get back your original purchase price. Meanwhile, you’re  paying annual fees whether you use the timeshare or not.

Total Costs

In figuring the cost of a timeshare, those annual fees are what really get you. You’re told up front what the fees are at the time you buy a timeshare. Yet you have no control over what the fees may be in five or ten years. The only thing you can count on is that they will increase.

Examples:

To illustrate these points, I recently investigated a resale site that listed a timeshare in a property in Boston, MA. It originally sold for $20,000 and was priced at $1,000. I passed on the opportunity because of the high fees.

In another example, I once took a serious look at a timeshare in a luxury apartment complex in London. It seemed like a possibility for fulfilling one of my dreams, living part of the year in Europe.

It wasn’t. As the salesperson told me, comparing the cost to buy a timeshare versus the cost to stay as a non-member, it would take around 30 years to recoup the purchase price. Then I—or more likely, my heirs—would have ten more years to stay for “free.” Free, that is, except for the annual fees.

Dr. Marcinko at Johns Hopkins University

[ME-P Editor-in-Chief in a Spring Fever Garden] 

Investment in Lifestyle

The sales rep was quite clear that a membership at this complex wasn’t intended as a good financial investment. She described it as an “investment in lifestyle.”

So, when it comes to timeshares; that’s the bottom line. If the lifestyle being sold truly fits for you, and you believe it will continue to fit for the long term, then it’s possible that a timeshare may make sense.

Assessment

For most doctors and folks like us however, my conclusion is that most timeshares are too expensive even if someone gives you one. The annual fees alone will keep it from being a good value. I’ve never found one that was cheaper than getting a nice hotel or resort for a couple of weeks. Paying for a hotel stay will cost less in the long run, and you can enjoy relaxing vacations with no long-term commitment.

Conclusion

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Physician Advisors: www.CertifiedMedicalPlanner.org

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The status of African American insurance coverage

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A Struggling PP-ACA Sector    

By FinancesOnline.com

The Affordable Care Act has developed into one of the critical pivots on which the success of President Obama’s second term is expected to turn. Yet, one sector that’s already struggling is African Americans.

In 2012, 17.4 percent of non-Hispanic African Americans were uninsured. More critically, only 55.9 percent of African Americans are expected to continue to live in good health, while a more or less healthy life is expected in 69.4 percen of white Americans.

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infographic-health-insurance-of-african-americans

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Assessment

These and other alarming facts were revealed by the National Health Interview Survey of the Center for Disease Control and Prevention, and corroborated by data from the U.S. Census Bureau. Both these agencies were data sources for this infographic, which takes a closer look at the health insurance situation of African Americans.

Conclusion

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

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But …. enough about me!

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Did you read my interviews?

Dr. David Edward Marcinko MBA

www.MedicalBusinessAdvisors.com

[CEO and Editor-in-Chief]

DEM 2013

AMA News:

Goodwill hunting – what’s your medical practice worth?

AMA News.Valuation.Marcinko

Best practices can help hospitals in recession

Arkansas Medical News:

Arkansas Medical News Interviews Dr. Marcinko

Conclusion

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

Our Other Print Books and Related Information Sources:

Health 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

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About Domestic Asset Protection Trusts

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Is There Stronger Protection in DAPTs?

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

Rick Kahler CFPMost financial advisors and attorneys who specialize in asset protection trusts have probably never visited South Dakota. Yet it’s one of their favorite places. A change made by the legislature this year has made them like it even more.

The reason asset protection experts are so fond of our state is that South Dakota is one of a few states (Nevada, Delaware, and Alaska are the others) to offer some of the strongest protections available for Domestic Asset Protection Trusts (About Domestic Asset Protection Trusts).

House Bill 1056

House Bill 1056, passed by the legislature and signed into law by Governor Dennis Daugaard, includes a small change in wording that makes DAPTs even stronger. The relevant section amends South Dakota Codified Law 55-16-15 by adding the five words shown here in all caps:

“Notwithstanding the provisions of §§ 55-16-9 to 55-16-14, inclusive, this chapter does not apply in any respect to any person to whom AT THE TIME OF TRANSFER the transferor is indebted on account of an agreement or order of court for the payment of support or alimony in favor of the transferor’s spouse, former spouse, or children, or for a division or distribution of property in favor of the transferor’s spouse or former spouse, to the extent of the debt.”

This change is not intended to allow divorcing spouses to hide assets from one another, cheat ex-spouses out of alimony, or avoid paying child support. Someone who owes alimony or child support to a former spouse cannot get out of that obligation by contributing assets to a DAPT. Any amounts owed at the time the trust is established must be paid. Attempting to avoid legitimate obligations through a DAPT would be fraud.

On Definitions and Meanings

What the new wording means is that, once a divorce settlement has been agreed upon, former spouses cannot come back later and make new claims against an ex-wife or ex-husband’s protected assets.

For many people, this change is irrelevant. Many divorcing couples, probably the majority, don’t have many financial assets and have never heard of a DAPT. They work out a financial settlement, go their separate ways, and that’s that.

Yet there are cases where this new law could make a huge difference.

Retirement vault

Here are just two examples: 

Suppose that at the time a couple divorce, the husband had just started a construction company. It had more debt than assets and wasn’t making any money yet. Several years later, business is booming and he is well on his way to becoming wealthy. Even though his ex-wife was not involved in building the company, she might try to benefit from his post-divorce success by suing for a share of his assets. He could protect those assets by contributing them to a DAPT.

Or suppose a divorce settlement required the wife to pay her husband a one-time cash amount in exchange for his share of their house and acreage. Several years after the divorce, he isn’t doing so well financially. She’s still living in the house, however, and the value of the property has increased significantly. He might sue to amend the original agreement in an effort to claim part of the real estate. His attempt to change the agreement after the fact couldn’t touch that property if she had contributed it to a DAPT.

Assessment

Until now, Nevada was the only state whose DAPT laws did not make an exception for former spouses. This change in the South Dakota law makes the two states very comparable in their DAPT provisions. It’s one more reason for asset protection professionals to find South Dakota a great place to do business. 

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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A Visual on Health Entitlement Spending

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A Story in Six Charts

By Nancy Chockley PhD www.NIHCM.org

Between the fiscal cliff, sequestration, a potential government shut down and the debt ceiling, Washington is experiencing a seemingly endless succession of budgetary crises.

Although health entitlement programs are often on the table in negotiations, there has been little agreement on the scope and direction of meaningful reform. The recent slowdown in health spending growth may strengthen the impulse on some fronts to delay action, but long-term projections leave little doubt that federal health spending will continue to be a major contributor to our fiscal woes.

Assessment

This chart story pulls together essential facts on how much the federal government is spending on mandatory health care programs, how that spending affects the budget, and the hard spending and revenue trade-offs necessary to improve our fiscal outlook.

chart story

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health 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

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Are Doctors Protecting their Credit Standing?

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Avoiding Credit Errors

By Lon Jefferies, MBA CFP™  http://www.NetWorthAdvice.comLon Jefferies

A clean, accurate credit history is a critical piece of the personal finance puzzle for doctors and us all. Staying on top of your credit standing over time can mean big savings since credit scores often determine your access to loans, interest rates, and monthly payments. An error on the report of any of the three major credit agencies – Experian, Equifax, or TransUnion – could be catastrophic next time you apply for a loan.

The Services

There are multiple credit-monitoring services you can utilize that charge approximately $15 per month, but these fees likely aren’t necessary. You can order a free credit report from each of the three major credit agencies every year by visiting AnnualCreditReport.com.

Additionally, several services will send you updates from the credit bureaus at no cost. Credit Sesame will track data on your Experian report daily and instantly email you if anything suspicious pops up. There are over 35 triggers for alerts, including new accounts opened, late payments, credit inquires, and address changes. The website also provides a running credit score daily.

Credit Karma has a similar tool that provides free daily monitoring of your TransUnion report. This tool also provides valuable data such as how many lines of credit are evaluated on your credit report and your auto insurance score (used to determine your insurance premiums).

Again, both monitoring tools are free, don’t require a credit card, and take no longer than a couple minutes to sign up for.

stand-out

Assessment

Getting an instant heads-up that there’s been a change in your report could help you fix errors quickly, catch an identity theft at work, or get on top of a delinquent account. As a doctor, you’ve worked hard to establish your credit, so make sure you protect it.

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health 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

Product Details  Product Details

How to Handle Incurred But Not Reported Health Insurance Claims [Webinar]

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Event Information
[Live Audio Conference – Webinar]
Dr. David E. Marcinko MBA
Presenter: Dr. David Edward Marcinko; MBA CMP™
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Conference Date: Tue, Apr 02, 2013
Aired Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Length: 60 Minutes
Product Description
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Here’s How to Augment Bottom-Line Revenues by Understanding IBNR Healthcare Claims

One of most relevant financial issues of the PP-ACA and contemporary healthcare and medical reimbursement is known as Incurred But Not Reported (IBNR) healthcare claims. IBNR claims are an indirect result of prospective payments systems, the insurance industry and commercial risk contracts, and to some extent fee-for-service medicine. IBNR claims represent a risk and an opportunity for managed care companies, healthcare organizations, clinics, physicians and related medical providers alike.

Join this enlightening event presented by expert speaker Dr. David Edward Marcinko MBA CMP™ who will provide you detailed insights on IBNR claims so that you do not face any compliance risk and optimize your organization’s bottom line.

Here is a brief sample of some details you may learn:

  • Historical Review
  • What Is an IBNR Claim?
  • IBNR Problems for Healthcare Organizations
  • IBNR Claims — Management Volume and Consequences
  • Inadequate Cash Flows
  • Reserve Shortfalls and Fiscal Instability
  • Inaccurate Pricing
  • Administrative Cost Increases
  • Regulatory Sanctions
  • Managed Care Organization Exacerbation of IBNR Claims
  • IBNR from a Net Present Value Perspective
  • Tax Strategies for IBNRs
  1. IRS Rules and Regulations
  2. IBNR Tax Qualifications for Managed Care Organizations
  3. How Managed Care Organizations Intensify IBNRs
  4. How Does IBNR Affect Net Present Value?
  • IBNR Challenges and Solutions

1. Tax and Court Penalties

  • IRC Section 4958
  • Excess Benefit Definition
  • Taxes under Section 4958

2.  Tax Deductibility

  • Potential Solutions to the IBNR Challenge
  • IBNR Calculations and Methodology
  1. Actuarial Data Analysis
  2. Open Referral Analysis
  3. Historic Cost Analysis

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? All charge-master coordinators, coding personnel, billing and claims transaction personnel, internal auditing personnel; and financial and compliance personnel! And, all administrators, accountants, comptrollers, office managers, billing clerks and physician-executives, CFOs, CXOs and other interested parties.

IBNRs

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http://www.audioeducator.com/medical-coding-billing/ibnr_problems-040213.html

ORDER HERE FOR WEBINAR