A Barclay Bank Ad Campaign Photo

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“For the best fixed rates”

Source: Paul Higgins and Sandy Teagle – Futurists from Melbourne and Brisbane in Australia.

Assessment

Truth in advertising.

Barclay campaign says pic.twitter.com/0XOmyQjg

Conclusion

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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:

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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Vital iMBA Inc Links for Savvy Doctors and their Financial Advisors

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An Educational Resource Supporting Doctors and their Consulting Advisors 

Healthcare OrganizationsMedical Business AdvisorsCertified Medical PlannerHDS

We are an emerging online and onground community that connects medical professionals with financial advisors and management consultants. We participate in a variety of insightful educational seminars, teaching conferences and national workshops. We produce journals, textbooks and handbooks, white-papers, CDs and award-winning dictionaries. And, our didactic heritage includes innovative R&D, litigation support, opinions for engaged private clients and media sourcing in the sectors we passionately serve.

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

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

Join the ME-P Nation today … and tell us what you think!

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We are sponsored by the Institute of Medical Business Advisors, Inc

www.MedicalBusinessAdvisors.com

INSTITUTE OF MEDICAL BUSINESS ADVISORS, INC.
Suite #5901 Wilbanks Drive
Norcross, Georgia, 30092-1141 USA
Phone: 770.448.0769

ADMINISTRATORS: http://www.springerpub.com/Search/marcinko
PHYSICIANS:www.MedicalBusinessAdvisors.com
PRACTICE: www.BusinessofMedicalPractice.com
PODIATRISTS: www.PodiatryPrep.com
HOSPITALS:http://www.crcpress.com/product/isbn/9781439879900
ADVISORS:www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

Assessment

Link: Letterhead.iMBA_Inc.

Link: Letterhead CMP

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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The Tax Man Cometh to Police You on Health Care

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About the New Health Care Tax and IRS Job Creation

WASHINGTON (AP)

The Supreme Court’s decision to uphold most of President Barack Obama’s health care law will come home to roost for most taxpayers in about 2 1/2 years, when they’ll have to start providing proof on their tax returns that they have health insurance.

LINK: New Jobs: IRS to hire thousands more agents to collect new health care taxes

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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Transitioning and Appraising a Podiatry [Medical] Practice

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A Round Table Fair Market Valuation Discussion of One

By Dr. David Edward Marcinko MBA CMP™

[Former – American Society of Health Economists (ASHE) member]

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Recently, I was asked to participate in a roundtable of expert’s discussion on the worth or fair market value [FMV] of a typical podiatric [medical] practice on an “ongoing concern” basis.

Of course, this is the type of engagement we often perform at the www.MedicalBusinessAdvisors.com And, I have written about this topic informally on this blog, and more formally in our white-papers and books: www.BusinessofMedicalPractice.com

So, I was pleased to add my experienced opinion to the discussion sponsored by a trade industry magazine upon the invitation of Editor Dr. Barry H. Block JD.

LINK: Podiatry Mgmt Round Table

Assessment

Due to copyright issues, I posted only my comments to the questions posed to all participants. Nevertheless, they are very representative of most medical practices with the exception of the noted podiatric-specific differences.

Invitation: Letterhead.iMBA_Inc.

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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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An Rx for Physician’s Financial Health

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Fundamental Principles for all Medical Professionals

Donald M. Roy CFP® CFS www.newealthadvisors.com

SPONSOR: www.PhysicianNexus.com

The demands on medical practitioners today can seem overwhelming. It’s no secret that health-care delivery is changing, and those changes are reflected in the financial issues that health-care professionals face every day. You must continually educate yourself about new research in your chosen specialty, stay current on the latest technology that is transforming health care, and pay attention to business considerations, including ever-changing state and federal insurance regulations.

Like many, you may have transitioned from medical school and residency to being on your own with little formal preparation for the substantial financial issues you now face. Even the day-to-day concerns that affect most people–paying college tuition bills or student loans, planning for retirement, buying a home, insuring yourself and your business–may be complicated by the challenges and rewards of a medical practice. It’s no wonder that many medical practitioners look forward to the day when they can relax and enjoy the fruits of their labors.

Unfortunately, substantial demands on your time can make it difficult for you to accurately evaluate your financial plan, or monitor changes that can affect it. That’s especially true given ongoing health care reform efforts that will affect the future of the industry as a whole. Just as patients need periodic checkups, you may need to work with a financial professional to make sure your finances receive the proper care.

Maximizing your personal assets

Much like medicine, the field of finance has been the subject of much scientific research and data, and should be approached with the same level of discipline and thoughtfulness. Making the most of your earning years requires a plan for addressing the following issues.

Retirement

Your years of advanced training and perhaps the additional costs of launching and building a practice may have put you behind your peers outside the health-care field by a decade or more in starting to save and invest for retirement. You may have found yourself struggling with debt from years of college, internship, and residency; later, there’s the ongoing juggling act between making mortgage payments, caring for your parents, paying for weddings and tuition for your children, and maybe trying to squeeze in a vacation here and there. Because starting to save early is such a powerful ally when it comes to building a nest egg, you may face a real challenge in assuring your own retirement. A solid financial plan can help.

Investments

Getting a late start on saving for retirement can create other problems.

For example, you might be tempted to try to make up for lost time by making investment choices that carry an inappropriate level or type of risk for you. Speculating with money you will need in the next year or two could leave you short when you need that money. And once your earnings improve, you may be tempted to overspend on luxuries you were denied during the lean years. One of the benefits of a long-range financial plan is that it can help you protect your assets–and your future–from inappropriate choices.

Tuition

Many medical professionals not only must pay off student loans, but also have a strong desire to help their children with college costs, precisely because they began their own careers saddled with large debts.

Tax considerations

Once the lean years are behind you, your success means you probably need to pay more attention to tax-aware investing strategies that help you keep more of what you earn.

Using preventive care

The nature of your profession requires that you pay special attention to making sure you are protected both personally and professionally from the financial consequences of legal action, a medical emergency of your own, and business difficulties. Having a well-defined protection plan can give you confidence that you can practice your chosen profession without putting your family or future in jeopardy.

Liability insurance

Medical professionals are caught financially between rising premiums for malpractice insurance and fixed reimbursements from managed-care programs and you may find yourself evaluating a variety of approaches to providing that protection. Some physicians also carry insurance that protects them against unintentional billing errors or omissions.

Remember that in addition to potential malpractice claims, you also face the same potential liabilities as other business owners. You might consider an umbrella policy as well as coverage that protects against business-related exposures such as fire, theft, employee dishonesty, or business interruption.

Disability insurance

Your income depends on your ability to function, especially if you’re a solo practitioner, and you may have fixed overhead costs that would need to be covered if your ability to work were impaired. One choice you’ll face is how early in your career to purchase disability insurance. Age plays a role in determining premiums, and you may qualify for lower premiums if you are relatively young. When evaluating disability income policies, medical professionals should pay special attention to how the policy defines disability. Look for a liberal definition such as “own occupation,” which can help ensure that you’re covered in case you can’t practice in your chosen specialty.

To protect your business if you become disabled, consider business overhead expense insurance that will cover routine expenses such as payroll, utilities, and equipment rental. An insurance professional can help evaluate your needs.

Practice management and business planning

Is a group practice more advantageous than operating solo, taking in a junior colleague, or working for a managed-care network? If you have an independent practice, should you own or rent your office space? What are the pros and cons of taking over an existing practice compared to starting one from scratch? If you’re part of a group practice, is the practice structured financially to accommodate the needs of all partners? Does running a “concierge” or retainer practice appeal to you? If you’re considering expansion, how should you finance it?

Questions like these are rarely simple and should be done in the context of an overall financial plan that takes into account both your personal and professional goals.

Many physicians have created processes and products for their own practices, and have then licensed their creations to a corporation. If you are among them, you may need help with legal and financial concerns related to patents, royalties, and the like. And if you have your own practice, you may find that cash flow management, maximizing return on working capital, hiring and managing employees, and financing equipment purchases and maintenance become increasingly complex issues as your practice develops.

Practice valuation

You may have to make tradeoffs between maximizing current income from your practice and maximizing its value as an asset for eventual sale. Also, timing the sale of a practice and minimizing taxes on its proceeds can be complex. If you’re planning a business succession, or considering changing practices or even careers, you might benefit from help with evaluating the financial consequences of those decisions.

Estate planning

Estate planning, which can both minimize taxes and further your personal and philanthropic goals, probably will become important to you at some point. Options you might consider include:

  • Life insurance
  • Buy-sell agreements for your practice
  • Charitable trusts

You’ve spent a long time acquiring and maintaining expertise in your field, and your patients rely on your specialized knowledge. Doesn’t it make sense to treat your finances with the same level of care?

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:

Dictionary of Health Insurance and Managed Care

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How to Get Started in Healthcare IT [Video Presentation]

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An Encore Presentation from a ME-P Thought-Leader

By Ann Miller RN MHA [Executive-Director]

In this ME-P, Shahid N. Shah MS shares his best advice for information technology workers looking to get started in the healthcare industry.

Mr. Shah is also known as the Healthcare IT Guy [http://www.healthcareguy.com] informing us about technology issues in the healthcare field.

Link: http://www.physbiztech.com/video/shahid-shah-how-get-started-healthcare-it

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More Expert Advice from Leaders in Healthcare Management

And, sourced below are related interviews with these experts:

  • Todd Linden, President and CEO of Grinnell Regional Medical Center (about rural healthcare management);
  • Paul Levy, former CEO of Beth Israel Deaconess Medical Center; and
  • Dr. Robert Wachter, Professor of Medicine, University of California, San Francisco (author of “Understanding Patient Safety” and the blog “Wachter’s World”).

Link: Health Administration Degrees http://www.healthadministrationdegrees.com

Assessment

Shahid also authored Chapter 13 on eMRs, HIT and Clinical GroupWare [INTEROPERABLE e-MRs FOR THE SMALL-MEDIUM SIZED MEDICAL PRACTICE] in our best-selling book, the “Business of Medical Practice” http://businessofmedicalpractice.com/chapter-13-2/

So, the text and videos are worth a look www.BusinessofMedicalPractice.com Our colleague, and uber hospitalist Robert Wachter MD, is also mentioned in the book.

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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IRA Strategies for Physicians in 2012

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Money Flows-In Even as Volatility Continues in Mid-Year

By Martha J. Schilling AAMS CRP ETSC CSA

http://www.schillinggroupadvisors.com

The amount of money in IRAs is climbing even as the volatility continues.

Most of us have at least one IRA and eventually many people roll over their main retirement assets, 403(b) and 401(k) accounts to IRAs.

Unfortunately, a lot of the value in IRAs isn’t being maximized.

By focusing on a few key strategies you can make an IRA more valuable in your lifetime and beyond.

Now, doctors and all medical professionals should consider the following:

OWN THE RIGHT ASSETS

An IRA has the advantage of tax deferral. Gains and income compound free of taxes until they are distributed. They have the disadvantage of converting long-term capital gains into ordinary income. All taxable distributions from an IRA are taxed as ordinary income. Research reveals that assets that pay high ordinary income are best held in IRAs. High-Yield bonds, Real Estate Investment Trusts and investment grade bonds as well as stocks, mutual funds and other investments that tend to be owned for less than a year generate short-term capital gains. Nontraditional, or alternative investments can be utilized, however know which are prohibited in retirement accounts.

PRACTICE TAX DIVERSIFICATION

No one can forecast how the tax code will alter. Different scenarios are in the works, perhaps one will be put into place late this fall. Different types of accounts have different tax treatments now, and that could change. Instead of forecasting one tax outcome and arranging your finances accordingly, it’s safer to have different types of accounts so you won’t be burned in any scenario. Try to own investments in taxable accounts, traditional IRAs, and Roth IRAs

CONVERT TO A ROTH

Every year, consider whether it makes sense to convert all or part of your traditional IRA into a Roth IRA. Discuss with your Tax advisor factors such as your expected rate of return, the difference between your current tax rate and future tax rates, the source of the cash to pay the taxes and whether future required minimum distributions would exceed your spending needs.

Your CPA/advisor will add other questions as he would know your personal situation and needs.

CONSOLIDATE or SPLIT?

Simplifying your finances often means consolidating all your accounts at one financial institution. Many people have multiple IRAs and simplifying means rolling them over into one IRA when practical. But suppose you have multiple heirs and expect IRAs to be a significant legacy. You could name all heirs as joint beneficiaries and let them decide what to do with the account. On the other hand, you could split the IRA now and name one person as the primary beneficiary for each.

SPEND ACCOUNTS in the RIGHT Order

As a general rule, it’s best to spend taxable accounts first, traditional IRA’s next and ROTH IRAs last. Not in all cases. When you visit your advisor and review what you need in cash flow at retirement, you may find that taking your RMD at 70 ½ puts you into a higher tax bracket. It may be less taxing to take normal distributions on a regular basis after 591/2.

REVIEW your BENEFICIARIES. There are horror stories of people who haven’t changed beneficiaries for decades and find a sibling or a parent is the beneficiary rather than your spouse.

CONSIDER CHARITY. Should you decide to leave part of your estate to charity, the most tax efficient way to do that might be to name the charity as beneficiary of your IRA? Individuals pay tax on distributions, Charities do not.

CATCH-UP CONTRIBUTIONS

When you’re still working and making contributions to IRAs, you can make higher contributions when age 50 or older. In 2012, the maximum for those over 50 is $6000 rather than $5000.

CONSIDER SPOUSE Generally IRA contributions can be made only to the extent you have earned income from a job or business. When filing a joint return, contributions can be made for both spouses up to the maximum of $6000.

REQUIRED DISTRIBUTIONS It appears people continue to make mistakes when taking and computing their RMD after 70 ½. The IRS has been lax on this in the past but is stepping up its tracking and enforcement.

Assesment

Can you think of any others?

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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Why the Government is Not-Like Medical Professionals

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An Endless Supply of US Dollars

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

Is the United States in danger of bankruptcy? Contrary to what you may read in the media or hear from many politicians, no, it isn’t. The US Treasury will never run out of dollars. Unlike doctors and medical professionals, it’s impossible.

Reasons Why?

The reason is relatively simple. The US government owns a printing press. As long as goods, services, or obligations are priced in US dollars, the supply of dollars to our government to buy those goods and services is unlimited. This is not true of individual physicians, corporations, cities, states, and countries that don’t issue their own currency.

For most people, this is a hard concept to grasp, with good reason. The capacity of our government to create an unconstrained supply of dollars is a relatively new phenomenon.

The Gold Standard

Until 1971, all US currency was theoretically redeemable in gold. This was known as the gold standard. In the early decades of the 20th century, you could actually go to a bank and change your dollars for gold. That ability was terminated in 1933, but the dollar’s value was still tied to gold. This basically meant the only way the US government could create new dollars was by obtaining more gold, the supply of which only increases by the new amount of gold mined.

Nixon

In 1971 we had a paradigm change in monetary policy that many still don’t understand. President Nixon decoupled the dollar from the gold standard [Nixon also wanted to flood the country with MDs, and drive down physician income, by opening up medical school admissions]. It became a fiat currency, which is used as a medium of exchange but has no intrinsic value. Suddenly, the US government was no longer constrained by solvency issues and could never run out of money. It could create as many dollars as it wished ie; inflation].

Constraints

This didn’t mean it had no constraints. The major constraint to an issuer of fiat currency is inflation. However, creating money does not guarantee inflation if the newly created money is not spent. Japan, for example, is still fighting deflation even though they’ve been pumping money into reserves like crazy for 20 years.

What should have caused a massive rethinking and reeducating of the financial sector went relatively unnoticed. Text books, professors, economists, and politicians largely continued to follow many pre-1971 monetary principles that became irrelevant overnight.

Unlike the federal government, US states, cities, and other government entities cannot print money. They have to get it the old-fashioned way—from taxes, fees, or borrowing. It’s entirely possible for these entities to go bankrupt, just like individuals and corporations, if their outflow exceeds their inflow.

Europe

Interestingly, the same is true for member countries of the European Union. When in 1999 they adopted the Euro and gave up their sovereign right to print their own money, they took on the same status as states. Therefore, a country like Greece, which is a user of currency as a member of the European Union, can involuntarily default on its obligations.

This is a significant difference between the United States and Greece. While Greece can (and most likely will) go bankrupt because it doesn’t have an unlimited supply of Euros, the US can’t go bankrupt because it does have an unlimited supply of dollars.

The major threat that sovereign countries face is not running out of money, but devaluing their currency through inflation. A devalued currency is one that loses its purchasing power and often results in a lower standard of living.

Assessment

Just because the US can’t involuntarily default on its obligations doesn’t mean we can keep on over spending and pretend we don’t have any money worries. As a nation, we still need to acknowledge and deal with our serious financial problems. So should our doctors, financial planners and financial advisors.

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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About Next-Gen Bath Salts

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By The DEA Agent

Innocent Name – The Dangerous Consequences of MDPV

The recent media explosion over bath salts is not unwarranted. Over the past two years, the public eye has zoomed in on dangerous drug, still legally sold in some states. And, there’ve been many bizarre cases of violence and psychotic outbursts from users.

About MDPV

But, what exactly are bath salts?

Assessment

Keep reading the above to learn about the history and effects of bath salts.

Source: rehab-international.org

More info: http://en.wikipedia.org/wiki/Methylenedioxypyrovalerone

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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Promoting the ME-P Holistic Physician Lifestyle

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Enter the Certified Medical Planners™

By Ann Miller RN MHA

[Executive-Director]

Life planning and behavioral finance, as proposed by physicians and financial advisors, and as integrated by the Institute of Medical Business Advisors (iMBA), emanates from a holistic union of personal financial planning and medical practice management solely for the healthcare space.

Source: https://www.mapsforthat.com/map.php?m=587

The CMP™ Difference

Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science. It has an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ zealous practitioners are called Certified Medical Planners (CMPs).

Assessment

Health 2.0 focused physician baby boomers & modern Gen-X financial advisors can help transition you successfully through medical practice and life changing financial events by exchanging knowledge, experiences and inspiration with industry professionals and peers in the casual and friendly atmosphere of the ME-P. Join us today.

More: https://medicalexecutivepost.com/2009/10/20/understanding-behavioral-finance/

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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Doctors Shouldn’t Wait Till Retirement To Act On Travel Dreams

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

What’s at the top of your retirement bucket list? If you are like most folks that I help prepare for retirement, travel is high on that list.  As I’ve grown older, my views on retirement travel have changed. I used to buy into the dream of retirement as the “Golden Years.” I thought of it as the time in life when people are free to do what they want, when they want, with whom they want.

Working with older clients has taught me that my younger views of the glory of retirement were a bit naïve. While certainly some people do experience years of unlimited and unfettered travel, many more don’t find it so easy. Doing “what you want, when you want, with whom you want,” assumes three things we often take for granted: good health, adequate finances, and meaningful relationships.

This seems especially true for command-control type medical professionals.

The Three Legs of Retirement Lifesyle

1. Health. When it comes to travel, good health may not be essential, but it will make your experience more fulfilling and enjoyable. Of course, we aren’t typically in either “good” or “poor” health, but fall somewhere on a continuum. With limited mobility, you may be able to shop at the bazaar in Istanbul, but chances are you won’t hike the Grand Canyon or explore the Acropolis.

Like most things, good health typically requires a conscious intention to create and maintain it. Someone who has a money script of, “When I retire I’ll have the time and money to take better care of myself” may be in for a surprise. Most people who chose not to take care of their health before retirement won’t do so in retirement. As one retired friend said, “If you didn’t have the energy to work out when you were young, you sure won’t have it when you retire!”

What’s even more uncontrollable is the health of those with whom you wish to share your travel adventures. Even if you’ve taken care of yourself, your significant other may be unable to travel. Instead of strolling a beach in the Bahamas, you could end up at home being a caretaker.

2. Money. On average, baby boomers have saved less than $100,000 for retirement. That won’t pay for many around-the-world cruises. If you want to travel after you retire, you need a serious commitment during your working years to live frugally and invest as much as you can. Otherwise, you may end up with just barely enough to cover your basic living expenses.

3. Relationships. If you spend your career working 80-hour weeks, you may accumulate enough assets to fund plenty of retirement travel—but by then you may be traveling alone. Saving for the future is out of balance if it’s done at the expense of enjoying life and close relationships today.

Assessment

By now you may think I’m suggesting you have no better choice than to spend your retirement years at home. Not at all. Here’s one possibility: If travel is one of your dreams, what would happen if you did some of it now? Use your vacation time while you can enjoy yourself. Take that motorcycle trip through Europe or go scuba diving in Belize while you’re in top shape. Do the international travel now when you can better negotiate airports, handle travel delays, and power through jet lag. To save on expenses, plan ahead, use a credit card that awards frequent flyer miles (which you pay off monthly), and use cost-saving options like home swaps and off-season travel.

Then, after you retire, when you need more access to medical care and less demanding travel, you can stay closer to home and enjoy the opportunities in your own back yard.

More: http://www.mississippimedicalnews.com/retirement-and-succession-planning-cms-1524

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On Smart Phones, Texting and Doctors Driving‏

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Doctors Beware – A Bad Idea

By Muhammad Saleem

Did you know that almost 60% of drivers use their phones on the road? What about doctors?

The numbers from our piece today could not be clearer on the consequences of using your smartphone while driving. For example:

  • You are 23 times more likely to get into an accident while texting.
  • 18% of distraction-related crashes are from cell phone usage.
  • Distracted driving is the number one killer of American teens.

Assessment

Doctors – Have you ever texted medical orders, or patient instructions etc., while driving? Be honest!

In addition to the above, our infographic discusses statistics on smarthpones and driving, illustrate the dangers, discuss the law, and provide tips to make you and your passengers safer.

Conclusion

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New IRS Guidance on Health FSAs for Doctors

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On Section 125 Cafeteria Plans

By Children’s Home Society of Florida Foundation

In Notice 2012-40; 2012-25 IRB 1 (29 May 2012), the IRS issued guidance on the changes required in 2013 for Sec. 125 Cafeteria Plans.

Section 125 Plans

Many companies have created healthcare flexible spending accounts under Section 125.  For 2013, the salary reduction contributions are limited to $2,500.  The notice indicates that this limit will be adjusted for inflation in 2014 and later years. If contributions greater than $2,500 are made to the account, the excess funds will not subject the employee to penalties if the funds are distributed as taxable income in the taxable year in which the cafeteria plan year ends.  The $2,500 limit does not apply to non-elective plans.  Many of these plans are described as “flex limit” or similar plans.

New Limits

Written cafeteria plans must be modified to reflect the new $2,500 limit and other provisions.  If the plan follows the proposed regulations issued in 2007, the participants may rely on the plan to be qualified.

Assessment

And so, as more and more medical professionals become employees, FSA rules should be monitored closely by doctors and their FAs.

Conclusion

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The Marcinko Method of Improving Quality while Reducing Medical Errors and Healthcare Costs

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Dr. David Edward Marcinko FACFAS MBA CMP

[Former – Certified Physician in Healthcare Quality]

[Former – Certified Financial Planner]

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

THINK TWICE!

Doctor’s Orders

Life Corollaries:

Marcinko’s Rx for Obesity: Eat less – Exercise more – Avoid noxious lifestyles.

Marcinko’s Rx for Practice Success: Treat sick patients – Be humble – Keep faith.

Marcinko’s Rx for Financial Success: Spend less – Earn more – Be a fiduciary. 

Marcinko’s Rx for Wealth & Happiness: Don’t divorce – Love kids – Practice philanthropy.

Professional Medical Corollary:

The Choosing Wisely® list, which is aimed at cutting down on unnecessary testing by doctors and patients.

Assessment  

I am not an oracle. What else can you ad to the list?

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Certified Medical Planner

Physicians as “Dr. Money Waster”

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Paging … Doctor Money Waster?

By Rick Kahler MS CFP® ChFC CCIM

www.KahlerFinancial.com

Be frugal. Live on less than you make. Save for the future. It’s my message, and I’m sticking to it.

Just in case you’re getting tired of that message, though, let’s take a look at thrift from a slightly different perspective.

And so, for any medical professional who wants to throw cash around, here are some effective ways to waste your money:

How to Waste Money on Travel:

  • Buy package vacation deals.
  • Buy a vacation home.
  • Get an RV and only use it one or two weeks a year.
  • Buy a timeshare unit.
  • Pay for hotel Internet packages.
  • Eat at hotel restaurants.
  • Use room service.
  • Over-pack and pay checked airline baggage fees.
  • Don’t bother to use a travel credit card that gives you frequent flyer credits.
  • Stay at full-service hotels with amenities you don’t use.

How to Waste Money on Big-Ticket Items:

  • Buy a new car every three years.
  • Buy hybrid cars.
  • Pay for extended warranties.
  • Fail to compare prices and check product reviews.
  • Pay full price for furniture.

How to Waste Money on Insurance:

  • Get a cancer or accidental death policy.
  • Buy credit life insurance.
  • Buy variable universal life insurance.
  • Have life insurance if you don’t need it.
  • Keep your deductibles low.
  • Purchase the cruise line’s trip insurance.
  • Purchase car rental insurance.

How to Waste Money on Investing:

  • Don’t take advantage of a retirement plan with employer matching that doubles your money.
  • Invest outside of a retirement plan instead of fully funding the plan first.
  • Buy variable and fixed annuities that charge you big commissions and high fees.
  • Buy load mutual funds and trade them often.
  • Cash in your 401(k) or 403(b) plan when you leave your job instead of rolling it to an IRA.
  • Cash in your IRA when money gets tight.

How to Waste Money on Health and Fitness:

  • Buy home fitness equipment and use it to hang clothes on.
  • Pay for a fitness center membership but rarely or never use it.
  • Be a sucker for the latest “cure-all de jour” supplement or multi-level marketing product.
  • Pay more for specialized brand-name vitamins even though store brands are just as good.
  • Buy junk food instead of stuff that’s good for you.
  • Skip those regular visits to the doctor and the dentist.

How to Waste Money with Your Everyday Habits:

  • Drive across town to save two or three cents on gas.
  • Buy grocery name brands instead of cheaper store brands.
  • Pay full retail price for clothes, furnishings, or other items instead of waiting for sales.
  • Buy bottled water.
  • Disregard ATM fees.
  • Pay hefty overdraft fees because you don’t bother to keep track of your bank balance.
  • Forget to change your furnace filter.
  • Don’t bother to maintain your car or house.
  • Be disorganized about taking care of bills on time, so you pay late fees.
  • Pay for premium cable TV packages with channels you rarely watch.
  • If you can’t afford something now, pull out the plastic. When you don’t pay a credit card bill in full at the end of the month, high interest rates can quickly double or triple the price of anything you buy.
  • Gamble. Online gambling, slot machines, gaming  tables, and lottery tickets are all good ways to get rid of extra cash.
  • Speed. This is a three-for-one deal. You’ll use extra gas, pay $100 or more for a speeding ticket, and end up with higher car  insurance premiums.

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Assessment

Even practicing a few of these overspending habits will give you more financial stress and less financial security. Just observing half of them will give you an interesting life full of financial chaos.

Follow more than half and you, too, can qualify as a first-class Dr. Money Waster.

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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How a Medical Answering Service Really Works

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The Traditional System

Ever wonder that happens when you call your doctor’s office after hours and someone picks up the phone? The office is not open at midnight if that’s what you were wondering. Most physicians / doctors / medical professionals have their phones forwarded to an answering service after hours!

What does that mean?

Well, it means that no matter what time it is you can always reach your doctor.

Check out the above infographic to learn out how the call routes from your cell phone to the service to the doctor.

Assessment

Now, with all these steps, it is no wonder modern doctors are using cell phones, iPads, direct or open access online patient scheduling systems.

Conclusion

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

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

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

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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How to Calculate your Financial APGAR Score

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Using a Well-Known Medical Model for Personal Financial Planning

By Andrew D. Schwartz CPA

The term “APGAR Score” should already be familiar to people who’ve experienced the birth of a child and to people in the medical community. Immediately after birth, every baby is evaluated by a doctor to determine its medical condition. The evaluation consists of the following five signs: appearance, pulse, grimace, activity, and respiration. The the eponymous Dr. Virginia APGAR score, developed in 1952, ranges from 0 to 10 and serves as an initial indication of the baby’s overall health.

The Financial Affairs Paradigm Shift

Anyone looking to gain control of their financial affairs must first get a sense of where they stand. And so, we’ve developed a variation of the APGAR test to help people make an initial self-evaluation of their financial condition. The five financial attributes of our APGAR test are as follows:

  1. Accumulated Wealth
  2. Payment of Credit Card and Consumer Debt
  3. Got Life and Disability Insurance
  4. Automobile Habits
  5. Residential Equity
Accumulated Wealth

In this first step, you compare your net investments, your age, and your income. You first need to calculate the total fair market value of all of your investments assets, excluding your principal residence and your cars. Make sure to include non-retirement savings, retirement savings, and any other investments that you may own. You should then calculate the total of all of your debts, excluding any loans on your principal residence and your cars. Don’t forget to include your student loans and your credit card debts.

You should then subtract your total debts (excluding loans on your principal residence and your cars) from your total assets (excluding your principal residence and your cars) and:

  • Give yourself 2 points if your net assets divided by your annual household income exceeds
    {[(your age – 30) * .2] +1}. Married couples should use the average of their two ages.
  • Give yourself 1 point if your net assets are greater than $0 but not enough to qualify you for 2 points.
  • Give yourself 0 points if your net assets are less than $0.
Payment of Credit Card and Consumer Debt

In this step, you’ll take a look at your credit card habits. Always maintaining a balance on your credit cards can really cause your financial position to erode significantly.

  • Give yourself 2 points if you generally pay off your credit cards each month.
  • Give yourself 1 point if you owe money on your credit cards, but will have them all paid off within 6 months.
  • Give yourself 0 points if there is no way that you’ll be out of credit card debt within 6 months.
Got Life and Disability Insurance

Life insurance and disability insurance are two key ingredients to a successful financial plan. Generally, a person will obtain life insurance and disability insurance either as part of their benefits package provided by their employer or on their own through an insurance salesperson or financial advisor.

  • Give yourself 2 points if you have purchased life insurance or disability insurance on your own.
  • Give yourself 1 point if you have life and/or disability insurance through the benefits package offered by your employer.
  • Give yourself 0 points if you have no life or disability insurance at all.
Automobile Habits

Besides one’s home, automobiles are generally a person’s largest purchase. The car you drive is also perceived as a status symbol and can be an area where even the most frugal person would consider being extravagant. How long do you generally hold onto your cars for?

  • Give yourself 2 points if you hold onto your cars for more than 5 years, are provided with a company car from your employer, or don’t own a car and spend less than $300 per month on rentals and cabs.
  • Give yourself 1 point if you generally hold onto your cars for less than 5 years, but more than 3 1/2 years or, if you don’t own a car, you spend more than $300 per month but less than $500 per month on car rentals and taxis.
  • Give yourself 0 points if you generally hold onto your cars for less than 3 1/2 years or, if you don’t own a car, spend more than $500 per month on car rentals and taxis.
Residential Equity

Owning a home is an essential component to most financial plans. Home ownership provides a hedge against inflation and a tax-free means of accumulating wealth. For this step, you’ll need to know the fair market value of your home and the current balance of any mortgages and equity loans on that property.

If you own a home, you must calculate the value of your home’s equity by subtracting the current balance of your mortgages and equity loans from the current fair market value of the home.

  • Give yourself 2 points if the equity in your home divided by the home’s fair market value exceeds {[(your age – 30) * 2.5%] +25%}.
  • Give yourself 1 point if the home’s value exceeds the current balance of the mortgage and equity loans but you don’t have enough equity to qualify for 2 points.
  • Give yourself 0 points if you do not own a home, or if the amount that is owed on your home exceeds its fair market value.

Your APGAR Score Card

A: _____________

P: _____________

G: _____________

A: _____________

R: _____________

TOTAL: ______________

 Assessment and Score Interpretation
  • If your score is 8 or higher, you appear to be on the right track with your finances. Take a look at any attribute that didn’t score a 2, and see if you should make any changes.
  • If your score is between 5 and 7, you have a pretty big job ahead of you. You should try to determine which of the financial attributes need work and put together a plan to make improvements in those areas.
  • If your score is 4 or less, you have lots of work to do. Take a deep breath, and make a commitment to get your finances on track. Keep in mind that the challenge you face may be daunting, but it is not insurmountable.

About the Author

Andrew D. Schwartz, CPA is founder and managing partner of Schwartz & Schwartz, PC, in Woburn, MA. Since 1993, Andrew has provided tax, practice management, payroll, and basic financial planning services to healthcare professionals and their practices. Andrew is also the founder of The MDTAXES Network, a national association of CPAs that specialize in the healthcare profession. Andrew is a frequent speaker at national and area conferences (including the Yankee Dental Congress and the 2012 National Audiology Conference), medical and dental schools, and community events.  Andrew is the author of many tax and basic financial planning articles on a variety of issues that impact healthcare professionals. He is frequently interviewed as a tax advisor on current topics in national media, such as ABCNews.com, Washington Post and Wall Street Journal, and local media, such as Greater Boston Radio 92.9 and Boston.com.  Andrew graduated from the Wharton School at the University of Pennsylvania. He is a member of the Massachusetts Society of CPAs (MSCPA) and the American Institute of CPAs (AICPA). Andrew was selected as a 2011 and a 2010 winner of Boston Magazine’s “Five-Star Wealth Manager – Best in Client Satisfaction” award.

Conclusion

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***

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

***

About the Institute of Medical Business Advisors, Inc

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Championing the Financial Success of

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Alternative Solutions to Medical Malpractice Insurance

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About Captive Insurance Companies

By William Clay Tucker CAP CMFC CRPS

The Woodville Group, LLC wctucker@thewoodvillegroupllc.com

Most states don’t recognize small captive insurance companies (CIC’s) as beneficial holders for required medical malpractice coverage.

Couple this with the fact that most medical practitioners aren’t insurance experts, and the end result is that doctors have only a few (very similar, quite expensive) malpractice insurance options.

So, when it comes time to purchase or renew your medical malpractice insurance, you have three options:

  1. Retail Med-Mal: While this may seem like the simplest solution, it is also the most expensive. With zero returns on premiums paid, you are funneling your money into a “black hole”. Regardless of your claims history, you never see a return on reserves. In the event of a claim, you may have little – or no – say in your defense or the claims negotiation and settlement process.
  2. Normal Risk Retention Groups (RRGs): Although an RRG is a step in the right direction, your medical group will be sharing overall medical malpractice risks with other medical groups insured by the RRG. While you may get back some of what you put in (as a return on equity or a stock repurchase), the amount depends on the claims experience of the RRG’s insureds as a whole and the financial condition of the RRG at the time of your departure from the RRG. Under this approach, the medical group’s financial investment remains 100% in the RRG during the entire insurance coverage period.
  3.  A Single Practice Risk Retention Group: A medical practice can now form its own small Risk retention Group (RRG).  The RRG retains a small percentage of overall insurance risk (an average of ten percent) and therefore your group’s participation in shared risk with all of other insured medical groups remains small.  The primary reinsurance structure is the reinsuring Captive Insurance Company (CIC) which is owned 100% by your  medical group’s owners and only reinsures the physicians in your medical group practice. In the Single Practice RRG model, the majority of your medical group’s financial investment remains in its CIC, which will remain owned and controlled by the owners of your medical group.

Enter the Single Practice Risk Retention Group

Year after year, as rates go up, doctors are funding their med-mal insurance and never seeing a return on the premiums they pay. With this structure you can insure your medical group’s practice and see a significant return on paid premiums by practicing good medicine and good risk management.

Advantages

Here are just a few advantages that a Single Practice Risk Retention Group can offer:

  • The insurance company is owned by the same medical groups it insures
  • Regulated financial and insurance reporting methodologies, no questionable loopholes or practices
  • Return of stock at book value when medical group is no longer an insured or medical practice changes its insured personnel.
  • Recapture lost wealth through practicing good medicine and risk management!
  • After five years, your medical group could get back more than 50% of what it has paid in total premiums
  • After ten years, your medical group could get back more than 100% of what it has paid in total premiums

Assessment

Those with the highest insurance rates, such as surgeons or OB/GYN doctors have the most to gain from self-insurance structures. In order to get started in forming your own Captive Insurance Company (CIC), you must first understand that this is not meant for a short-term solution. Because of the fees due when getting started, a minimum of three years commitment is required. The longer you hold this insurance with fewer claims, the more assets will be available at its completion. Recapture lost wealth—you owe it to yourself to investigate.

Conclusion

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The True Cost of Automobile Ownership for Physicians

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The First Ten Thousand Miles is the Most Expensive

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By Dr. David Edward Marcinko MBA FACFAS CMP™

[Editor-in-Chief]

With the July Fourth Holiday behind us, America’s summer long vacation road-trips begin.

But, anyone looking to buy a new car should be well aware that the cost of a car doesn’t end at the purchase price.

Other Factors

For example, you must consider additional concerns such as: depreciation, fuel costs, insurance, maintenance and repair, invoicing and sales tax.

***

***

To help potential buyers with their purchases, we’ve put together the above infographic that outlines the real cost of ownership of various types of cars.

Source: www.insurancequotes.org

And, always let some other fool take the depreciation hit; buy previously owned [a.k.a. used] cars.

Assessment

Anyone who is a regular reader of the ME-P knows about my vintage 2000 Jaguar XJ-V8-LWB European touring sedan built in Coventy, England. She is a beauty who has never known rain, winter or snow. Mostly highway miles, always garaged. She not only clicks – she ROARs!

Conclusion

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Transparency Emerges in Dentistry

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Cavities Blamed on Patients

[By D. Kellus Pruitt DDS]

If your car repeatedly requires costly repairs because you never change the oil, would you blame your mechanic?

PBS Frontline

Dentists are justifiably upset because the recent PBS Frontline documentary “Dollars and Dentists” blames them for our nation’s deteriorating oral health.

http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/

When in reality, good oral hygiene habits are the very basics of personal accountability – reinforced by painful and embarrassing lessons as needed.

Tradition Dentists Usually Silent

Traditionally, dentists seldom speak up. But at a time when they are finding it difficult to keep their chairs filled, even by discounting their fees, “Dollars and Dentists” struck an inflamed nerve – causing dentists to publicly react in defense of the profession like never before.

As an example, here is Dr. Alan Mead’s blunt response which he posted for his patients to read on his Mead Family Dental website:

“If you have dental problems, it’s mostly your fault. And if you want to have less dental problems, it’s your responsibility. It’s not the fault of the dental insurance company. It’s not the government’s responsibility. It’s on you.”

http://meadfamilydental.com/2012/07/preventable/

Responses

According to other responses, apparently far fewer blameless people are born with “soft teeth” than one might be led to believe by people with lots of cavities. Dentists have politely, but futilely reminded people for decades that it’s refined sugar, bacteria and poor brushing habits that rots teeth.

Assessment

I think the demand for truth in healthcare is going to continue. Over the next few months watch for one or more recognized leaders in the dental profession to actually mention the word “transparency” for the first time since 2008 when an ADA President-elect candidate from California used the word in his campaign platform. He lost. But now that dentists are finally becoming sufficiently annoyed by reporters’ broad accusations of greed and malfeasance, it could be interesting to watch the predictable emergence from obscurity of this perky little healthcare niche – one agitated dentist at a time.

Conclusion

If openness were popular, someone would have long ago told Grandpa his breath smells like death.

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A Review of LP / LLC Transfer Hazards for Physicians

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Can standard boilerplate and default corporate law provisions inadvertently disinherit your family from controlling the business or cost millions in additional estate/gift tax?

By Ed Morrow, JD, LL.M. (tax), MBA, CFP®

[Manager, Wealth Strategies Communications, Key Private Bank]

Many physicians use limited liability companies, limited liability partnerships or limited partnerships (“LLCs”, “LLPs” and “LPs”) to operate a trade or business, to hold real estate, or even to hold investment assets.  When only immediate family are owners, these are often referred to as family limited partnerships or limited liability companies (“FLPs” and “FLLCs”).  There are numerous business, asset protection and estate planning reasons for using these entities (hereinafter lumped together for simplicity as “LLCs”).  In many cases, these are preferable to old-fashioned corporations (see separate companion article on LP/LLC Advantages).

As a doctor – you must be very careful, however, when transferring LLC shares during lifetime or at death, to your spouse, children, trusts or others.  Especially when there are co-owners outside the immediate family.  This is due to a stark difference between LLC/partnership law and corporate law and the concept known as “assignee interests”.  Understanding this is even more crucial in 2012 because of the overwhelming demand and interest in transferring LLC interests to irrevocable trusts to exploit the $5.12million gift tax exclusion, which is slated to reduce to only $1 million in 2013.

An LLC owner (called a “member”, not a “stockholder”) has two bundles of rights:

  1. Economic rights – which are the rights to receive property from the LLC both during existence and upon liquidation, along with tax attributes and profit/losses; and
  2. Management rights – the right to vote, participate in management and receive reports and accountings.

It is the latter category that can cause problems when transferring LLC interests by gift or at death.

Members of an LLC usually establish an Operating Agreement to set the rules for transfer of interests.  State statutes (such as the Uniform Limited Liability Company Act) usually provide default rules where the document is silent.

The problem occurs when an LLC member transfers a portion of his or her ownership interest in the LLC to another person, either during lifetime or at death.  At that point, the transferee may become a “mere assignee” of the LLC interest, and not a full “substitute member.”  Under the laws of most states, unless the Operating Agreement provides or parties otherwise agree, an assignee only receives the transferor’s economic rights in the LLC, but not the management rights.

In fact, some court cases require member consent even if the operating agreement seems to otherwise permit such transfers (Ott v. Monroe, 719 S.E.2d 309, 282 Va. 403 (2011).  These state laws were enacted to protect business owners from unwillingly becoming partners with someone they never intended or contracted to be partners with.

This treatment is completely different from transferring C or S corporation stock – when you buy P&G stock, you get the same rights as the previous owner.  S Corporation stock is not even allowed to have differing classes of ownership interests (although voting/non-voting is permitted).  Usually, this quirk in the law has numerous asset protection benefits to LLC owners (discussed in the companion article), but it can cause havoc to one’s business planning in unforeseen circumstances.

Examples of Inadvertent Loss of Control

#1- Doctors Able and Baker, unrelated parties, form and operate an LLC.  Able owns 49% and Baker owns 51%.  Baker has a controlling interest in the LLC.  Baker dies and his 51% interest in the LLC is transferred to his revocable living trust.  Now, the trust is a “mere assignee” and while the trust receives 100% of Baker’s economic rights in the LLC (51% of the total LLC economic rights), it has none of the management rights.  After Baker’s death, Able will have 100% of the LLC’s management rights.  The trustee may have serious difficulty even getting books and records of the LLC, much less have any say on reviewing Able’s business decisions (including new hire and new salary expectations).

#2 – Same ownership structure as above, but Baker leaves assets via Transfer on Death designation or via Will to his spouse, children or others directly.  Same result.

#3 – Same ownership scenario as above, but Baker gifts his membership interests during life to his spouse, children, UTMA account or an irrevocable grantor trust.  Same result.

#3a – Same scenario as above, but Baker simply transfers his shares to his revocable living trust (called “funding”) via Schedule A attached to trust or other assignment.  Same result.

#4 – Same scenario, but Dr. Baker got express permission of Able to transfer his LLC interest to his revocable living trust and have it remain a full substitute member.  No issue – until Baker dies and the LLC interests pass to a new subtrust, such as a bypass, marital, QTIP, or other irrevocable trust, or to beneficiaries outright.  Able must have agreed to this subsequent transfer as well, otherwise the transfer to the new subtrust will be a mere assignee interest and the Baker family loses control.

Creditor Issues

Again, Able and Baker own 49%/51%.  Baker has some creditor issues from a tort claim and co-signed loans unrelated to the LLC.  He files bankruptcy to reorganize or get a clean start (or perhaps the creditor forces a bankruptcy).  This is probably another trigger that causes Baker to lose all of his management rights in the LLC.

Incapacity Issues

Again, Able and Baker own 49% and 51% economic and management rights respectively.  This time, Baker has a stroke or an accident and his wife or one of his family takes over as guardian or conservator.  Similar result.  Able now has 100% controlling management rights, even though Baker still keeps the same economic rights.  He can fire Baker and raise his own salary.

Estate/Gift Tax Issues 

Able and Baker’s company is worth $10Million.  Baker’s 51% interest gets marketability discount, but a controlling premium, so valuation experts and the IRS agree it is worth $4Million.  Able’s 49% interest gets a marketability and lack of control discount, so his interest is only worth $3 million.  Yet when Baker dies, he leaves this 51% interest to his spouse (or marital trust) as a mere assignee, and because the interest has no voting control or management rights, it may be worth only about $3 million in the hands of the spouse/trust (because there is no “control” or management rights, the 51% is worth considerably less).  Thus, Baker’s 51% interest is taxed at $4 million, but only gets a $3 million marital deduction (this same discrepancy is true for charitable gifts, which is why physicians should also be careful gifting LLC interests to charities or charitable trusts).  Did $1 million in value inadvertently pass to Able?  At best, this wastes Baker’s estate tax exemption.  At worst, it may lead to an additional 55% tax (and probably penalties, since it would unlikely be reported and caught on audit) on $1million, or $550,000 additional tax that could easily be avoided.

This same issue arises in gifting shares to a spouse or to a trust for a spouse that is intended to qualify for the marital deduction (or to charities or charitable trusts).

In addition, gifting a mere “assignee” interest risks disqualifying any LLC/LP gifts for the “present interest” annual exclusion under IRC 2503(e) ($13,000 per donor per donee) pursuant to the recent IRS wins in the Hackl, Fisher and Price cases.

Furthermore, it adds grist to a favorite line of attack that the IRS uses to add to taxpayers’ estate tax bill.  If a taxpayer has a “retained interest” in a gift, the IRS has been successful in pulling such gifts back into a taxpayer’s estate (therefore causing additional 35-55% estate tax).

What Can Physicians Who Own LP/LLCs Do?

If you want to transfer both economic rights and management rights in your LLCs, similar to shares of stock of a corporation, then the LLC’s written Operating Agreement should be reviewed and/or revised to admit certain transferees or assignees (like a guardian/conservator, spouse, children, trust, subtrusts, etc) as full “substitute members”, while other transferees (like creditors, ex-spouses) can remain “mere assignees”, with no management rights.

LLC owners may decide on other variations on the above solution if desired.  For instance, some owners might prefer to exclude a surviving spouse or children from management rights, but be perfectly comfortable with having an independent or agreed upon trustee of a marital trust accede to those rights.  The key to good planning is to know the consequences of gifts/bequests beforehand to adequately plan.

Make sure your entire wealth management team is on the same page when orchestrating your wealth planning.  Ask whether they use a checklist of any sorts in their planning, or even if they do, whether they communicate the checklist with other advisors on your team – many do not.

Assessment

As noted in Atul Gawande’s The Checklist Manifesto, simple checklists can often prevent mistakes and miscommunications among even the most educated of professionals – this is certainly true for asset protection and tax planning for LLC interests, and at no time more than in 2012 with all of the anticipated tax changes and proposals threatening to snare any missteps in planning.

ABOUT THE AUTHOR

© 2012 Edwin P. Morrow III and KeyBank, NA.  The author holds the following designations:  J.D., LL.M. (masters in tax law), MBA, CFP® and RFC®.  He is a Board Certified Specialist in Estate Planning, Probate and Trust Law through the Ohio State Bar Association.  He is an approved arbitrator for the Financial Industry Regulatory Association (FINRA).  He currently provides educational and consultative services nationwide for the financial advisors and clients of Key Private Bank.  Contact:  (937) 285-5343 or:  Edwin_P_Morrow@KeyBank.com Ed is also a friend of the ME-P and designated “thought-leader”. 

Conclusion

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Do Clients Trust Financial Advisors More than Doctors or CPAs?

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I Think … Not in My Universe

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Survey after survey has shown that the public does not trust the financial services industry; it was – in fact, the least trusted industry in a recent Rick Edelman survey.

John Hancock?

But, perhaps they were looking at the wrong industries, or maybe investors just don’t trust your firm. A new survey by John Hancock shows that investors with assets of $200,000 or more, trust their financial advisor [FA] more than their primary doctor, accountant, contractor/handyman, boss and real estate agent. It was penned by one young staff writer named Diana Britton.

Link: http://wealthmanagement.com/blog/clients-trust-you-more-doctors-cpas?NL=WM-04&Issue=WM-04_20120611_WM-04_597&YM_RID=marcinkoadvisors%40msn.com&YM_MID=1318408

My View Point is Pretty Unique

Now, I am a doctor and board certified surgeon who held Series #7, #63 and #65 securities licenses, and was a Certified Financial Planner® for more than a decade. I was registered with a BD, SEC and NASD/FINRA, and held life, health and PC insurance licenses. This is the so-called “dual registration” to earn commissions and fees.

And, I’ve got a current partner who is a doctor-CPA who has a Master’s Degree in Accounting.  So, I know from whence I speak.

An Insurance Company!

Now, I resigned all of the above financial services monikers because of their lack of education and fiduciary accountability. These are sales licenses, certifications to hold a certification, and related gimmicks, all. Insurance agents have a duty to the company, not the client. Always ask them to put your best interests ahead of their own – in writing before hire – and watch them run.

Assessment

I suspect this study from an insurance company is less than accurate. How do I know? My gut heuristics tell me. Agency law tells me. No surveys needed or damn statistics for me. How about you? OR, are the marketing and PR gurus winning the public opinion battle with their insurance company advertising chicanery? ie., Hancock’s the future is yours!

If really so, here is my razzy for them.

 
Note: It is for the above reasons, and more, that we started the www.CertifiedMedicalPlanner.org online education program for financial advisors and management consultants that truly want to be trusted.

Conclusion

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How Health Reform Could Expand Medicaid

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PP-ACA Results State-by-State

By Lena Groeger
ProPublica

Experts estimate that nearly 16 million Americans could be added to the Medicaid rolls by 2019 under an expansion in the Affordable Care Act. But, the Supreme Court ruled last Thursday that states can opt out without risk of losing federal support for Medicaid, raising the stakes that some may do so.

The Big Picture

Here is a look at forecast growth in state Medicaid rolls under the expansion. Twenty-six challenged the act in court.

IMAGE LINK: http://www.propublica.org/special/state-by-state-how-health-reform-could-expand-medicaid

Related: Mystery After the Health Care Ruling: Which States Will Refuse Medicaid Expansion?

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Are Doctors Withdrawing Enough for Retirement OR Too Much?

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Retirement Planning www.KahlerFinancial.com

By Rick Kahler MS CFP® ChFC CCIM

One of the biggest adjustments for doctors, and all medical professionals, when they retire is making the switch from saving to spending. For years and years, they’ve been putting money away for the future. It’s hard to accept that it’s time to start taking that money out because “the future” has arrived.

How Much – The Big Question

Financial planners can help retired clients make this transition more comfortably by helping them decide on a reasonable withdrawal rate to answer the crucial question, “How much can I take out of my portfolio every year?” That rate needs to balance the need to have enough money to live comfortably and the need to make sure there is enough money for the rest of the clients’ lives.

Pessimism Rules

This is one area of financial planning where pessimism is a virtue. If an advisor claims you can withdraw eight or ten percent, or even more, that’s a red flag that you’re getting bad financial advice. For most people, rates that high are simply not sustainable. A few planners are comfortable recommending withdrawal rates of five or six percent. The more standard rate is four percent. Conservative planners, me among them, tend to recommend three percent.

The Four Percent Anchor

Over my years as a financial planner, however, I’ve come to realize the futility of anchoring on a set withdrawal rate. This is a number that needs to be established based on each client’s needs and circumstances. Because so many variables affect safe withdrawal rates, planners need to keep up on the latest research and continually refine their thinking in this area.

Every time we change the investment mix in clients’ portfolios, it changes the standard deviations, which in turn affect withdrawal rates. For example, at Kahler Financial Group we historically have used a cost-of-living estimate for Social Security of 3%. This was even with our long-term projected increase for the Consumer Price Index (CPI). With some of the current turmoil and lack of confidence that Congress will put Social Security on a firm footing without some type of crisis, we have lowered our COLA expectations to 1% under the CPI, or 2%. Of course, this affects the withdrawal rate we recommend to clients.

The Frugal Types

Most financial planners have some clients who withdraw significantly less than they could. These frugal types are extremely unlikely to run out of money before the end of their lives. They will almost certainly “leave some money on the table.” This is fine if they want to leave money to their heirs. The possible downside is that they could have used some of that money to live more comfortably during their retirement years.

The Spendthrift Types

At the other extreme are those who, for various reasons, take out the maximum that the planner recommends or even more. The higher the withdrawal rate, the lower the probability that they will have enough money to last as long as they live. Only the clients themselves can decide whether their comfort level is at a 99% chance of having enough and even leaving money on the table, a 95% chance, or even down to a 60% or 50% probability of having enough.

Assessment

A projected withdrawal rate is just that, a projection. It’s an educated guess. Markets change, economies change, and unplanned events happen in life. All of those circumstances will affect portfolios and withdrawal rates.

And so, what type of medical professional drawdown participant are you?

Conclusion

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Some Starting Salaries for New Under-Graduates

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Jobs Outlook

Many doctors and medical professionals have offspring about to enter the job market. While the current economy can certainly make job hunting frustrating for some recent grads, it’s not all bad news.

Source: Online Colleges Guide

Assessment

Nearly 60% of employers surveyed rated the current job market good to excellent, and many plan to increase their number of hires this year.

Conclusion

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The Supreme Court Permits Healthcare Taxation “Penalty”

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On the PP-ACA

By Children’s Home Society of Florida Foundation

In 2010 Congress passed the Patient Protection and Affordable Care Act (PPACA). A key part of the Act is an individual mandate for health insurance. All individuals must have health insurance by 2014 or pay a tax-penalty.

The Tax Penalty

The tax-penalty starts at the greater of $285 per family or 1% of income in 2014. However, by 2016, the tax-penalty increases to $2,085 per family or 2.5% of income, whichever is larger.

Commerce Clause

Many states sued the federal government and asked that the individual mandate be held invalid. While the various courts had different positions on the issue, some federal judges were concerned that requiring a person to purchase insurance could be a violation of the Commerce Clause of the U.S. Constitution.

CJSC John Roberts

Chief Justice of the Supreme Court John Roberts wrote the opinion for a 5-4 majority in the PPACA case. First, he determined whether or not the Court was prohibited from ruling on the case under the Anti-Injunction Act. He decided that the required payment would be a “penalty” for purposes of that Act and not a tax. Therefore, the Supreme Court could issue a ruling.

Second, Chief Justice Roberts reviewed the powers of government under the Commerce Clause. He agreed with the other four justices opposing PPACA that Congress had the right to regulate commerce, but does not have the right to regulate non-activity. Therefore, requiring individuals to purchase health insurance is not a permitted power under that provision. PPACA could not be approved under the Commerce Clause.

However, Roberts observed that it is permissible for the Court to consider the validity of PPACA under the power of the government to tax. He determined that the individual mandate to purchase insurance or pay a penalty-tax is permitted under that power. Roberts stated, “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” He carefully approved the use of the power without discussing the appropriateness of PPACA provisions.

Roberts found several reasons for permitting the taxing power. The tax-penalty will be paid when filing IRS Form 1040. As is true with other tax provisions, lower-income individuals are excluded from this tax-penalty. The tax-penalty is part of the Internal Revenue Code and will be collected by the IRS.

Dissenters

The four dissenting Justices would have determined that PPACA fails to meet the requirements of the Commerce Clause and would have invalidated the entire bill.

Editor’s Note: The taxes to pay for PPACA include a new tax on medical devices that will increase costs to individuals and healthcare providers. There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains. If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%. The increase in capital gains rate may influence charitable gifts of appreciated property in 2013.

Conclusion

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Taxes and the SCOTUS ACA Decision

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My Synopsis for Physician Investors

By Dr. David Edward Marcinko FACFAS MBA CMP™

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

I was at Emory University this past weekend for an unrelated colloquium. But all the chatter, of course, was about SCOTUS, taxes and the just announced ACA decision.

Most doctors I know – just don’t like paying needless taxes. So, what’s the buzz for physicians and other medical professional investors, and their financial advisors [FAs]?

The Synopsis

The taxes to pay for the Affordable Care Act include a new tax on medical devices that will increase costs to individuals and healthcare providers.

There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains.

If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%.

In addition to dividend seeking investors, the increase in capital gains rate may also influence charitable gifts of appreciated property in 2013.

Assessment

Please weigh-in all you FAs and healthcare focused CPAs. What is a physician investor supposed to do, now?

Conclusion

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Events Planner: July 2012

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Events-Planner: JULY 2012

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“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:

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Community Rating and Guaranteed Issue in the Individual Health Insurance Market

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Expert Voices

[By Staff Reporters]

In this essay Dr. Anthony Lo Sasso provides empirical evidence of the adverse selection that resulted when states adopted community rating and guaranteed issue requirements in their individual health insurance markets but did not implement complementary mechanisms to keep lower risk individuals in the insurance risk pools.

Results of Adverse Selection

Such adverse selection can raise premiums, destabilize markets and even lead to market failure through the following cycle of events:

  • Community rating prohibits differential premiums based on health status, effectively lowering premiums for individuals in poorer health and increasing them for healthier individuals.
  • Guaranteed issue allows people to purchase coverage when they get sick, decreasing the need to maintain insurance coverage.
  • Healthy individuals respond by dropping coverage and entering the market only when they need coverage, thus the pool of enrollees becomes increasingly older and sicker.
  • This adverse selection pushes premiums for all remaining enrollees higher, provoking further departures by those at the healthier end of the spectrum.
  • Premiums increase again to reflect the ever-worsening risk pool of enrollees.
  • The cycles continue, further destabilizing the market and potentially leading to complete market collapse.

Assessment

Dr. Lo Sasso’s findings highlight the importance of providing effective mechanisms to protect the integrity of the risk pool in conjunction with the community rating and guaranteed issue provisions contained in the SCOTUS upheld Patient Protection and Affordable Care Act.

Link: EV-LoSassoFINAL

Conclusion

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ACA – UPHELD

The Patient Protection and Affordable Care Act

S.C.O.T.U.S.

UPHELD

Read the Entire Court Ruling

The Centenarian Diet

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Is There Such a Thing?

By Muhammad Saleem

Source: www.TermLifeInsurance.org

Conclusion

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How Americans Embrace Medicare Reform

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The 2012 Elections … and Medigap

[By Staff Reporters]

Americans are spending more on Medicare than is coming in.

In fact, Rand Paul states, “It’s your grandparents’ fault for having too many kids and then your fault for not having enough kids. It’s a demographic problem.”

Source: www.mostmedicare.com

Conclusion

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Update on Tax Reform and New Revenue with FFS Medicare Plans?

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About the Bipartisan Policy Center Debt Reduction Task Force

By Children’s Home Society of Florida Foundation

Senator Max Baucus (D-MT) is continuing his series of tax reform hearings as Chairman of the Senate Finance Committee. On June 19, former Sen. Pete Domenici (R-NM) and Alice Rivlin, former Director of the Congressional Budget Office and the Office of Management and Budget, described their solution. Domenici and Rivlin are the Co-Chairs of the Bipartisan Policy Center Debt Reduction Task Force.

The Domenici-Rivlin Plan

Domenici emphasized that there are two essential parts of the potential 2013 financial reform. He stated, “Healthcare reform and tax reform that raises additional revenue are essential pieces of any serious plan.” Then, Rivlin continued to describe the basic principles for tax reform. She commented, “Assume that all income from whatever source is taxable, which would enable you to raise more revenue from much lower rates, and then go back to decide which modifications are absolutely essential, even though they would raise the rates.”

Two Major Changes

The Domenici-Rivlin plan starts with a modification of Medicare. They propose two major changes.

1. Federal Medicare Exchanges. Private companies could offer fee-for-service and other comprehensive Medicare plans. All Medicare beneficiaries could choose their plan.

2. Competitive Pricing. The private plans and traditional fee-for-service Medicare plans would receive federal support at the level of the second-lowest-cost plan. This pricing method encourages plan providers to economize and reduce overall costs.

Tax Reform

Domenici and Rivlin also offered very specific proposals for comprehensive tax reform.

1. Tax Brackets. Their personal tax system has brackets of 28% and 15%. The corporate rate is 28%.

2. Capital Gains. All gains from capital asset sales are taxed at ordinary income rates. Most taxpayers would pay 28% capital gains rates.

3. Child Credit. The credit per child would be $1,600.

4. Itemized Deductions. None; except miscellaneous deductions that exceed 5% of adjusted gross income.

5. Mortgage Deduction. A 15% credit on interest paid with a limit of $25,000 per year.

6. Charitable Gifts. A 15% credit on deductible gifts.

7. State and Local Taxes. Not deductible.

8. IRAs and Retirement Plans. A 15% tax credit or deductions up to $20,000 per year.

Assessment

Ms. Rivlin concluded her discussion by observing that the plan under discussion was similar to the Bowles-Simpson plan approved by the National Commission on Fiscal Responsibility and Reform. She observed, “The basic structure is the same. You can’t get there any other way.”

Editor’s Note:

Sen. Baucus and House Ways and Means Chairman Dave Camp (R-MI) are steadily moving toward major tax reform in 2013. The two bipartisan groups advocating reform have agreed on general principles. However, there still remains a major political discussion at the end of this year before broad-based reform can commence. Your editor and this organization take no specific position on these recommendations. This information is offered because it will have major impact on all Americans.

Conclusion

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How Financial Advisors and Medical Management Consultants Grow their Business Online

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Discover 30 Ways You Can Grow Your Business Online!

Free Guide. Learn how tap in to social media, ramp up your SEO efforts and work on your website and email marketing with InfusionSoft.

Download this FREE Internet Marketing Guidebook

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Doctors on Drugs

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Profitable Prescriptions?

Increasing in costs each year, prescription pills are one of the most profitable and dominating industries in the nation, with annual sales in the hundreds of billions. Prescribed medications constitute a significant bulk of work that medical coders must transcribe.

The Rx Pill Industry

Shockingly, the prescription pill industry uses questionable practices to increase their bottom line, and in turn, increase coding workload through unnecessary prescriptions. Though pharmaceutical companies have long-earned a reputation for wooing doctors with gifts, bribes, and incentives, it was only revealed in recent years that they’ve also been paying doctors huge sums of money to promote certain products. And, some and doctors are taking up on these offers.

These pre-selected medications are not only violating a conflict of interest, but they can also be largely responsible for increases in patient and insurance costs: a doctor may feel obligated to prescribe an expensive “sponsored” medication over a cheaper alternative.

Assessment

This in turn, is reflected on the overall rising cost of healthcare, which unfortunately, is exactly what the doctor ordered.

Conclusion

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On Rising Used Car Prices

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Good News if You’re a Seller

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]Dr David E Marcinko MBA

Smart doctors, nurses and medical professionals never buy a new car; they let someone else take the economic depreciation hit. I did and loved restoring my vintage Jaguar 2000-V8-LWB European touring sedan. What a class act – it doesn’t click – it ROARS!

Yet, used car prices are starting to fall after rising steadily for much of the year. Easing gas prices in much of the nation, and more trade-ins coming back to dealers because new car sales have picked up, are behind the decrease.

How Much?

Used car prices are expected to decline 2 percent in June from May, according to the National Automobile Dealers Association Used Car Guide. Used truck prices are expected to dip 1 percent.

Read more: http://www.bankrate.com/finance/auto/used-car-prices-up-and-staying-strong.pdf

Assessment

Some cars, especially fuel-efficient autos, will see much larger drops, the National Automobile Dealers Association said, as falling gas prices reduce demand for the vehicles.

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Are Cost Estimates Leading To The Wrong Decisions in US Hospitals?

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Rethinking Cost-to-Charge Ratios

By www.ObjectiveHealth.com

More than half of US hospitals use cost-to-charge ratios as a primary cost estimation method since true procedural cost accounting can be prohibitively expensive.

Risks are Present

Although many hospitals believe that cost-to-charge ratios are relatively acceptable for internal planning purposes, there are many risks of this approach which can lead to sub-optimal strategic decisions.

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Appreciating the Harmful Effects of Multi-tasking, Social Media and Digital Internet Stress‏

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Internet Use and Brain Atrophy

By Muhammad Saleem

While conventional wisdom teaches us that multitasking makes us more efficient, research suggests that we’re incapable of efficiently managing more than two tasks at a time.

Brain Impact

eHRs, CPOEs and MU … oh my!

If you have a moment, take a break from what you’re doing to look at this infographic on how multitasking induced stress impacts our brains.

Synopsis

Here are some of the findings in brief:

  • Our daily consumption of social media has more than doubled in the last 50 years from 5 hours to 12 hours.
  • The average computer user checks 40 websites a day, switching between programs 36 times an hour.
  • 61% of adults admit to being addicted to the internet.

Assessment

Excessive internet use by doctors and Financial Advisors may lead to the atrophy of grey matter and impact memory, goal-setting, and decision making.

Conclusion

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Life Planning 101 for Young Adults and New Doctors

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My Annual Graduation and Wedding Advice

By Rick Kahler MS CFP® ChFC CCIM

www.KahlerFinancial.com

June is traditionally filled with college and medical school graduations and weddings; rituals that mark two of our most important life transitions. Whether you are a new physician walking across the stage or a new spouse walking down the aisle, you’re focusing on your future. It’s a perfect opportunity to think about what you need to do financially to provide for that future.

My Best Financial Advice

Here, adapted from a column I originally wrote a few years ago, is what I might call “Life Planning 101 for Beginning Adults.” It’s a summary of my best financial advice for graduates, newlyweds, and anyone else just starting out in their adult lives and careers; including doctors. Here’s how anyone can manage money wisely to create a life with more security, flexibility, and opportunity.

  1. On every gross dollar you earn, pay your taxes first. Estimate your total tax liability and be sure your employer withholds enough to cover it. If you are self-employed, set up a savings account, deposit a percentage of every check, and use that money to pay your quarterly estimated taxes. Never “raid” these funds.
  2. Save for the future by putting away 20% or more of every gross dollar you earn until you have six months to one year of living expenses in an emergency account [physicians may actually need more]. Then begin investing in your employer’s 401(k) or a retirement plan. If you are self-employed, set up a retirement plan that will allow you to invest as much as you possibly can. My co-authored book Conscious Finance (www.consciousfinance.com) includes a chapter on how to begin investing.
  3. Set up a short-term savings account for future lump sum expenses like car and home repairs, vacations, holiday giving, college tuition,and medical emergencies Figure out how much you’ll need to save from each paycheck to fund all of them annually; then, if possible, have your employer automatically send that amount to a savings account.
  4. After you’ve taken out for your taxes, long-term savings, and short-term savings, you get to blow the rest any way you want. For most people, this means living on 30 to 60 cents out of every gross dollar you earn.
  5. To maintain a comfortable lifestyle, spend frugally. Shop sales, clip coupons, read labels, compare and bargain. People who build wealth usually don’t wear designer clothes, drive luxury cars, live in extravagant houses, or shop at Neiman Marcus [doctors beware]. They typically wear jeans bought on sale, drive Fords, live in middle class neighborhoods, and shop at Walmart.
  6. Pay cash for everything but your home. For convenience, you can use a debit card. Never use a credit card unless you pay it off every month. If you ever find yourself unable to pay off your card, cut it up. Pay off the balance as quickly as you can, and then don’t use a credit card for at least one year.
  7. When you get a raise, a new job, or a promotion, don’t change your lifestyle. Save at least half of the increased income.
  8. Your career is your number one financial asset. As much as possible, find a job you love. Invest in educating yourself and keeping abreast of changes in your career field.

Assessment

Use money as a tool, not a goal. Money itself will never give you meaning or make you happy, but it is a valuable tool to support your quest for meaning and happiness.  This self-disciplined approach isn’t going to help you get rich in a hurry. What it will do is establish a lifetime pattern of sound money management. It can help you create a satisfying, responsible relationship with money now as well as a secure, prosperous future.

Conclusion

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The Physician’s Home Mortgage Tax Benefit

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What is the Real Benefit?

Your home is likely your biggest investment. So, knowing exactly what, and how much, you’re paying is just common sense.

Total Costs

But, when medical professionals map out the life of their home mortgage and the total cost — even factoring the best mortgage rate – they often fail to consider the copious tax benefits they will receive.

Going Granular

We take a look at three home-buyer scenarios to determine just how much they will receive in tax benefits over the life of their loan, and the total amount they will have paid when their loan is finally over.

Assessment

Also included is the cutoff point for each filing status for when the standard tax deduction becomes more than the itemized deduction.

Conclusion

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The Case for Major Tax Reform in 2013

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Tax Code is “Beast with Hundreds of Heads”

By Children’s Home Society of Florida Foundation

Senate Finance Committee Chairman Max Baucus (D-MT) has been holding a series of hearings in preparation for major tax reform in 2013. In an address on June 11 to the Bipartisan Policy Center, Baucus outlined the basic guidelines for major tax reform. He compared the current tax code to “Hydra, the mythical Greek beast with hundreds of heads.” Baucus noted that the last major tax reform of the entire code was 1986. Since that time, Congress has made 15,000 changes to the Tax Code. He suggested it is long past time to “get rid of the deadwood and simplify the code.” Baucus believes that the Tax Code needs to reflect the major changes in America since 1986.

Deficits and Debt:

There has been a rapid growth in both the deficit and the debt in the past decade. The public debt is now 73% of America’s gross domestic product (GDP). This is the highest level of debt since World War II. In addition, with the reduction in tax revenue from capital gains and other business revenue, the total receipts by the government are the “lowest they have been since World War II.” A combination of higher spending and lower revenues has created a serious debt and deficit problem. Tax reform will need to be accompanied by a sound budget that reduces the national debt and deficit. This will include both tax increases and spending reductions.

World Competition:

All of America faces major challenges because of the changing world. The U.S. economy has grown 88% since 1986. However, most of the gains have gone to upper-income individuals. In the past 15 years, America has 15% more college graduates. However, some of the other nations in the third world have increased their number of graduates by 90%. All of these new college graduates throughout the world are creating substantial competition for job growth. Families have also changed significantly. In 1986, there were more couples with one breadwinner. Now there are more single persons and working couples. There are fewer manufacturing jobs. The American economy has moved steadily from manufacturing to exporting financial services, software and engineering.

Finally, many foreign nations have acted aggressively to modernize their education systems, infrastructure and tax codes. Foreign companies increasingly have grown to join the members of the Fortune Global 500. Many of these large foreign companies have been acquiring U.S. companies and reducing the jobs in this nation. For example, when the European company Unilever acquired the U.S. company Alberto Culver, it closed an Illinois production facility and moved hundreds of jobs overseas.

A Solution?

Baucus foresees a four-part solution. A new tax code will be needed that has a focus on jobs, competition, innovation and opportunity.

1. Jobs.

The primary factor that will increase employment is to reduce personal income tax rates. This will require reducing or eliminating tax expenditures (such as deductions for medical care, retirement plans, mortgage interest, state and local taxes and charitable giving).

2. Competition.

The foreign nations have all reduced their corporate tax rates. America now has the highest corporate tax rate in the industrial world. The corporate tax rate will need to be reduced by eliminating many corporate deductions.

3. Innovation.

America will need to encourage research and new technologies with appropriate incentives.

4. Opportunity.

In the present world, education is more important than ever before. Therefore, a new tax code will need to facilitate higher education opportunities. Baucus stated that he is “making progress on a detailed tax reform proposal that will attract bipartisan support.”

Editor’s Note: Chairman Baucus and House Ways and Means Chair Dave Camp (R-MI) are both holding hearings. They believe that 2013 is the “once-in-a-generation” opportunity for them to craft comprehensive new personal and corporate tax codes.

Conclusion

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

 

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Top Financial Challenges for Physicians‏

 

 

Insufficient Income Rated as #1 Financial Challenge

The financial health of physicians continues to lag significantly behind other measures in the Physician Wellbeing Index:

  • Overall Wellbeing: 57%
  • Financial Wellbeing: 50%

 

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US Senate Seeks [Medical] Student Loan Solution

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Will Medical and Health Sciences Students Benefit?

By Children’s Home Society of Florida Foundation

The Senate was still unable to craft a compromise last week on efforts to maintain the current student loan interest rate. If there is no action before July 1st, the student loan interest rate on most loans will increase from 3.4% to 6.8%. Both major parties have proposed a one year freeze on the interest rate at 3.4%. However, the leaders from the two parties have different opinions on how to offset or pay for the $6 billion cost of that interest rate freeze.

Democrats

The Democratic proposal by Senate Majority Leader Harry Reid (D-NV) carries the title Stop the Student Loan Interest Rate Hike Act of 2012 (S. 2343). It failed on a vote of 51-43 last week, nine votes below the required 60-vote threshold for passage.

Republicans

The Republican alternative is the Interest Rate Reduction Act (S. 2366). It also failed on a vote of 34-62.

Both Sides

Senate Democrats proposed requiring Subchapter S corporations with three or fewer members and income levels of $200,000 per year ($250,000 for joint filers) to make payroll tax contributions on all income. The Republican solution is to repeal the Prevention and Public Health Fund.

Response

In response to the vote, White House Press Secretary Jay Carney stated, “For the second time this month, they voted to ask millions of students to pay an average of $1,000 each rather than close a loophole that allows the very wealthy to avoid paying their fair share.”

Assessment

Senate Republican Leader Mitch McConnell (R-KY) stated, “In order to cover the cost of a temporary rate freeze that both parties want, they proposed to divert $6 billion from Medicare and to raise taxes on small businesses – hurting the very companies we are counting on to hire today’s college graduates.”

Editor’s Note: There is very broad support for a one year extension and it is an election year. While the parties have been unable to agree on offsets during the past year, eventually they may choose to pass the bill without offsets. It is quite possible that will happen with the student loan interest freeze.

Conclusion

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