From the ME-P and iMBA Inc

Learn How to Profit and Thrive in the PP-ACA Era
Filed under: Book Reviews, iMBA, Inc., Practice Management | Tagged: iMBA, Inc., ME-P, www.medicalbusinessadvisors.com, www.MedicalExecutivePost.com | Leave a comment »


Filed under: Book Reviews, iMBA, Inc., Practice Management | Tagged: iMBA, Inc., ME-P, www.medicalbusinessadvisors.com, www.MedicalExecutivePost.com | Leave a comment »
Will technology replace doctors?
[By ME-P Staff Reporters]
Here is a video encore presentation of Silicon Valley investor Vinod Khosla‘s controversial interview with Thomas Goetz from last month’s Health Innovation Summit where he likens modern healthcare to witchcraft and says technology will replace 80% of doctors.
Video link: http://www.hitconsultant.net/2012/09/15/vinod-khosla-thoughts-health-innovation/
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Conclusion
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Filed under: iMBA, Inc., Information Technology | Tagged: Vinod Khosla’s Controversial Thoughts on Health Innovation Video | 8 Comments »
A Review of Serious Penalties
The Health Insurance Portability and Accountability Act (HIPAA) was instituted in order to protect the personal health information held by covered entities, including doctors, pharmacies and health insurance companies.
The Violations
A HIPAA violation can cost an individual or entity millions of dollars in fines and can even land those responsible in prison.
Assessment
In this HIPAA infographic, we detail some of the most serious penalties ever dished out by the federal government and break down the various fines that are on the table for noncompliance.
Conclusion
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
Filed under: Health Law & Policy, Practice Management | Tagged: Health Insurance Portability and Accountability Act, High Cost of HIPAA Violations | 5 Comments »
A ME-P Voting and Opinion Poll
Who Won the Vice Presidential Debate Last Night?
Assessment
The pressure is on: http://firstread.nbcnews.com/_news/2012/10/10/14340705-first-thoughts-the-pressure-is-on?lite>1=43001
Conclusion
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
Filed under: Health Law & Policy, Voting Polls | Tagged: Joe Biden, Paul Ryan, who won the VP debate? | 2 Comments »
It’s About … the Invoice
By Staff Reporters
Here, Connance visually shows how hospital billing process is directly correlated to the patient experience.
Assessment
Patients who encounter problems with their physician’s billing office are less likely to recommend that physician/clinician to others.
www.BusinessofMedicalPractice.com
Conclusion
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org


Filed under: Health Insurance, Practice Management | Tagged: Connance, CPT codes, Hospital Billing, medical invoices, Patient Experience | 2 Comments »
2012 – Nobel Prize for medicine awarded to Gurdon and Yamanaka for stem cell discoveries
[By Staff Reporters]
British scientist John Gurdon and Japanese researcher Shinya Yamanaka were jointly awarded the Nobel Prize in physiology or medicine yesterday, for experiments separated by nearly half a century.
In the words of the selection committee, their work … “revolutionaized our understanding of how cells and organisms develop.”
Official announcement: http://www.nobelprize.org/nobel_prizes/medicine/laureates/2012/press.html
Conclusion
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Filed under: Alerts Sign-Up, Breaking News | Tagged: John Gurdon, nobel prize medicine, Shinya Yamanaka | 18 Comments »
About Accounting Fraud
Definition: Any act or attempt to falsify an accounting statement for financial gain.
A clear example of accounting fraud is the act of deliberately overpricing a company’s assets in order to drive up its share price.
Another example is filing bankruptcy to avoid debt, rather than because of financial hardship.
One of the biggest accounting frauds in history occurred during the Enron scandal in 2001.
Conclusion
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
Filed under: Accounting, Ethics | Tagged: Accounting Fraud, Financial Institutional Fraud, money laundering | 6 Comments »
Human versus Enhanced Human
From: http://www.Keithley.com
Assesment
Link – http://www.keithley.com/knowledgecenter/How-Nanotechnology-Could-Reengineer-Us
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
Filed under: Information Technology | Tagged: enhanced humans, Keithley.com, nanotechnology | Leave a comment »
One Doctor Asks the ME-P
The scourge of foreclosures has brought a lot of moral issues to light. So, Dr. Jones from Las Vegas asks, is it OK to simply stop paying your mortgage?
The answer you get depends on who you ask and what the circumstances are. If you’ve never thought much about this question, you may soon. There are so many mortgages going into foreclosure that it may soon happen to you or someone you know. And even those who don’t go through foreclosure may still be vulnerable to terrible mortgage conditions.
How Bad Is the Foreclosure Rate?
The epidemic of foreclosures is worse than you would believe. Since 2005, there have been 2.5 million foreclosures. In July of 2010, the foreclosure rate went up 6 percent over the same month a year earlier.
Are You Underwater?
If you owe more on your house than your house is actually worth, you may feel like you’re underwater. With excess borrowing against equity and falling home prices, this situation has reached epidemic proportions. It isn’t just a few people in this situation or even a few million people. One quarter of all families are underwater, with negative equity in their own homes.
The states with the worst numbers of people underwater are Florida, Wisconsin, Nevada, California and Arizona. By far, the worst state for this situation is Nevada. In Nevada, 65 percent of borrowers owe more on their mortgage than their house is worth.
What Do People Think About Walking Away From a Mortgage?
If you have already formed an opinion about whether it’s OK to ditch a mortgage or not, you’re not alone in being opinionated. Everyone has an opinion on this, from renters to homeowners and from the young to the old.
In total, 25 percent of renters think it’s okay to walk away from a mortgage. Homeowners aren’t as hip to ditching, though. Among those who own homes, only 17 percent think it’s OK to stop paying.
Is It a Moral Issue?
Some homeowners believe that whether or not to pay is a moral issue. Their own ethics come into play, telling them that someone who signed a contract should see it through, regardless of how home prices have fallen. The mortgage industry loves that—they are really playing up the idea that paying is a moral obligation.
Assessment
What people believe about this issue often comes down to their age and gender.
To see what age groups and genders believe it’s OK to walk away, review the above graphic. And, men and women aren’t as far apart on this issue as you may think. Many people of both genders believe that if your financial circumstances are dire, it may be OK to ditch that mortgage. What about medical professionals? Do you agree with your peers? Click on the graphic to see.
Conclusion
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Filed under: Ethics, Risk Management | Tagged: foreclosed homes, housing crisis, underwater mortgages, Walking Away from A Mortgage | 3 Comments »
The 2012 Presidential Election
The conventions have passed and the presidential debate season is upon us. And the 2012 Presidential Election is just a few months away. Let’s take a look at Mitt Romney’s tax policy based on information posted on his campaign’s official website www.mittromney.com.
Extend the Bush Tax Cuts:
If Congress doesn’t act by the end of the year, the 2001 Bush tax cuts will expire on December 31st causing tax rates across the board to increase. According to Mitt Romney:
While the entire tax code is in dire need of a fundamental overhaul, Mitt Romney believes in holding the line against increases in marginal tax rates. The goals that President Bush pursued in bringing rates down to their current level— to spur economic growth, encourage savings and investment, and help struggling Americans make ends meet—are just as important today as they were a decade ago. Letting them lapse, as President Obama promises to do in 2012, is a step in precisely the wrong direction. If anything, the lower rates established by President Bush should be regarded as a directional marker on the road to more fundamental reform.
Eliminate Taxes on Investment Income for People Earning Below $200k:
Romney’s Tax Policy includes a provision to cut taxes for taxpayers earning less than $200k. Let’s see what the Romney Campaign calls the Middle-Class Tax Savings Plan:
As with the marginal income tax rates, Mitt Romney will seek to make permanent the lower tax rates for investment income put in place by President Bush. Another step in the right direction would be a Middle-Class Tax Savings Plan that would enable most Americans to save more for retirement. As president, Romney will seek to eliminate taxation on capital gains, dividends, and interest for any taxpayer with an adjusted gross income of under $200,000, helping Americans to prepare for retirement and enjoy the freedom that accompanies financial security. This would encourage more Americans to save and to invest for the long-term, which would in turn free up capital for investment flowing back into the economy and helping to facilitate economic growth.
Implement Tax Simplification:
Promising tax simplification is nothing new. When I started practicing accounting in 1987, President Reagan had just signed the huge Tax Reform Act of 1986 into law. That Tax Act really complicated the tax code, and it has continued to become increasing more complex over the past 25 years. Remember Steve Forbes? He ran two presidential campaigns on his Flat Tax Platform.
Here is Romney’s spin on tax simplification:
In the long run, Mitt Romney will pursue a conservative overhaul of the tax system that includes lower and flatter rates on a broader tax base. The approach taken by the Bowles-Simpson Commission is a good starting point for the discussion. The goal should be a simpler, more efficient, user-friendly, and less onerous tax system. Every American would be readily able to ascertain what they owed and why they owed it, and many forms of unproductive tax gamesmanship would be brought to an end. Conversely, tax reform should not be used as an under-the-radar means of raising taxes. Where reforms that simplify the code or encourage growth have the effect of increasing the tax burden, they should be offset by reductions in marginal rates. Washington’s problem is not too little revenue, but rather too much spending.
Mitt Romney also wants to eliminate the Death Tax and repeal the Alternative Minimum Tax. You can read Mitt Romney’s complete Tax Policy atwww.mittromney.com/sites/default/files/shared/TaxPolicy.pdf
President Obama’s Rebuttal:
There actually isn’t very much information about Obama’s tax policy on his campaign’s official website. Check out The President’s Record on Taxes available at: www.barackobama.com/record/taxes?source=issues-nav and all you will find is mention of the Buffett rule and these four bullet points:
President Obama’s official campaign site also includes a link to a report that pokes holes in the Romney Tax Policy, available at:www.taxpolicycenter.org/UploadedPDF/1001628-Base-Broadening-Tax-Reform.pdf.
Which Candidate’s Tax Policy Makes the Most Sense?
Tough question. What makes it tougher is that the President doesn’t write the laws. Instead, the President’s job is to sign bills that have been passed by Congress into law. Even so, having an understanding of the tax philosophy of the country’s two presidential candidates is probably a prudent idea.
Assessment
As an interesting exercise, check out President Obama’s views on taxes from the prior election cycle in our article called What’s The Tax Plan, Man? included in ourOctober 2008 Newsletter, and compare his suggestions from 2008 to what’s been enacted during his first term. A few of the items that he proposed during his previous campaign, including raising the Social Security taxes on people earning more than $250k and implementing a “Make Work Pay” tax credit, have come to fruition during his first term in office.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
Our Other Print Books and Related Information Sources:
Health Dictionary Series: http://www.springerpub.com/Search/marcinko
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
Filed under: Taxation | Tagged: 2012 Presidential Election, Alternative Minimum Tax., Andrew D. Schwartz, Bush Tax Cuts, CPA, death tax, IRS, Middle-Class Tax Savings Plan, Mitt Romney’s Tax Policy, tax | 3 Comments »
Gold in That There IRA
By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com
Here in the Black Hills, home of the historic Homestake Mine, we know a gold rush when we see one. The last few years have tempted investors to take part in a modern gold rush. The precious metal is thought of as a safe harbor for investment capital during times of economic and political unrest and chaos.
Holding Gold
There are many ways to own gold, including holding an interest in it via a financial medium like a mutual fund or an Exchange Traded Fund (ETF). Those who want gold as protection against political or economic turmoil, though, probably are thinking of owning physical gold.
Since Americans’ savings and investing rates are so low, most folks don’t have any extra funds to put into gold. Their only investment vehicle may be an IRA. Yet IRAs are specifically excluded from owning collectibles, metals, and coins.
There are exceptions, however: U.S. gold coins minted by the U.S. Treasury, or bullion bars or coins of a fineness of 995 parts per 1,000. Several non-U.S. minted gold coins meet that standard. The key here is that the coins or bars must be in the physical possession of a qualified trustee. That means gold you stash in a safe or bury in the back yard does not qualify.
Most banks, brokerage firms, or mutual fund companies are not interested in holding physical gold, so finding a qualified trustee can be difficult. You must do a reasonable amount of due diligence to be sure the trustee you find is really trustworthy.
The Trustee
A trustee needs to arrange for the shipping, handling, and storage of your gold. For this reason, you will certainly pay much higher fees than you would for normal stock, bond, and cash investments. The fees can amount to hundreds or thousands of dollars annually.
Even if you are willing to pay the high fees, first ask yourself, “What’s the point?” The reason most folks want to own physical gold or silver is to have “real” money available in case of an economic crisis or political uprising. How does owning physical gold in an unknown location that may be thousands of miles from you fulfill that requirement? Wouldn’t owning an ETF like GLD actually accomplish the same thing, only without the high costs? Yes, it would.
If you want to own gold, my strong suggestion is to own the GLD ETF and avoid all the high fees. The total cost of purchasing GLD is probably about $10.
Other Options
Other options are mutual funds that purchase gold mining stocks, which is probably a better way to participate in the gold market. This is because of the leverage factor. In a rising market, the cost of mining gold is much lower relative to the market value of the gold. So if a mining company pays $1,000 to mine an ounce of gold and can sell it for $1,500, the company—and you, as an owner of its stock—make $500 per ounce. Gold could stay at that same price for a year and your company would continue to make a 33% gross profit.
However, if you owned the physical gold and it stayed at the same price for a year, your profit would be 0%. You would only make that same $500 profit if the gold appreciated from $1,500 to $2,000 an ounce.
Assessment
Of course, the reverse is also true. If gold turns downward, you will stand to lose much more owning the mining company than the physical gold. That’s why I recommend owning gold, like any other asset, only as part of a diversified portfolio of investments.
Conclusion
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Filed under: Investing | Tagged: Gold as an Investment Option for Medical Professionals?, gold asset class, gold ETFs, gold mutual funds, IRA, rick kahler | 13 Comments »
A Review of Some Software Solutions
As the deadline for implementation in the US draws near, talk of electronic medical records (EMR) and electronic health records (EHR) software is a hot topic at the doctor’s office lately.
These systems assist medical practitioners in the creation, storage, and organization of electronic medical records, including patient charts, electronic prescriptions, lab orders, and evaluations (just to name a few common features).
While the terms “EMR” and “EHR” are often used interchangeably, EMR solutions allow for patient information to be shared within one health care organization, whereas EHR solutions allow for health-related records to be shared across multiple organizations.
Assessment
Above is a look at some of the most popular options in both categories, but to see a comprehensive list, visit the EMR Software Directory.
Conclusion
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Filed under: Information Technology | Tagged: Capterra, EHRs, electronic medical records, EMRs, The Era of Electronic Medical Records | 2 Comments »
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Events-Planner: OCTOBER 2012
By Staff Writers
“Keeping track of important health economics and financial industry meetings, conferences and summits”
Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.
First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 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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Filed under: Events-Planner, Marketing & Advertising | Tagged: Events-Planner October 20122, ME-P, Medical Executve-Post | Leave a comment »
By Ann Miller RN MHA
[Executive-Director]
Contributors
The Medical Executive-Post is written by contributors that represent a range of professional expertise. From PhDs, MDs, DDSs, FAs, CPAs, MBAs, CFPs and CMPs, RNs etc; becasue managing a medical practice, clinic or healthcare business, and tracking one’s personal financial career is a complex and difficult task.
So, we have asked physicians, practice managers, CXOs and financial services industry participants and leaders to provide advice, experience and insight.
Link: ME-P MAST HEAD
Want to Join Us?
Have something important to add – join us.
Link: Why Post Your e-Content or Print Publish with Us?
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Crowd-Sourced Print Examples of Our Text Books


Filed under: Career Development, Experts Invited, MAST-HEAD, Research & Development | Tagged: Write for the Medical Executive-Post | Leave a comment »
The Greatest Miscreants of All Time
“If you think you are too small to make a difference, try sleeping with a mosquito.” ― Dalai Lama XIV
Viruses are inevitably small in nature, yet engineered to unleash intense and often terrifying devastation. They leave a costly aftermath whether it’s the irreparable loss of human life, or millions (sometimes billions) of dollars in lost revenue and property.
We have gone through history to find the worst viruses of them all; little creatures and scripts that have taken advantage of social and economic situations to propagate and amplify their prowess in mayhem and destruction.
Assessment
The above graphic is a brief journey through time, spanning back as early as 1348 where we met the darkest and most wicked viruses to ever afflict mankind.
Conclusion
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Filed under: Information Technology, Risk Management | Tagged: CHI virus, computer viruses, ebola, Human and Digital Viruses, human viruses, nimda, Stuxnet, trojans, Uniblue, worms | 1 Comment »
The Treasury Secretaries Opine
By Children’s Home Society of Florida Foundation
At a meeting in Washington on September 12, former Treasury Secretaries Robert Rubin and James Baker discussed the upcoming “fiscal cliff.” The forum was held in order to discuss the national debt and potential financial solutions. Treasury Secretaries from both parties were invited to discuss future financial options.
Both responded to the Congressional Budget Office (CBO) report that indicates the increased taxes and reduced spending scheduled to take place in January of 2013 could lead to recession. The Washington name for the potential financial challenge to the nation is “fiscal cliff.”
Rubin Speaks
Former Secretary Rubin stated, “It may be that for all kinds of reasons one party or another decides that’s the way to negotiate. But if we go over, we can’t stay over for very long, that’s for sure.” Rubin was referring to the effect of the potential fiscal cliff on negotiations between the parties in the November Congressional session.
Baker Speaks
Former Treasury Secretary James Baker joined by satellite; he stated, “There will be a recognition that we have to move the cliff out … so that we have time to deal with it and deal with it in an effective and orderly way, and I think that’s what’s going to happen.”
Secretary Baker was referring to proposals by Assistant Senate Majority Leader Richard Durbin (D-IL) and others. Durbin has introduced a plan to delay the scheduled changes for six months to enable the Senate Finance Committee and House Ways and Means Committee to develop and pass new legislation.
Boehner Speaks
House Speaker John Boehner (R-OH) was asked this week about the fiscal cliff and whether a compromise is possible. Boehner stated he is “not confident at all” that the House and Senate will be able to act. The House passed the Job Protection and Recession Prevention Act of 2012 (H.R. 8) to extend all tax rates for one year. The House also has passed the Pathway to Job Creation through a Simpler, Fairer Tax Code Act of 2012 (H.R. 6169) to set up a fast-track process for tax reform in 2013.
Assessment
However, the Senate has passed the Middle Class Tax Cut Act (S. 3412) and would increase taxes for upper-income individuals. Senate Majority Leader Harry Reid (D-NV) still indicated that he hopes for a compromise in November.
Conclusion
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Filed under: Alerts Sign-Up, Financial Planning, Health Law & Policy | Tagged: CBO, COngressional Budget Office, Fiscal Cliff, James Baker, John Boehner, Richard Durbin, Robert Rubin | 9 Comments »
Center for U.S. Health System Reform
By McKinsey & Company [A Re-Print]
Conclusion
Your thoughts and comments on this ME-P are appreciated. What are your thoughts on the pre-reform trends and the impact of the recession?
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Filed under: Accounting, Book Reviews, Health Economics, Health Insurance, Healthcare Finance | Tagged: Accounting for the Cost of US Health Care | 1 Comment »
Understanding the IRS Position
At my public accounting firm, we get this question all the time from our medical professional and lay clients:
Q: “How long do I need to keep my tax records?”
Here is the IRS answer to this question:
Well organized records make it easier to prepare a tax return and help provide answers if your return is selected for examination, or to prepare a response if you receive an IRS notice.
What to Keep – Individuals.
In most cases, keep records that support items on your tax return for at least three years after that tax return has been filed. Returns filed before the due date are treated as filed on the due date. Examples include bills, credit card and other receipts, invoices, mileage logs, canceled, imaged or substitute checks or other proof of payment and any other records to support deductions or credits claimed. You should typically keep records relating to property at least three years after you’ve sold or otherwise disposed of the property.
Examples include a home purchase or improvement, stocks and other investments, Individual Retirement Account transactions and rental property records.
What to Keep – Doctors as Small Business Owners.
Typically, keep all your employment tax records for at least four years after the tax becomes due or is paid, whichever is later. Also, keep records documenting gross receipts, proof of purchases, expenses, and assets. Examples include cash register tapes, bank deposit slips, receipt books, purchase and sales invoices, credit card charges and sales slips. Forms 1099-Misc, canceled checks, accounts statements, petty cash slips and real estate closing statements. Electronic records can included databases, saved files, e-mails, instant messages, faxes and voice messages.
There is no period of limitations to assess tax when a return is fraudulent or when no return is filed. If income that you should have reported is not reported, and it is more than 25% of the gross income shown on the return, the time to assess is 6 years from when the return is filed. For filing a claim for credit or refund, the period to make the claim generally is 3 years from the date the original return was filed, or 2 years from the date the tax was paid, whichever is later. For filing a claim for a loss from worthless securities the time to make the claim is 7 years from when the return was due.
Assessment
For more information from the IRS, check out:
For a more complete listing, please check out: Record Retention Guide Compiled by the Massachusetts Society of CPAs.
Conclusion
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Filed under: Taxation | Tagged: Andrew D. Schwartz, CPA, How Long to Keep Tax Records, IRS | Leave a comment »
An Organization Chart
By Staff Reporters
If you have ever wondered exactly how health care reform will work for the United States, there is unfortunately no easy answer.
But, with the democrats and republicans strongly divided on universal health care, it can be tough for the average American citizen to find answers.
Fortunately, the graphic below will help.
PP-ACA
Assessment
However, it is important to listen to both sides to make a well-rounded decision of whether or not you can get behind health care reform.
Conclusion
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Filed under: Health Law & Policy | Tagged: ACA, Democrats Health Plan, healthcare reform, ObamaCare, PP-ACA | 2 Comments »
A Historical Review
The marginal tax rate is the rate paid on the “last dollar” earned.
But, when you view the taxes you paid as a percentage of income, the effective tax rate is less than your marginal rate, especially after you take into account the deductions and exemptions, i.e. income that is not subject to any tax.
Conclusion
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Filed under: Taxation | Tagged: marginal tax rates | 3 Comments »
The Concept
Turn in your used or expired medication for safe disposal on September 25th.
Assessment
This novel program is actually available, anytime.
Conclusion
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Filed under: Drugs and Pharma | Tagged: Drugs, Got Drugs?, used medication | 2 Comments »
Just Think Like an Entrepreneur
By Rick Kahler MS CFP® ChFC CCIM
This Monday [9/24] morning I got up at 6:30 am. I took a hot shower, turned on the sprinkler to water the lawn, cooked an omelet for breakfast, put the dishes in the dishwasher, read The Wall Street Journal on my iPad while I enjoyed a cup of espresso, and answered five questions from my staff and clients via email. Then I got into my car and drove five miles to arrive at work at 7:45 am.
Technology
The point here isn’t that there’s anything exciting about my morning routine. It’s to emphasize how much our current technology allows one person to do in 75 ordinary minutes. Some of what I do every day, like getting to work in ten minutes or reading an East Coast newspaper the same day it’s published, would have taken hours or days to accomplish 100 years ago.
Time
One of the greatest benefits we all receive from new inventions, discoveries, technology, and tools is time. The most valuable commodity a dollar can buy is time. Time to do what we want, when we want to do it … Time that allows us to easily provide for our day-to-day needs and frees us to develop and use our own particular skills.
Thanks
Who do we have to thank for that gift of time? The entrepreneurs [medical, healthcare and others]. Through their inventions and services, successful entrepreneurs don’t just make it possible for us to live more comfortably and have easy access to more goods and services. They create more time for all of us.
Politicians
According to many politicians, the real problem with America is its entrepreneurs. If all those business people just paid more taxes, focused less on profitability, hired more people, and spent more money, all our problems would be solved.
I would suggest the opposite is true. Entrepreneurs are actually what is right with America. Instead of demonizing them, our politicians should support them in every manner possible. Entrepreneurs are the reason for our nation’s relatively high standard of living.
Disdain of entrepreneurs shows an ignorance of how a successful economy works. Production drives an economy. Show me a nation where the government produces most of the goods and services, and I will show you a nation in poverty. Cuba comes to mind.
Government
Certainly, governments do have an important role to play. They provide services and infrastructure that support and encourage entrepreneurship. To do so, governments must take a portion of the production of their citizens by requiring them to pay taxes. Therefore, citizens must sell their labor, goods, and services to acquire the country’s currency with which to pay their tax obligations.
A government must strike a fine balance in the amount of productivity it takes from its citizens and what it leaves them. Taking too much risk killing the golden goose of productivity. If entrepreneurs decide that what is left after paying taxes is not worth their capital, time, and risk, they will expend less effort and become less productive. Some will even move to countries that encourage productivity.
Assessment
According to Adam Smith, “The real price of everything, what everything really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.”
The work of entrepreneurs like Alexander Graham Bell, Thomas Edison, and Bill Gates continually reduces the toil and trouble it takes us to acquire goods and services. The enormous improvements in our standard of living over the past 100 years have come from the creativity and risk-taking of entrepreneurs. It is they who provide us with the most important form of wealth—more time to do what matters to us in our own pursuit of happiness.
Link: On Disruptive Healthcare Innovators and Financial Industry Change Agents
Conclusion
But … Who and where are the medical and healthcare entrepreneurs?
Link: About HealthSpottr.com
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Filed under: Experts Invited, Research & Development | Tagged: biomedical innovation., healthcare entrepreneurs, medical innovation, Rick Kahler CFP® | Leave a comment »
Medical Executive-Post Disaster Preparedness Instructions
By Ann Miller RN MHA [Executive-Director]
It occurrs to us that if this ME-P blog’s RSS feed fails (due to Feedburner troubles) those who subscribe that way won’t know it.
So, here’s a big hint: we rarely go a day without a post. It’s probably been years since we’ve gone two days without one. So, if you don’t see the ME-P in your reader for a day or two, check the site. We will have posted instructions for how to regain the RSS feed, or otherwise communicate what we’re doing to resolve the interruption.
By the way, another way to find out what is going on in an ME-P technical emergency is to contact me:
Conclusion
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The Budget Control Act of 2011
By Children’s Home Society of Florida Foundation
Speaking in Chicago last week, Senate Whip Richard Durbin (D-IL) proposed a change in the plan to reduce spending starting January 1, 2013. Under the Budget Control Act of 2011, substantial spending cuts in both defense and Medicare providers will commence on that date. These cuts together with potential tax increases have been described as a “fiscal cliff” that could send the nation back into recession.
Spending Cuts
The spending cuts are required because the Joint Congressional Committee in 2011 was unable to agree on a budget and tax plan. The anticipated spending cuts are designed to reduce costs by $1.2 trillion over the next decade.
Sen. Durbin proposes delaying the spending cuts for a term of six months. The Budget Control Act would be modified to allow the Senate Finance Committee and the House Ways and Means Committee an opportunity to develop a new plan.
Under Durbin’s proposal, the two committees must submit bills by June of 2013. The plans must total $4 trillion in budget savings. There would be $1.33 trillion in increased taxes and $2.67 trillion in budget reductions.
Assessment
Following hearings by both committees, the bill would need to be submitted to a conference committee. After passage by both the House and the Senate, the $4 trillion plan could be signed by the President. If all of those steps were completed by June 30, 2013, the mandatory budget cuts would not take place. They would be replaced by the agreements for tax increases and budget cuts in the new law.
Editor’s Note: The mandatory budget reductions in defense and Medicare take effect in 2013 because the Joint Congressional Committee was unable to agree on the balance of tax increases and budget reductions. There will be an opportunity for enacting new tax and budget provisions in the November session following the elections. Because the time is quite short for writing major legislation, many Senators and Representatives would like to defer action to 2013. However, there is a general reluctance to agree on the level of tax increases and budget reductions necessary for a compromise bill.
Conclusion
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Filed under: Health Law & Policy, Taxation | Tagged: Budget Control Act of 2011, Children's Home Society of Florida Foundation, Is There a Six Month Deferral for the Fiscal Cliff?, Richard Durbin | 4 Comments »
Not as Safe as We Think?
Conclusion
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Filed under: Quality Initiatives | Tagged: healthcare quality, Hospital Hazards, medical quality assurance | 1 Comment »
A Medical Practice Risk Management Strategy
Successful practices face multiple risks in their daily operations including loss of a medical license or professional certification, legal defense reimbursement, medical/Medicare collections risk, HIPAA violations, and reputational risk. Small- to medium-sized practices can benefit from risk-management tools that can help them handle such risks more effectively and reduce their overall insurance costs. To that end, the practice may want to consider the establishment of a Captive Insurance Company (CIC) to protect themselves from risks not typically covered by traditional insurance companies.
Captive Insurance Planning
Captive insurance planning is a strategy for physicians to manage risk through the purchase of a property-casualty insurance policy. Premiums paid by the practice to a properly structured CIC should be tax-deductible to the practice under section 162(a) of the IRS code just like their workers’ compensation or malpractice coverage.
When the practice forms a CIC, it receives premium income tax-free up to $1,200,000 per year, per captive. Profits that come out of the CIC come out as a distribution from a C-corp. as qualifying dividends or long-term capital gains, which are currently 15%. Furthermore, the CIC may retain surplus from underwriting profits within reserve accounts, free from income tax. Profits that accumulate within the CIC can be used as a tax-deductible sinking fund in order to save money on malpractice premiums by shifting to a high deductible policy and/or insuring that deductible through the CIC.
No Rules – Just Right
There are no hard-and-fast rules regarding the minimum amount of gross revenue from a practice or the minimum amount of insurance premiums paid by a practice before considering the establishment of a CIC.
Planning Opportunities
The establishment of a CIC creates immense planning opportunities for physicians because of the flexible ownership of the CIC. The CIC is set up as a C-Corp and someone or some entity owns the shares of the C-Corp While it’s important to keep in mind the primary business purpose of the CIC is for risk management, some potential planning opportunities include the following:
Enter the Experts
Physicians would be encouraged to discuss the various CIC planning strategies with their tax, estate planning, and other legal professionals to ensure that the most appropriate structure is utilized to fit their unique planning objectives. As part of our services to the practice, we would be happy to meet with the practice management and advisors to answer any questions and start the process of the feasibility of a CIC for the practice. As reassurance, this is already IRS-tested, and we strictly adhere to each IRS Safe Harbor Revenue Ruling for a conservative model offering very predictable risk management and tax planning results.
Assessment
While this is not intended to be a thorough discussion of CICs, it is meant to initiate a conversation with practices or conduct due diligence with their key advisors as to the many potential benefits of establishing a Captive Insurance Company.
About the Author
Mr. Guy P. Jones is a Certified Financial Planner in Houston, TX who has specialized in serving the financial planning needs of medical professionals and their families since 1990. He can be reached at 832.677.1692, email: guypjones@guypjones.com, or by visiting his website: www.guypjones.com
Conclusion
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Filed under: Insurance Matters, Professional Liability, Risk Management | Tagged: Captive Insurance Company, Guy P. Jones CFP, IRS Safe Harbor Revenue Ruling, medical malpractice, professional medical liability | 2 Comments »
A Snapshot as Deadlines Approach
The federal health law [PP-ACA] gives states the option of creating health insurance exchanges [HIEs] through which residents can purchase coverage.
Now, with a November 16 deadline for states to declare their readiness to build an exchange, most states are expected to let the feds take over by default–only 15 states, and the District of Columbia, have created a health insurance exchange thus far.
Conclusion
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Filed under: Information Technology | Tagged: ACA, Affordable Care Act., Health Information Exchanges, HIE's, PP-ACA | 22 Comments »
By Michael Zhuang
10. Would You Buy This Variable Annuity with Income Guarantees?
9. Portfolio Rebalancing Returns
8. Be Careful When Buying a Condo as a Rental Property
7. Variable Annuity Fees You Don’t Know You are Paying
6. Small Cap Value: Risk and Returns
5. Recession and stock market performance
4. Managed commodities can counter volatility…NOT
Conclusion
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Filed under: Financial Planning, Insurance Matters, Investing | Tagged: annuities, asset classes, financial planning for doctors, harry dent, Michael Zhuang, rich doctors, Wealth Management Posts | Leave a comment »
The Big Picture View
By Suevon Lee ProPublica, Sept. 14, 2012, 2:26 p.m.
Medicare and Medicaid, which provide medical coverage for seniors, the poor and the disabled, together [1]make up nearly a quarter [1] of all federal spending. With total Medicare spending projected to cost [2] $7.7 trillion over the next 10 years, there is consensus that changes are in order. But what those changes should entail has, of course, been one of the hot-button issues [3] of the campaign.
With the candidates slinging charges [4], we thought we’d lay out the facts. Here’s a rundown of where the two candidates stand on Medicare and Medicaid:
THE CANDIDATES ON MEDICARE
Big Picture
Earlier this year, the Medicare Board of Trustees estimated [5] that the Medicare hospital trust fund would remain fully funded only until 2024. Medicare would not go bankrupt or disappear, but it wouldn’t have enough money to cover all hospital costs.
Under traditional government-run Medicare, seniors 65 and over and people with disabilities are given health insurance for a fixed set of benefits, in what’s known as fee-for-service [6] coverage. Medicare also offers a subset of private health plans known as Medicare Advantage, in which roughly one-quarter [7] of Medicare beneficiaries are currently enrolled. Obama retains this structure.
The Obama administration has also made moves that it says would keep Medicare afloat. It says the Affordable Care Act would extend solvency [8] by eight years, mainly by imposing tighter spending controls on Medicare payments to private insurers and hospitals.
In contrast, Rep. Paul Ryan, Mitt Romney’s running mate, has proposed a more fundamental overhaul of Medicare, which he says [9] is on an “unsustainable path.” On his campaign website [10], Romney says that Ryan’s proposals “almost precisely mirrors” his ideas on Medicare. But he’s been fuzzy on other aspects of the plan.
A Romney-Ryan administration would replace a defined benefits system with a defined contribution system [11] in which seniors are given federal vouchers to purchase health insurance in a newly created private marketplace known as Medicare Exchange. In this marketplace, private health plans, along with traditional Medicare, would compete for enrollees’ business. These changes wouldn’t start until 2023, meaning current beneficiaries aren’t affected – just those under 55.
Under the Romney-Ryan, the vouchers would be valued [12] at the second-cheapest private plan or traditional Medicare, whichever costs less. Seniors who opt for a more expensive plan would pay the difference. If they choose a cheaper plan, they keep the savings.
Who’s Covered
In the current system, people 65 and over are eligible for Medicare, which Obama has said he would keep [13] for now.
Romney has proposed [14]raising the eligibility age for Medicare beneficiaries from 65 to 67 in 2022, then increasing it by a month each year after that. In the long run, he would index [15] eligibility levels to “longevity.” Ryan’s budget plan proposes [16] raising Medicare eligibility age by two months a year starting in 2023, until it reaches 67 by 2034.
Many others looking to keep Medicare solvent have also proposed [17]raising the age of eligibility.
The Congressional Budget Office estimates [18]that raising the minimum age from 65 to 67 would reduce annual federal spending by 5 percent.But it would also result in higher premiums and out-of-pocket costs for seniors who would lose access to Medicare.
Obama’s health care law also adds [19] some benefits for seniors, such as annual wellness visits without co-pays, preventive services like free cancer screenings and prescription drug savings.
Proposed Savings
The Affordable Care Act is projected to reduce Medicare spending by $716 billion over the next 10 years. These reductions, as detailed [20] by Washington Post’s Wonkblog, will come mostly from reducing payments to hospitals, nursing homes and private health care providers.
While Ryan criticized [21] such spending cuts in his speech at the Republican National Convention, his own budget proposed [22] keeping these reductions.
“The ACA grows the trust fund by giving more general revenue to the Treasury, which then gives the trust fund bonds. But it then uses the money from those bonds to expand coverage for low- and middle-income people,” explains [23] Dylan Matthews on Washington Post’s Wonkblog.
Romney hasn’t really come up with a solid answer: he previously said he would restore [24] the $716 billion savings that the health care law imposes. Per this New York Times story [24], the American Institutes for Research calculates this would increase premiums and co-payments for Medicare beneficiaries by $342 a year on average over the next 10 years.
For more on where the candidates stand on the $716 billion, the private health policy Commonwealth Fund offers this helpful explanation [25].
Caps on Spending
Both Obama and Ryan have set an identical target rate [26] that would cap Medicare spending at one-half a percentage point above the nation’s gross domestic product.
But they have different ideas on mechanisms to achieve it.
The Affordable Care Act establishes a 15-member Independent Payment Advisory Board [27] that, starting in 2015, would make binding recommendations to reduce spending rates. As Jonathan Cohn points out [28] in the New Republic, the commission is prohibited from making any changes that would affect beneficiaries.
Ryan has proposed hard caps on spending and derided [29]this panel of appointed members as “unelected, unaccountable bureaucrats.” When laying out his plan in a 2011 memo [30], Ryan wrote that to control spending, “Congress would be required to intervene and could implement policies that change provider reimbursements, program overhead, and means-tested premiums.”
Romney hasn’t stated [31] clear proposals for imposing a cap on spending.
THE CANDIDATES ON MEDICAID
Big Picture
Though, it’s far less discussed [32] on the campaign trail, Medicaid actually covers more people than Medicare. The joint federal-state insurance program for the poor, the disabled, and elderly individuals in long-term nursing home care currently covers about 60 million Americans. The Affordable Care Act hasexpanded [33] Medicaid coverage further. Beginning 2014, Medicaid will include [34]people under 65 with income below 133 percent of the federal poverty level (roughly $15,000 for an individual, $30,000 for a family of four). This was estimated [35] to cover an additional 17 million Americans as eligible beneficiaries.
In June, however, the U.S. Supreme Court ruled [36] that states could opt out of the Medicaid expansion. A ProPublica analysis estimated [37] that the 26 states that challenged the health care law, and thus may possibly opt out, would account for up to 8.5 million of those new beneficiaries.
Romney and Ryan would overhaul this current system by turning Medicaid into a system of block grants [38]: the federal government would issue lump sum payments to the states, who would determine eligibility criteria and benefits for enrollees. These grants would begin in 2013.
Effects on spending
The Congressional Budget Office estimates [39] that Medicaid expansion under the new health care law would cost an additional $642 billion over the next 10 years.
Under the Ryan plan, federal Medicaid grants would be adjusted only for inflation, but not health care costs, which grow at a much higher rate. The CBO estimates [40] Ryan’s plan would save the federal government $800 billion over the next 10 years. Another study conducted by Bloomberg News shows that the block-grants could decrease Medicaid funding by as much as $1.26 trillion [41] over the next nine years.
Actual Impact
The New York Times points out [42] that more than half of Medicaid spending goes toward the elderly and disabled. An Urban Institute analysis estimates [43] the Ryan plan would result in 14 million to 27 million fewer people receiving Medicaid coverage by 2021.
Assessment
Though rarely mentioned by any of the candidates, Medicaid costs are soaring to cover the elderly who require long-term nursing care. As the Times’ details [44] how, states saddled by high Medicaid costs have begun turning to private managed care plans to blunt the cost.
Conclusion
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Filed under: Health Law & Policy | Tagged: ACA, Affordable Care Act., Dylan Matthews, Medicaid, medicare, obama, Paul Ryan, Presidential Candidates Stand on Medicare and Medicaid, ProPublica, romney, Suevon Lee | 7 Comments »
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Goals for Sound Tax Policy
By Children’s Home Society of Florida Foundation
The nonpartisan Tax Foundation states that its goals for sound tax policy include, “simplicity, neutrality, transparency and stability.”
The Review
It published a review on September 6, 2012 of three different major tax proposals. The review discussed the tax proposals of the National Commission on Fiscal Responsibility and Reform, co-chaired by Alan Simpson and Erskine Bowles, the proposals of President Obama and the proposals of Presidential Candidate Mitt Romney. The nonpartisan Tax Commission attempted to provide an objective comparison of the three proposals. It discussed proposals for income tax, capital gains tax, corporate tax and gas tax for each plan.
The National Commission on Fiscal Responsibility and Reform produced a plan in December of 2010. With nine Democrats and nine Republicans on the committee, the plan received 11 of 18 votes. However, it did not receive a sufficiently large majority to be submitted for a vote by the House and Senate.
The plan is commonly described as the “Simpson-Bowles” plan after the Republican and Democratic Co-Chairs of the Commission.
The “Simpson-Bowles” Plan
Simpson-Bowles proposes a 28% top rate on personal income taxes. Capital gains and corporations would also be taxed at 28%. Corporations would not pay tax on earnings overseas. The alternative minimum tax would be repealed. Taxes on gasoline would be increased from 18 cents to 23 cents per gallon.
With the reduction in the top income tax rate, most credits and deductions would be greatly limited. There would be a child credit, an earned income tax credit, a limited deduction for mortgage interest and deductions for health and retirement plans.
The principal goal of Simpson-Bowles is to reduce spending to 21% of gross domestic product (GDP) and to raise taxes to that same level. Simpson-Bowles is projected to balance the budget by 2037.
The Tax Foundation
The Tax Foundation study of proposals by President Obama covered many of the same areas. The top income tax rate would be set at 39.6%. Long-term capital gains are taxed at 30% under the “Buffett Rule.” Dividends are potentially taxed at the top rate of 39.6% plus the 3.8% additional tax under the Affordable Care Act. Corporate taxes for both U.S. and foreign profits are 28%. The alternative minimum tax is retained with the “Buffett Rule” level of 30%.
President Obama proposes retaining most credits and deductions with some technical changes. The benefit of deductions for the upper income brackets of 39.6% and 36% would be limited to the tax savings in the 28% bracket.
Presidential Candidate Mitt Romney proposes a top income tax rate of 28%. Capital gains would continue to be taxed at 15% and dividends at 15%. Corporate tax rates would be reduced to 25%, and foreign income would not be taxed. There would be substantial limits on credits and deductions. There would be limited deductions for home mortgage, charitable gifts, retirement plans and health plans. The alternative minimum tax would be repealed. Candidate Romney’s plans are projected to balance the budget by 2020.
Editor’s Note: This nonpartisan review by Dr. McBride and the Tax Foundation is offered as an educational service to our readers. Your editor and this organization take no position on the specific provisions that are involved. Our readers should recognize that with the complexity of our tax system, the comparison by Dr. McBride involves review of extensive information and a number of judgments on the various proposals.
Conclusion
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Filed under: Health Law & Policy, Taxation | Tagged: Children's Home Society of Florida Foundation, National Commission on Fiscal Responsibility and Reform, Simpson-Bowles, Tax Foundation Reviews the Presidential Candidates' Tax Proposals | 1 Comment »
And … Its’ Impact on eHRs
Carol Miller RN MBA millerconsultgroup@gmail.com
The American Recovery and Reinvestment Act of 2009introduced the “Meaningful Use” requirement for EHR systems with three main components:
The Components
1) The use of a certified EHR in a meaningful manner, such as e-prescribing, 2) The use of a certified EHR technology for electronic exchange of health information to improve quality of health care, and 3) The use of a certified EHR technology to submit clinical quality and other measures.
Meaningful Use refers to a set of 15 criteria that medical providers must meet in order to prove that they are using their EHRs as an effective tool in their practice. There are also 10 additional criteria that are considered a la carte from which only 5 need to be demonstrated by the medical provider.
In total, 20 Meaningful Use criteria must be used within the EHR to qualify for stimulus payments during Stage One of the EHR incentive program. Each of the criteria were developed and further reviewed by the Office of the National Coordinator [ONC] with public input.
A Five Year TimeLine
Meaningful use will be measured in stages over five years. Each stage represents a level of adoption. Many certified EHRS will allow providers to complete all Meaningful Use criteria, whereas others will only certify what is required in the early stages and modify at a later date with any new criteria.
The three stages are:
Stage One: Essentially, Stage One is using the major functionality of a certified EHR. This includes documenting set percentages of your visits, diagnoses, prescriptions, immunizations and other relevant health information electronically; using the clinical support tools (warnings and reminders that will be included in a certified EHR); and sharing patient information. Providers and hospitals must report quality measures and public health information. For providers they must report on 6 clinical quality measures – 3 required core measures and 3 additional measures selected from a set of 38 clinical quality measures. Eligible hospitals and Critical Care Hospitals (CAHs) must report on all 15 of the clinical quality measures. Stage One is required in years 2011 and 2012.
Stage Two: In addition to continuing to use all functionality from Stage One, physicians will be required to use EHRs to send and receive information such as lab orders and results. Other criteria may be added. Stage Two is expected to be implemented in 2013.
Stage Three: This stage will continue fulfilling the criteria from Stages One and Two and will include clinical decisions support for national high priority conditions; emailing patients in a Personal Health Record (PHR); accessing comprehensive patient data; and improving population health. Stage Three criteria have not been developed to date and the implementation is not expected until 2015.
Assessment
CMS payment penalties for non-compliance to the meaningful use regulations will begin in 2016 with an initial 1% penalty which could escalate to 5% five years later. Therefore, with these criteria in place, we are likely to see virtually all hospitals attempt to meet the meaningful use criteria to avoid penalty cost.
Conclusion
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Filed under: Information Technology | Tagged: American Recovery and Reinvestment Act, Carol Miller RN, CMS, EHRs, meaningful use, Office of the National Coordinator, ONC, PHRs | 8 Comments »
COMMONFUND: NONPROFIT HEALTHCARE ORGANIZATIONS REPORT FLAT INVESTMENT RETURNS
For Fiscal Year 2011
By Ron Chernus
Press Release
Link: 2012 CBS Healthcare release final
Conclusion
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Filed under: Breaking News, Investing | Tagged: non-profit healthcare organizations, Ron Chernus | 3 Comments »
Is it all about Subjectivity?
By Brent Mefesel MD
Patient Satisfaction data [PSD] is a subjective measure of what the patient perceives in terms of the level of service quality and care provided by the clinician.
Many health plans consider patient satisfaction an important measure of physician quality. Although not a direct measure of clinical quality, many researchers link patient satisfaction to clinical outcomes.
Resource Intense
This PSD however, is also resource-intensive to collect and requires commitment on the part of the patient to fill out the forms and return them in the mail or on-line. Selection bias may also occur in terms of patient satisfaction data, in that patients who choose to fill out and return the forms may in some cases not be representative of the overall patient population for a physician.
Recent Evolution
More recently, the field has been moving from measuring “satisfaction” to elucidating a more validated and specific “patient experience of care”. The Consumer Assessment of Healthcare Providers and Systems (CAHPS®), funded and administered by the Agency for Healthcare Quality (AHRQ), is a part of a national initiative to measure, report on, and improve health care quality from the viewpoint of patients and other consumers. Separate surveys are used for evaluating ambulatory care and facility or hospital care.
More CAHPS®
In addition, the National CAHPS Benchmarking Database contains over 10 years of CAHPS survey data from commercial and Medicaid plans and is designed to facilitate comparative analysis of individual CAHPS survey results with benchmarks, including national or regional averages.
Assessment
The CAHPS program works closely with other public and private research agencies, known collectively as the CAHPS Consortium, for continued review and enhancement of the survey tools.
Conclusion
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Filed under: Book Reviews, Quality Initiatives | Tagged: Agency for Healthcare Quality, AHRQ, By Brent Mefesel MD, CAHPS®), Consumer Assessment of Healthcare Providers and Systems, Patient Satisfaction Data | 3 Comments »
Why are Doctors and Investors Eschewing Full Service Brokers?
By Dr. David Edward Marcinko MBA CMP™
[Founder and CEO] www.CertifiedMedicalPlanner.org
There are many studies that show that active trading garners inferior results to a longer term buy and hold type of strategy.
The UC-Davis Study
One of the most publicized recently was conducted by a UC-Davis team led by Dr. Terrance Odean. The study examined the actual tracing activity of thousands of self-directed accounts at a major discount brokerage over a six-year period. The results were clear. Regardless of trading level, most of the accounts underperformed the market and showed that the higher the number of trades, the worse the result.
Link: http://faculty.haas.berkeley.edu/odean/
Ego Driven
In addition to cost savings, discounters appeal to one’s ego for business. Everyone wants to feel like a smart investor. There is also a strong appeal to one’s sense of control. Hiring a professional advisor should not result in losing these feelings, but should solidify them. And, advice to sell has a far greater impact on investment results than the cost of a purchase trade as long as the level of trading is kept at a prudent level.
Avoidance of Sales Pressure
The final reason people turn to discount and on-line brokerages is to avoid sales pressure. Unlike the stereotypical stockbroker or financial advisor [FA], no one calls to push a particular stock. Instead, sales pressure is created within the mind of the investor.
Assessment
By maintaining a steady flow of information about stocks and the markets to the account holders, brokerages keep these issues in the forefront of the investor’s minds. This increases the probability that the investor will act on the information and execute a trade. Ironically, this focus on trading is one of the very conflicts investors are trying to avoid by fleeing a traditional full service broker.
Conclusion
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Filed under: CMP Program, Investing | Tagged: BDs, behavioral finance, brokerages, certified medical planner, Discount and On-Line Brokerages, Dr. David Edward Marcinko MBA, Terrance Odean, UC-Davis | 1 Comment »
The Mount Carmel Health System
By Mark Matthews MD
A “Scrubbed” True Illustration
One of the earliest healthcare adopters of Six Sigma was the Mount Carmel Health System in Columbus, Ohio.
The organization was barely breaking even in the summer of 2000 when competition from surrounding providers made things worse. Employee layoffs added fuel to an already all-time low employee morale.
The CEO
Chief Executive Officer Joe Calvaruso was determined to stem the bleeding, break the cycle of poor financial performance and return the hospital system to profitability. He sought the potential benefits of Six Sigma and began a full deployment of its methodology. The plan was a bold move, as the organization ensured that no one would be terminated as a result of a Six Sigma project having eliminated his or her previous duties. These employees would be offered an alternative position in a different department. Moreover, top personnel were asked to leave their current positions to be trained and work full time as Six Sigma expert practitioners who would oversee project deployment while their positions were backfilled.
Assessment
The Six Sigma deployment was the right decision. More than 50 projects were initiated with significant success. An example of an early Mount Carmel success story is the dramatic improvement in their Medicare + Choice product reimbursements, previously written off as uncollectible accounts. These accounts were often denied by HCFA due to coding of those patients as “working aged.”
Since the treatment process status often changed in these patients, HCFA often rejected claims or lessened reimbursement amounts, effectively making coding a difficult and elusive problem. The employment of the Six Sigma process fixed the problem, resulting in a real gain of $857,000 to the organization. The spillover of this methodology to other coding parameters also has dramatically boosted revenue collection.
A Glimpse of Lean Medical Management Tools and Techniques
Conclusion
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Filed under: Book Reviews, iMBA, Inc., Quality Initiatives, Recommended Books | Tagged: A Six Sigma Healthcare Pioneer, CMS, HCFA, hospital quality, Joe Calvaruso, mark matthews MD, Mount Carmel Health System | 2 Comments »
How to Reduce Exposure to Higher post-2012 Taxes on Investment Income and Gains By Perry Dalesandro CPA perry@dalecpa.com Doctors and most all individuals face the prospect of a darker tax climate in 2013 for investment income and gains. Under current law, higher-income taxpayers will face a 3.8% surtax on their investment income and gains under changes made by the Affordable Care Act. Additionally, if current tax-reduction provisions sunset, all taxpayers will face higher taxes on investment income and gains, and the vast majority of taxpayers also will face higher rates on their ordinary income. This Alert explores year-end planning moves that can help reduce exposure to higher post-2012 taxes on investment income and gains. This first part explains who has to worry about the 3.8% surtax and what it covers. It also briefly discusses key sunset rules, and begins examining some essential year-end moves. Future parts will describe other planning moves in detail. Who has to worry about the 3.8% Surtax and what it covers For tax years beginning after Dec. 31, 2012, a 3.8% surtax applies to the lesser of (1) net investment income or (2) the excess of modified adjusted gross income (MAGI) over the threshold amount ($250,000 for joint filers or surviving spouses, $125,000 for a married individual filing a separate return, and $200,000 in any other case). MAGI is adjusted gross income (AGI) increased by the amount excluded from income as foreign earned income (net of the deductions and exclusions disallowed with respect to the foreign earned income). Illustration 1: For 2013, a single taxpayer has net investment income of $50,000 and MAGI of $180,000. He won’t be liable for the tax, because his MAGI ($180,000) doesn’t exceed his threshold amount ($200,000). Illustration 2: For 2013, a single taxpayer has net investment income of $100,000 and MAGI of $220,000. He would pay the tax only on the $20,000 amount by which his MAGI exceeds his threshold amount of $200,000, because that is less than his net investment income of $100,000. Thus, the surtax would be $760 ($20,000 × 3.8%). Observation: An individual will pay the 3.8% tax on the full amount of his net investment income only if his MAGI exceeds his threshold amount by at least the amount of the net investment income. Ilustration 3: For 2013, a single taxpayer has net investment income of $100,000 and MAGI of $300,000. Because his MAGI exceeds his threshold amount by $100,000, he would pay the tax on his full $100,000 of net investment income. Thus, the tax would be $3,800 ($100,000 × .038). The tax is taken into account in determining the amount of estimated tax that an individual must pay, and is not deductible in computing an individual’s income tax. What is net investment income? For purposes of the Medicare contribution tax, “net investment income” means the excess, if any, of: (1) the sum of: … gross income from interest, dividends, annuities, royalties, and rents, unless those items are derived in the ordinary course of a trade or business to which the Medicare contribution tax doesn’t apply (see below), … other gross income derived from a trade or business to which the Medicare contribution tax does apply (below), … net gain (to the extent taken into account in computing taxable income) attributable to the disposition of property other than property held in a trade or business to which the Medicare contribution tax doesn’t apply, over (2) the allowable deductions that are properly allocable to that gross income or net gain. Trades and businesses to which tax applies. The 3.8% surtax applies to a trade or business if it is a passive activity of the taxpayer, or a trade or business of trading in financial instruments or commodities. Investment income won’t include amounts subject to self-employment tax. Specifically, net investment income won’t include any item taken into account in determining self-employment income and subject to the self-employment Medicare tax Observation: Thus, the same item of income can’t be subject to both self-employment tax and the Medicare contribution tax. If self-employment tax applies, the Medicare contribution tax won’t apply. The tax doesn’t apply to trades or businesses conducted by a sole proprietor, partnership, or S corporation. But income, gain, or loss on working capital isn’t treated as derived from a trade or business and thus is subject to the tax. Exception for certain active interests in partnerships and S corporations. Gain or loss from a disposition of an interest in a partnership or S corporation is taken into account by the partner or shareholder as net investment income only to the extent of the net gain or loss that the transferor would take into account if the entity had sold all its property for fair market value immediately before the disposition. Retirement plan distributions. Investment income doesn’t include distributions from tax-favored retirement plans, such as qualified employer plans and IRAs. Looming Sunsets Would Affect Almost all Taxpayers Unless Congress acts, the Bush-era tax breaks-those in the EGTRRA and JGTRRA legislation of 2001 and 2003-will come to an end (i.e., they will sunset) at the end of 2012. Depending on how the November elections play out, the sunsets may be: (1) abolished for everyone, (2) deferred for everyone (as they were in December of 2010, when they originally were to sunset), or (3) deferred for all taxpayers other than those with higher incomes. Still a fourth, albeit unlikely, possibility is that the parties will not be able to agree on remedial legislation and the Bush-era tax breaks actually will sunset at the end of 2012 for everyone. There are scores of income tax rules that would be altered if the Bush-era tax breaks sunset at the end of 2012, but arguably the most important ones are as follows: … Tax brackets. The 10% bracket will disappear (lowest bracket will be 15%); the 15% tax bracket for joint filers & qualified surviving spouses will be 167% (rather than 200%) of the 15% tax bracket for individual filers; and the top four tax brackets will rise from 25%, 28%, 33% and 35% to 28%, 31%, 36% and 39.6%. … Taxation of capital gains and qualified dividends. Currently, most long-term capital gains are taxed at a maximum rate of 15%, and qualified dividend income is taxed at the same rates that apply to long-term capital gains. Under the sunset, most long-term capital gains will be taxed at a maximum rate of 20% (18% for certain assets held more than five years). And, dividends paid to individuals will be taxed at the same rates that apply to ordinary income. If the EGTRRA/JGTRRA sunset rules go into effect at the end of 2012 and dividends and interest are taxed at ordinary income rates up to 39.6% in 2013, it seems highly unlikely that dividends and interest also would be subjected to a 3.8% surtax on net investment income (i.e., Congress would at least repeal the surtax). Year-end Planning for Investments Beginning below, and to be continued in future articles, are specific steps that taxpayers can take now in order to reduce or avoid exposure to the 3.8% surtax as well as possibly higher tax rates on capital gains and dividend income. Accelerate Home Sales The sale of a residence after 2012 can trigger the 3.8% surtax in one of two ways. It also can expose taxpayers to a higher capital gain tax rate if the sunset rules affect them next year.
Recommendation: A taxpayer expecting to realize a gain on a principal residence substantially in excess of the applicable $250,000/$500,000 limit who is planning to sell either this year or the next should try to complete the sale before 2013. Doing so rather than selling after 2012 will remove the portion of the gain that doesn’t qualify for the Code Sec. 121 exclusion from the reach of the 3.8% tax. It also will reduce the taxpayer’s exposure to possibly higher rates of tax on capital gains under the sunset rules. Illustration 4: A married couple earn a combined salary of $260,000. They plan to sell their principal residence for $1.2 million, and should net a gain of about $700,000, of which $500,000 will be excluded under Code Sec. 121. If they sell this year they will pay a tax of $30,000 (15%) on their $200,000 of taxable residence gain. If they wait till next year to sell, their gain will be fully exposed to the surtax, which in their case equals 3.8% multiplied by the lesser of: (1) $200,000 of net investment income; or (2) $210,000 ($460,000 of MAGI [$260,000 salary + $200,000 of taxable home sale gain] − the $250,000 threshold). Thus, the tax on their gain will be at least $37,600 ([.15 + .038] × $200,000). The tax could be even more if they are subject to a higher capital gains tax next year under the sunset rule (or a modified sunset rule). Illustration 5: A single taxpayer earns a salary of $170,000 and also has $30,000 of investment income (interest and dividends). He plans to sell his vacation home for $500,000 and will net a gain of approximately $400,000. If he sells this year, he’ll pay a $60,000 tax on his gain (.15 × $400,000). If he waits till next year, his MAGI will swell to $600,000 ($170,000 salary + $30,000 investment income + $400,000 gain). He will pay an additional $15,200 of tax on his vacation home gain (3.8% of $400,000), on top of the regular capital gain tax. Additionally, sale of the vacation home in 2013 will expose his $30,000 of investment income to an additional $1,140 of tax (3.8% of $30,000). |
Conclusion
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Filed under: Taxation | Tagged: ACA surtax, AGI, EGTRRA, IRS, JGTRRA, MAGI, medicare surtax, Obamacare tax, Perry Dalesandro, Year end tax planning | Leave a comment »
The Importance of Rules
By Jacqueline Mitus, MD, Senior Vice President, Product Strategy; Steve Silverstein, MD, FACEP, Vice President, Chief Clinical Architect; and Matthew Zubiller, Vice President, Decision Management, McKesson Health Solutions
Clear, consistent and reproducible rules logic is at the core of translating information into actionable content. In other words, rules make content more intelligent by tying disparate pieces of information together — for example, heart failure codes and care guidelines — so that a conclusion can be drawn, a recommendation can be made or an action can occur. In so doing, the content becomes meaningful and can drive the right, timely intervention or behavior.
Value Driven
Rules do not have to be complex to drive value. A very simple rule can be very actionable: for example, an automated reminder to both member and physician about annual mammograms.
Simple or complex, transforming clinical content into reproducible, actionable rules is a highly precise endeavor. Consider how nuance and meaning can be lost in any translation and the time and effort that can be spent debating an author’s original intent. In healthcare, the stakes are significantly higher in “getting it right,” and shades of gray in meaning can affect the intended outcome.
For example, concepts such as “worsening,” “severe” and “over time” are common parameters that need specific definition to become actionable and measurable.
“Rules” for a good rule:
Assessment
To learn more, download the full white paper on Actionable Content: A Framework for Better Decision-Making.
###
Learn more about McKesson Health Solutions at:http://www.mckesson.com/en_us/McKesson.com/Our+Businesses/McKesson+Health+Solutions/McKesson+Health+Solutions.html.
Conclusion
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Filed under: Experts Invited, Practice Management | Tagged: Jacqueline Mitus MD, Making Medical Content Actionable, Matthew Zubiller, McKesson Health Solutions, Steve Silverstein MD | Leave a comment »
On Changing Financial Behaviors
By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com
From time to time I offer financial courses through Community Education of the Black Hills. Classes on the fundamentals of making good investments and how to do your own financial planning usually fill quickly.
But, a class on “financial sobriety”—how to change your psychological behaviors around money and begin making wiser money decisions—had only one person sign up. Based on my 30 years of financial advising, this wasn’t a big surprise.
The Research
Research tells us 70% of US citizens have no savings and live month to month or are insolvent. Only 9% have saved over $100,000 and just 3% over $500,000. The stats for medical professionals are not so transparent.
Why is this? The simple answer is Americans have a significant resistance to saving, including some doctors, according to ME-P Editor-in-Chief, Dr. David Edward Marcinko FACFAS MBA CMP® www.CertifiedMedicalPlanner.org
Mathematically, the solution to this is very simple. Out of every dollar earned, do this: First, pay taxes. Second, save and invest 20% or more. Third, live on the rest. This formula has a high probability of successfully creating financial independence.
So, why are fewer than one in 10 Americans able to follow this simple formula? The answer to that isn’t so simple.
Psychological Responses
The first response to these options is often, “I can’t.” Non-savers tell themselves there is nowhere to cut. When put in context of maintaining their current lifestyle, this is true—and therein lies the problem. When you’re living month to month, becoming a saver inherently means either reducing your lifestyle or increasing your income.
Unfortunately, too many people vaguely intend to start saving when their income goes up. This is backwards. Focusing instead on reducing your lifestyle is what creates the habit of saving.
It may seem that a lifestyle reduction would be a lot easier for high income earner. Yet I’ve seen those earning $750,000 have as much trouble saving $10,000 a year as those earning $50,000. The self-talk and reasons why it’s impossible to cut spending are exactly the same.
Not about Money
It’s not about the money. It’s never about the money. It’s not that most non-savers don’t know the solution to saving more; it’s that they don’t like the solution. We cannot change what we refuse to confront.
It takes a lot of courage to admit you have to change and then take action to actually put a plan into motion. It can feel overwhelming, embarrassing, and fearful. It’s hard saying goodbye to the old lifestyle and the trappings we come to enjoy.
Adaptable Humans
Fortunately, the difficult times are temporary. Humans are very adaptable. Before long you will settle into the new “normal.” You will discover you can be just as happy with your new lifestyle as you were in the old. The anxiety of losing that lifestyle will be replaced with the satisfaction of watching your savings and investments grow, knowing you will someday be able to support yourself without working.
Assessment
Eventually, you will experience much less anxiety than you did when you were living in denial. Knowing you have enough savings to see you through a job loss or other financial calamity is a real anxiety buster.
You may even choose not to increase your lifestyle as your income increases. You’ll be too busy enjoying the financial serenity, satisfaction, and joy that comes with living on less than you earn and building financial independence.
Conclusion
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Filed under: CMP Program, Events-Planner, Financial Planning | Tagged: behavioral finance, budgeting, CMP, Financial Planning, Financial Sobriety, Rick Kahler CFP®, www.certifiedmedicalplanner.com | 2 Comments »
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Events-Planner: SEPTEMBER 2012
By Staff Writers
“Keeping track of important health economics and financial industry meetings, conferences and summits”
Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.
First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 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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Filed under: "Doctors Only", Breaking News, Career Development, Events-Planner | Tagged: Events-Planner | Leave a comment »
Adroitly Handling a Tough but Common Office Situation
[By Dr. Gary L. Bode MSA CPA]
A common scenario, in medical practice, is patient disgruntlement over professional fees.
The Scenario
This scenario should not occur in front of other patients. Many receptionists find that genuine, cute little quips like, “I know it seems high, but (wink), I’m expensive to maintain,” defuse the situation by gentling pointing out the overhead factor.
The Balk
When a patient balks at fees, gently and politely imply that we could inquire if the local plumber was available to do the exam, procedure or surgery.
Assessment
This brings training and relative cost issues into play while making them smile. Costs are high, but justifiable.
More:
Conclusion
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Filed under: Career Development, Practice Management | Tagged: CPT codes, disgruntled patients, Gary Bode, medical fee schedules, Medical Office Fee Strategies for Disgruntled Patients | 2 Comments »
Understanding Succession and Exit Planning for Physicians
By Michael J. Searcy, ChFC, CFP®, AIFA®
Doctors who once planned to rely on the sale of their practice to fund their retirement are now finding it more difficult to recruit younger physicians for their succession plan. If you are a mature doctor today who owns a smaller medical / dental practice (one or two doctor groups), you may be finding that both the economy and desires of younger doctors are changing the game for developing an exit strategy.
The Plan
In preparing a succession plan, a major key to success is starting the process early. Waiting until you near retirement to begin thinking about selling your practice may leave you with limited (often unfavorable) options. While some doctors choose to fund a buy-out vehicle during the early stages of their practice with the end goal of selling and retiring in mind, the majority are not in a position where they have a longstanding plan in place. For doctors who are more than 5-7 years out from retirement, making time to consult with professionals and come up with an enticing purchase proposition for a younger doctor can lead to receiving maximum value for the practice.
Understand the Obstacles
Several factors lead to younger doctors not purchasing existing practices. These include the heavy competition from hospitals that are competing for more doctors, their desire to set up their own practice, or their aversion to the responsibilities of running a business. By understanding the obstacles you may face in finding a successor, you can plan ahead to overcome them and get your practice in optimal operating order to increase its attractiveness to potential successors.
The Questions
Questions to consider during the process include:
Build an Alternative Nest Egg
While the sale of your practice may be a wonderful addition to your retirement fund, it is important to build a nest egg as you work and not rely on that big chunk from a sale at the end of your career. No sale or purchase price is guaranteed and economic changes or new regulations could make your practice unsellable. By building a nest egg for retirement throughout the course of your career, you can have greater peace of mind that you can experience financial freedom in retirement.
Assessment
Developing your exit strategy will take time, organization and careful planning. Avoid adding additional stress by viewing the sale of your practice as your financial freedom for retirement. When it comes time to transfer your ownership out of your practice, make sure you are able to focus solely on a successful outcome!
The Author
Michael J. Searcy, ChFC, CFP, AIFA, is President of Searcy Financial Services, Inc., a registered investment advisory firm in Overland Park, KS, offering integrated wealth management solutions to doctors. Searcy has been listed by Medical Economics as one of the “Top 150 Financial Advisors for Doctors” in 2002-2006 and 2011. For additional information, visit www.SearcyFinancial.com
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Filed under: Career Development, Retirement and Benefits | Tagged: A Retirement Game Changer for Mature Physicians?, Michael J. Searcy | 4 Comments »
How a Lawyer Exploited the Fine Print and Found Himself Facing Federal Charges
By Jake Bernstein / @Jake_Bernstein / ProPublica
The Industry
The life insurance industry tried to make variable annuities irresistible to investors and was enraged when a Rhode Island lawyer exploited the fine print for his own profit.
The Story
This story was co-reported with This American Life from WBEZ Chicago and NPR’s Planet Money.
Video: Excerpts of Video Depositions in the Case Against Joseph Caramadre
Link: http://www.propublica.org/article/death-takes-a-policy-how-a-lawyer-exploited-the-fine-print
Conclusion
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Filed under: Insurance Matters | Tagged: Annuities and Insurance, Death Takes a [Variably Annuity] Policy, insurance, Jake Bernstein, ProPublica, variable annuity, Variably Annuity | 1 Comment »
An important means of external financing for hospitals
By Calvin W. Wiese CPA CMA
By Dr. David Edward Marcinko MBA
www.CertifiedMedicalPlanner.org
Tax-exempt debt has become an important means of external financing for hospitals, primarily because its cost is very attractive. Interest rates on tax-exempt financing are lower than interest rates on financing that is not tax-exempt because the interest income earned by the holders is exempt from federal income tax. In some states, it is also exempt from state income tax and in some cities; it is also exempt from city income tax. Thus, the holders of these debt instruments (usually bonds) are willing to accept lower rates of interest.
State and Local Governments Only
Hospitals themselves are not capable of issuing tax-exempt debt. Only state and local governments are. A state or local government issues tax-exempt debt for hospitals and then loans the proceeds to hospitals. This is called “conduit” financing: the state or local government acts as a conduit through which hospitals can access tax-exempt debt markets. State and local governments are authorized to loan proceeds of their bond issues to hospitals through state statutes, and each state statute is different. Some states authorize any state or local government to issue bonds to loan to hospitals. Other states restrict such power to special purpose governmental entities only. And some states restrict this power to a single governmental entity that is specially formed for the sole purpose of issuing tax-exempt bonds on behalf of hospitals.
The IRS
The Internal Revenue Service (IRS) regulates the issuance of tax-exempt financing. While the IRS code nominally provides that debt instruments issued by state and local governments are exempt from federal income tax, it imposes special rules on conduit issues. Thus, tax-exempt issues whose proceeds are loaned to hospitals must comply with special IRS rules. Although very complex, these rules primarily regulate the use of proceeds, restricting the use of tax-exempt proceeds to the acquisition of property, plant components and equipment.
Given state statutes, IRS code and applicable security laws (both state and federal), issuing tax-exempt bonds is legally complex. Many lawyers get paid handsome fees every time tax-exempt debt is issued. The quarterback of the legal team is the bond counsel who represents the interests of the bondholders; the bond counsel issues the critical tax opinion that investors rely upon to claim tax-exemption on the interest from these instruments. Everything revolves around getting this opinion.
The Underwriter’s
Given its critical nature, only highly qualified lawyers are accepted by the market to provide this opinion. Underwriter’s counsel represents the interests of the investment bankers; their primary concern is compliance with security laws. Issuer’s counsel represents the interests of the state or local government, and hospital counsel represents the interests of the hospital; both have relatively minor roles. In the event credit enhancement is involved, credit enhancement counsel represents their interests and has significant influence on the process.
The Trustees
Another unique party to most tax-exempt bond issues is the bond trustee. The bond trustee is usually a bank who performs a fiduciary duty on behalf of the bond holders throughout the life of the bonds. The face of the faceless bond holders, they act on their behalf. And they, too, are represented by counsel in the bond issuance process.
State or local government typically appoints bond counsel. In many cases, they work with only a single firm. Not unusually, these relationships are quite cozy, and often result in fees being paid that are well in excess of what otherwise would be paid.
The Documents
An excess of documents is involved in most tax-exempt financings. The heart of the documents is the indenture, which is the agreement between the bond trustee (on behalf of the bond holders) and the state or local government issuer. It contains the promises made to the bond holders, and it describes the work of the bond trustee. The bond trustee will only perform actions on behalf of bond holders that are explicitly set forth in the bond indenture. The bond indenture is the security given to the bond holders, describing all their recourses.
Assessment
The bond indenture is typically supported by the loan agreement between the state or local government that issues the bonds and the hospital to which the proceeds are loaned. Its terms complement the terms of the bond indenture, which together, form the conduit.
Conclusion
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Physician Advisors: www.CertifiedMedicalPlanner.org


Filed under: Book Reviews, CMP Program, Healthcare Finance, iMBA, Inc. | Tagged: "conduit" financing, certified medical planner, CMP, Dr. David Marcinko, hospital financing, IRS, municipal bonds, On Hospital Tax-Exempt Debt | Leave a comment »
IRS Help for Charitable Taxpayers
[By Children’s Home Society of Florida Foundation]
The IRS has published a series of six tips that are designed to help charitable taxpayers. Both the Department of the Treasury and the IRS hope to enable donors to support various charities. The six recommendations will help donors to be certain that their gifts are deductible.
1. Tax Exempt Status
A charity must be qualified under the IRS guidelines for a gift to be deductible. At www.irs.gov there is an “Exempt Organization Select Check” that allows donors to be certain the charity is qualified to receive deductible gifts.
2. Itemizing
Your charitable gifts are deductible only if you itemize deductions on IRS Form 1040, Schedule A.
3. Fair Market Value
Gifts of cash are deductible at face value. Gifts of appreciated stock, land and many other types of property are often deductible at fair market value. There are special rules for cars, boats, clothing and household items. If the charity gives value in return, such as goods, services, admission to a charity banquet or sporting event, that amount will reduce the value of your charitable deduction.
4. Good Records
You need to maintain records of all donations. All cash gifts must be documented even if they are quite small. You should keep cancelled checks, bank or credit card statements, payroll deductions or a statement from the charity with its name, contribution, date and amount for your gifts.
5. Larger Gifts
If your gift is $250 and above, you must receive a receipt or written acknowledgement from the charity. The acknowledgement should state the amount of the gift and may include a description and fair market value for property gifts. It must state whether the charity provided goods or services for your gift. Non-cash gifts over $500 require you to file IRS Form 8283, Non-Cash Charitable Contributions, with your Form 1040. If the non-cash property is over $5,000 and is not a public stock, bond or mutual fund, you usually must obtain a property appraisal from a qualified appraiser who holds himself or herself out to the public for that purpose. In some cases, the appraisal must be attached to the return with a signed Form 8283.
6. Timing
If you make a pledge, the gift will be deductible only when it actually is made. For example, a donor may make a pledge in November and then make the gift the following March. The gift is deductible in the year it is made. End-of-year donations by check or credit card are generally deductible in the year that they are made or placed in the U.S. mail.
Editor’s Note: In nearly all cases, your charitable gifts will qualify for a substantial reduction in your taxes. For specific information, go to www.irs.gov and search for IRS Publication 526, Charitable Contributions. Valuation rules are available in IRS Publication 561, Determining the Value of Donated Property.
Conclusion
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Filed under: Estate Planning, Taxation | Tagged: 8283, gifts, IRS, IRS Form 8283, IRS Tips for Charity Minded Medical Professionals, Non-Cash Charitable Contributions, Schedule A | 5 Comments »