The “BADLANDS” Off-Shore Tax Havens in South Dakota

By Morning Brew, NF and Staff Reporters

One of the world’s most prolific offshore tax havens is located more than 1,000 miles from any shore.

The US state of South Dakota now rivals notorious tax shelters like Panama, the Cayman Islands, and Switzerland as a destination for the top 0.01% to shield their  wealth from the grubby hands of tax authorities, the newly released Pandora Papers show.

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CITE: https://www.r2library.com/Resource/Title/0826102549

Quick recap: The Pandora Papers, published one week ago, represent one of the biggest leaks of financial docs in history. They show how celebrities, world leaders, and business magnates take advantage of opaque financial laws to hold onto as much of their wealth as they can…and, in some cases, get away with crimes.

And while none of that is particularly surprising, what is surprising is the changing geography of tax havens. The ultrarich are taking their money out of traditional tax shelters like the island of Jersey (one of the Channel Islands) and stashing it in rural US states like Nevada, Wyoming, and, most of all…South Dakota.

  • Of the more than 200 US trusts appearing in the Pandora Papers, 81 were located in South Dakota.

South Dakota’s trust industry held $367 billion in anonymous, untraceable assets in 2020, a nearly 4x increase from $75.5 billion in 2011. And these trusts aren’t catering to cattle ranchers who made it big—they’re linked to individuals in 40 different countries outside the US.

The bigger issue? 28 US-based trusts are linked to individuals or companies accused of misconduct overseas, such as money laundering, bribery, and human rights abuses, per the Washington Post.

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Badlands National Park Has Stunning Landscapes and Diverse Wildlife -  Here's How to Experience It (Video) | Travel + Leisure

And now the question you’ve all been waiting for…

Why South Dakota?

It’s not why most people arrive in South Dakota—by accident. For decades, the state has intentionally loosened regulations on its financial services sector to grow its economy and create finance jobs, particularly in the city of Sioux Falls.

This deregulation push, spurred by trust industry insiders, turned a South Dakotan trust into “the most potent force-field money can buy,” wrote the Guardian’s Oliver Bullough.

By setting up a trust in South Dakota…

  • Your assets are protected from claims by creditors, angry clients, or even your ex-spouse (a level of security not afforded by other tax havens).
  • You are not subject to income tax, inheritance tax, or capital gains tax in the state…because South Dakota has none of those.
  • You never actually have to go to South Dakota.

In sum, if you’re a shady billionaire or a corrupt president of a Latin American country with something to hide, South Dakota looks like a mighty attractive place to shield your fortune from governments.

Or, rather, the US more broadly is an attractive place to hide your wealth. After years of bashing “offshore” havens for sheltering tax avoiders, the US has moved up to second in the world rankings for financial secrecy.

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MORE: https://www.msn.com/en-us/money/markets/the-worlds-rich-and-powerful-are-stashing-dollar500-billion-in-this-tax-haven/ar-AAPw6Ny?li=BBnb7Kz

MORE: https://www.msn.com/en-us/news/politics/opinion-the-reason-its-so-easy-for-wealthy-americans-to-hide-their-money-%e2%80%94-and-how-to-stop-it/ar-AAPzf9W?li=BBnb7Kz

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Two Vital IRS Audit Flags for Physicians

For Doctors and all Investors

By Hayden Adams

Image result for irs

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Red Flag #1: Under reporting income

Generally speaking, all income is taxable unless it’s specifically excluded, as is the case with certain gifts and inheritances. In most instances, the income you earn will be reported to both you and the government on an information return, such as a Form 1099 or W-2. If the income you report doesn’t match the IRS’s records, you could face problems down the road—so be sure you include the income from all of the following forms that are applicable to your situation:

  • 1099-B: The form on which financial institutions report capital gains.
  • 1099-DIV: The form on which financial institutions report dividends.
  • 1099-MISC: The form used to report various types of income, such as royalties, rents, payments to independent contractors, and numerous other types of income.
  • 1099-R:The form on which financial institutions report withdrawals from tax-advantaged retirement accounts.
  • Form 1099-INT: The form on which financial institutions report interest income.
  • Form SSA-1099:The form on which the Social Security Administration reports Social Security benefits (a portion of which may be taxable, depending on your level of income).
  • Form W-2:The form on which employers report total annual compensation, payroll taxes, contributions to retirement accounts, and other information.

If you receive an inaccurate statement of income, immediately contact the responsible party to request a corrected form and have them resend the documents to both you and the IRS as soon as possible to avoid delaying your tax return. Also, be aware that you must report income for which there is no form, such as renting out your vacation home.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Red Flag #2: Misreporting investment gains

When you sell an investment, you’ll need to know both the cost basis (what you paid for the investment) and the sale price to determine your net gain or loss. The cost basis of your investment may need to be adjusted to account for commissions, fees, stock splits, or other events, which could help reduce your taxable gain or increase your net loss.

Financial institutions are required to adjust your investments’ cost basis and provide that information on a Form 1099. However, brokerages aren’t required to report the cost basis for investments purchased prior to a certain date, which means you’ll be responsible for supplying that information (see the table below). Be sure to keep records of all investment purchases and sales—even those for which your brokerage is responsible.

Your reporting responsibility

Depending on security type and date of purchase, you—rather than your brokerage—could be responsible for reporting the cost basis of your investment to the IRS.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Security typeInvestor’s responsibility if
Stocks (including real estate investment trusts)Acquired before 01/01/2011
Mutual funds, exchange-traded funds, and dividend reinvestment plansAcquired before 01/01/2012
Other specified securities, including most bonds, derivatives, and options

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PODCAST: Medicare Financial Matters

WHAT COUNTS AS INCOME SOURCES?

BY CMS

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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

FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: Healthcare Stocks, Investing & IPOs?

By Eric Bricker MD

Healthcare Stock and IPO Investing Can Be Confusing. The Story of Privia Health is a Good Case Study in Understanding the Underlying Economics in Healthcare Investing:

CITE: https://www.r2library.com/Resource/Title/0826102549

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Benefits of Healthcare Participation in Multiple Medical Payment Models

BY HEALTH CAPITAL CONSULTANTS, LLC

New Research Explores Benefits of Participation in Multiple Payment Models


An August 2021 study published in the Journal of the American Medical Association (JAMA) analyzed medical and surgical episodes of care in U.S. hospitals to determine whether outcomes differed in hospitals that participated in Medicare’s Bundled Payments for Care Improvement (BPCI) Initiative depending on whether the patient being treated was attributed to a Medicare Shared Savings Program (MSSP) accountable care organization (ACO).

This Health Capital Topics article will discuss the study’s findings and potential policy implications. (Read more…)

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

ORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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What is Medical Practice FINANCIAL RATIO ANALYSIS?

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BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Financial ratio analysis typically involves the calculation of ratios that are financial and operational measures representative of the financial status of a clinic or medical practice enterprise.  These ratios are evaluated in terms of their relative comparison to generally established industry norms, which may be expressed as positive or negative trends for that industry sector. The ratios selected may function as several different measures of operating performance or financial condition of the subject entity.

CITE: https://www.r2library.com/Resource/Title/0826102549

Common types of financial indicators that are measured by ratio analysis include:

  • Liquidity. Liquidity ratios measure the ability of an organization to meet cash obligations as they become due, i.e., to support operational goals. Ratios above the industry mean generally indicate that the organization is in an advantageous position to better support immediate goals.  The current ratio, which quantifies the relationship between assets and liabilities, is an indicator of an organization’s ability to meet short-term obligations.  Managers use this measure to determine how quickly assets are converted into cash.
  • Activity. Activity ratios, also called efficiency ratios, indicate how efficiently the organization utilizes its resources or assets, including cash, accounts receivable, salaries, inventory, property, plant, and equipment.  Lower ratios may indicate an inefficient use of those assets.
  • Leverage. Leverage ratios, measured as the ratio of long-term debt to net fixed assets, are used to illustrate the proportion of funds, or capital, provided by shareholders (owners) and creditors to aid analysts in assessing the appropriateness of an organization’s current level of debt.  When this ratio falls equal to or below the industry norm, the organization is typically not considered to be at significant risk.
  • Profitability. Indicates the overall net effect of managerial efficiency of the enterprise. To determine the profitability of the enterprise for benchmarking purposes, the analyst should first review and make adjustments to the owner(s) compensation, if appropriate.  Adjustments for the market value of the “replacement cost” of the professional services provided by the owner are particularly important in the valuation of professional medical practices for the purpose of arriving at an ”economic level” of profit.

The selection of financial ratios for analysis and comparison to the organization’s performance requires careful attention to the homogeneity of data. Benchmarking of intra-organizational data (i.e., internal benchmarking) typically proves to be less variable across several different measurement periods.

However, the use of data from external facilities for comparison may introduce variation in measurement methodology and procedure. In the latter case, use of a standard chart of accounts for the organization or recasting the organization’s data to a standard format can effectively facilitate an appropriate comparison of the organization’s operating performance and financial status data to survey results.

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

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What is EBITDA?

A TERM ALL PHYSICIAN INVESTORS MUST KNOW

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What Is Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA)?

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EBITDA, or earnings before interest, taxes, depreciation, and amortization, is a measure of a company’s overall financial performance and is used as an alternative to net income in some circumstances. EBITDA, however, can be misleading because it strips out the cost of capital investments like property, plant, and equipment.

This metric also excludes expenses associated with debt by adding back interest expense and taxes to earnings. Nonetheless, it is a more precise measure of corporate performance since it is able to show earnings before the influence of accounting and financial deductions.

Why EBITDA is still a Great Financial Management Metric

Simply put, EBITDA is a measure of profitability. While there is no legal requirement for companies to disclose their EBITDA, according to the U.S. generally accepted accounting principles (GAAP), it can be worked out and reported using the information found in a company’s financial statements.

The earnings, tax, and interest figures are found on the income statement, while the depreciation and amortization figures are normally found in the notes to operating profit or on the cash flow statement. The usual shortcut to calculate EBITDA is to start with operating profit, also called earnings before interest and tax (EBIT) then add back depreciation and amortization.

CITE: https://www.r2library.com/Resource/Title/0826102549

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

MORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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MENTAL ACCOUNTING: What is it?

By Dr. David E. Marcinko MBA CMP®

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DEFINITION: Mental accounting attempts to describe the process whereby people code, categorize and evaluate economic outcomes. The concept was first named by Richard Thaler. Mental accounting deals with the budgeting and categorization of expenditures. People budget money into mental accounts for expenses or expense categories

CITE: https://www.r2library.com/Resource/Title/0826102549

Mental Accounting is the act of bucketizing investments and then reviewing the performance of the individual buckets separately (e.g. investing at low savings rate while paying high credit card interest rates).

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Mental Accounting • Money is

Examples of mental accounting are: (1) matching costs to benefits (wanting to pay for vacation before taking it and getting paid for work after it was done, even though from perspective of time value of money the opposite should be preferred0, (2) aversion to debt (don’t like long-term debt for short-term benefit), (3) sunk-cost effect (illogically considering non-recoverable costs when making forward-going decisions).

In investing, treating buckets separately and ignoring interaction (correlations) induces people not to sell losers (even though they get tax benefits), prevent them from investing in the stock market because it is too risky in isolation (however much less so when looked at as part of the complete portfolio including other asset classes and labor income and occupied real estate), thus they “do not maximize the return for a given level of risk taken).

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PODCAST: Warren Buffett’s Thoughts on Healthcare

BY ERIC BRICKER MD

CITE: https://www.r2library.com/Resource/Title/0826102549

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In Response to a Question Regarding the Ending of Haven Healthcare–the Joint Venture Among Berkshire Hathaway, JP Morgan Chase and Amazon to Improve Healthcare for their Employee Health Plan Members–Warren Buffett Made the Following Statement:

“Healthcare is the Tapeworm of the US Economy and the TAPEWORM WON.”

Additionally, Warren Buffett Goes on to Say that ‘Prestigious‘ People in the Community Run Hospital Boards and These People Are ‘Fairly Happy‘ with the Healthcare System the Way It Currently Is.

It is Likely that Warren Buffett Formed Some of This Opinion in Speaking About Healthcare with the Vice Chairman of Berkshire Hathaway, Charlie Munger, and Berkshire Board Member and Famous CEO, Tom Murphy.

Charlie Munger Has Served on the Board of a Los Angeles Hospital for 31 Years and Tom Murphy Currently Serves on the NYU Langone Hospital System Board of Directors.

The Support of the Status Quo by ‘Prestigious,’ ‘Fairly Happy’ Hospital Board Members Cannot Be Understated… It Blocks Change and Warren Buffett Appears to Think Similarly.

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PODCAST: “The Hospital” Book Review

By Brian Alexander

If You Like Michael Lewis Books, You’ll Love This

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ANNUAL FINANCIAL STATEMENT REPORTS: Health Insurance Companies

FOR PHYSICIAN INVESTORS

By David Belk MD

Health Insurance Company Financial Index

Below is a listing of the Nine largest for-profit health insurance Companies. The Annual financial statements are linked to the year for each Company and a four page summary report is linked to the name of the health insurance company at the top of the listing.

CITE: https://www.r2library.com/Resource/Title/0826102549

The relevant pages in each financial statement I used to prepare my summaries are listed next to each year’s statement. Aetna and Coventry’s summaries are combined because they merged in 2012. Health Net also Merged with Centene in 2016 leaving only seven major health insurance companies.

A composite summary for the data for all eight companies is here

Composite Data Table

Click on the name of the health insurance company to open the accordion and view the financial statements.

LINK: https://truecostofhealthcare.org/health-insurance-financial-index/

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US DEBT BUSTERS: The 1 TRILLION DOLLAR Coin

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BY MORNING BREW

The Legend of the $1 Trillion Platinum Coin

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See the source image

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You may have heard that a deadline to suspend the debt ceiling is rapidly approaching, and if lawmakers don’t do anything it could lead to “economic catastrophe,” in the words of Treasury Secretary Janet Yellen.

But what if we told you there was a solution to the debt ceiling fiasco so crazy…it just might work?

The solution: Yellen could have the Treasury mint a $1 trillion platinum coin, deposit it at the Fed to “retire” loads of US federal debt, and then enable the government to carry on with business as usual without having to worry about defaulting on its existing debt.

But can the Treasury really do that? Yes. According to Section 31 US Code § 5112

  • “The Secretary may mint and issue platinum bullion coins and proof platinum coins in accordance with such specifications, designs, varieties, quantities, denominations, and inscriptions as the Secretary, in the Secretary’s discretion, may prescribe from time to time.”

The law is crystal clear, and has been deemed kosher by numerous academics. “The statute clearly does authorize the issuance of trillion-dollar coins,” Laurence Tribe, a Harvard Law professor, told Washington Monthly back in 2013.

In fact, nothing says we have to stop at $1 trillion. Yellen could go big with a $10 trillion coin, hypothetically. As Bloomberg’s Joe Weisenthal explains, none of this would lead to inflation because it’s merely an “accounting trick”—not an influx of money into the economy.

Have we tried this before? The $1 trillion platinum coin idea seems to pop up every time the US faces a debt ceiling crunch. It was first introduced by a Georgia lawyer in 2010 and gained traction during the debt-ceiling crisis of 2011.

Things really turned up in 2013, when the government was…you guessed it, facing another debt ceiling deadline. The hashtag #MintTheCoin became popular on Twitter, and economists like Paul Krugman advocated for unleashing the coin. “If we have a crisis over the debt ceiling, it will be only because the Treasury Department would rather see economic devastation than look silly for a couple of minutes,” he wrote.

But each time the $1 trillion coin is mentioned as a way of resolving debt ceiling problems, the people in charge dismiss it as a distraction from Congress doing its job. “Neither the Treasury nor the Federal Reserve believes that the law can or should be used to produce platinum coins for the purpose of avoiding an increase in the debt limit,” The Treasury wrote during…well, yes, another debt ceiling emergency in 2015.

As for our current predicament, the Biden administration rejected the minting of the $1 trillion coin yet again last week.

CITE: https://www.r2library.com/Resource/Title/0826102549

Bottom line: Perhaps some enterprising future Treasury Secretary will manifest the platinum coin into existence, but for now it remains as mythical as Camelot.

MORE: https://medicalexecutivepost.com/2021/09/21/what-is-the-us-debt-ceiling/

COINS: https://www.msn.com/en-us/news/politics/2-democrats-say-they-want-to-mint-a-coin-to-solve-the-debt-ceiling-showdown-and-save-the-us-from-catastrophic-default/ar-AAOXLcU?li=BBnb7Kz

GOVERNMENT Rxn: https://www.msn.com/en-us/news/politics/heres-what-would-happen-if-washington-doesnt-prevent-a-government-shutdown/ar-AAODYi5?li=BBnb7Kz

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PODCAST: Medicare and Nursing Home / Long Term Care

By CMS

CITE: https://www.r2library.com/Resource/Title/0826102549

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What is Financial CARRIED INTEREST?

A TAX LOOPHOLE?

BY DR. DAVID E. MARCINKO MBA CMP®

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Carried interest, or carry, in finance, is a share of the profits of an investment paid to the investment manager in excess of the amount that the manager contributes to the partnership, specifically in alternative investments (private equity and hedge funds).

CITE: https://www.r2library.com/Resource/Title/0826102549

In small businesses that are not blind pools, such as single property real estate, the investment manager often funds the business prior to the formation of the partnership. It is a performance fee, rewarding the manager for enhancing performance. The structure also takes advantage of favorable tax treatment in the United States.

However, critics of carried interest want it to be reclassified as ordinary income – not capital gains – to be taxed at the ordinary income tax rate. Private equity advocates argue that the increased tax will subdue the incentive to take the kind of risk that is necessary to invest in and manage companies to profitability.

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What is the carried interest tax loophole?

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TAXATION: https://www.taxpolicycenter.org/briefing-book/what-carried-interest-and-how-it-taxed

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PODCAST: On Covid Pandemic Hospital Costs

FOR EMPLOYERSEMPLOYER SPONSORED HEALTH PLANS

BY ERIC BRICKER MD

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FRANCHISE Healthcare Opportunities?

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BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Healthcare Business and Medical Franchises

The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last year.  On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support.

Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc. Some well know established healthcare and medical franchises are:  Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now, etc.

On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations. Questions to consider when contemplating this business entity include:

  • Franchise stability, track record, licensing and costs.
  • Training, support and proximity of other franchises.
  • Independence, ownership laws, contracts and dispute resolutions,
  • Screening methods, market size and potential market share.
  • Replacement cost and transferability?

For more information on Uniform Franchise Offerings Circulars (UFOCs) contact www.FranChoice.com or:

Frandata

1130 Connecticut Avenue, NW

Washington DC 20036

202.659.8640

http://www.frandata.com

International Franchise Association

1350 New York Avenue, NW

Washington, DC 20005

202.628.800

http://www.franchise.org


Also visit:
www.aafd.org; www.franNet.com

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

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Physician Owned Hospitals Myths DeBunked

BY HEALTH CAPITAL CONSULTANTS, LLC

Literature Review Debunks Claims Against Physician-Owned Hospitals


Approximately 250 hospitals across the U.S. are completely or partially physician owned. These physician-owned hospitals (POHs) can offer a variety of services, from general care to specialty services, such as cardiovascular or orthopedic care, known as “focused factories.”

Over the past several decades, healthcare providers and policymakers have claimed that POHs have a negative impact on the healthcare industry, suggesting that: (1) POHs “cherry-pick” the most profitable patients; (2) the quality of care provided at POHs is substandard; and, (3) conflicts of interest exist due to the financial incentive for physician owners to refer patients to their POHs. (Read more…) 

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What Exactly is a Financial DAO?

A decentralized autonomous organization

DR. DAVID EDWARD MARCINKO FACFAS MBA CFP MBBS [Hon] [Executive Summary] -  PDF Free Download

BY. DR. DAVID EDWARD MARCINKO MBA CMP®

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What is DAO - Decentralized Autonomous Organizations

A decentralized autonomous organization (DAO), sometimes called a decentralized autonomous corporation (DAC), is an organization represented by rules encoded as a computer program that is transparent, controlled by the organization members and not influenced by a central government. A DAO’s financial transaction record and program rules are maintained on a blockchain. The precise legal status of this type of business organization is unclear.

A well-known example, intended for venture capital funding, was The DAO, which launched with $150 million in crowdfunding in June 2016, and was nearly immediately hacked and drained of US$50 million in cryptocurrency. The hack was reversed in the following weeks, and the money restored, via a hard fork of the Ethereum blockchain: the Ethereum miners and clients switched to the new fork.

CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://www.msn.com/en-us/money/topstocks/what-is-a-dao/ar-AAOIpjw?li=BBnb7Kz

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What Exactly is a PONZI SCHEME; etc?

AND OTHER INVESTING SCAMS!

By Dr. David E. Marcinko MBA CMP®

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A Ponzi scheme (/ˈpɒnzi/, Italian: [ˈpontsi]) is a form of fraud that lures investors and pays profits to earlier investors with funds from more recent investors. Recall Bernie Madoff.

More: https://medicalexecutivepost.com/2010/06/04/the-madoff-circle/

The scheme leads victims to believe that profits are coming from legitimate business activity (e.g., product sales or successful investments), and they remain unaware that other investors are the source of funds. A Ponzi scheme can maintain the illusion of a sustainable business as long as new investors contribute new funds, and as long as most of the investors do not demand full repayment and still believe in the non-existent assets they are purported to own.

Link: https://en.wikipedia.org/wiki/Ponzi_scheme

A pyramid scheme is a business model that recruits members via a promise of payments or services for enrolling others into the scheme, rather than supplying investments or sale of products. As recruiting multiplies, recruiting becomes quickly impossible, and most members are unable to profit; as such, pyramid schemes are unsustainable and often illegal.

CITE: https://www.r2library.com/Resource/Title/0826102549

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How to Spot and Protect Yourself From Investment Fraud

Pyramid schemes have existed for at least a century in different guises. Some multi-level marketing plans have been classified as pyramid schemes.

And, there are MANY other schemes in the financial services sector.

MORE: https://www.msn.com/en-us/money/other/are-you-about-to-be-the-victim-of-a-ponzi-scheme/ar-BB1cqabu?li=BBnb7Kz

Front Running: https://medicalexecutivepost.com/2018/02/06/what-is-front-running/

Churning: https://medicalexecutivepost.com/2021/07/23/churning-front-running-and-pumping-dumping/

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MEDICAL RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: APPEALS Traditional [Original] Medicare

BY CMS

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The STEP-UP In Investment Value?

Understanding the TAX loophole of a ‘step up’ in BASIS value

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

The term “step-up” refers to the difference in value and tax liability that an asset has when it is acquired and when it is transferred to an inheritor.

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CITE: https://www.r2library.com/Resource/Title/0826102549

EXAMPLE #2: The proverbial millionaire Doctor Joe, for example, could buy a home for $350,000 and sell it for $1 million, after which he’d pay taxes on the $650,000 gain. But if Dr. Joe passes the home onto his daughter Ella, and she has it appraised at $1 million, its value has taken a “step up” in value to $1 million. If Ella sells the home for $1 million or less, she wouldn’t owe anything in taxes.

ASSESSMENT: For billionaires like Jeff Bezos, Bill Gates and Elon Musk who earn far more through their investments than their salaries, this loophole is a perfect way to shield their wealth. Intergenerational wealth has contributed to surging inequality in America, which grew wider during the pandemic. Since 2019, the wealth of the top 400 richest people in the US increased by $1.4 trillion, per research from Gabriel Zucman and Emmanuel Saez, a pair of left-leaning economists at the University of California, Berkeley.

“Often, for these people, wealth accumulates tax-free their entire lives,” Frank Clemente, executive director at the left-leaning advocacy group Americans for Tax Fairness, opined. President Joe Biden proposed ending this loophole and making billionaires “pay their fair share,” so why does it look like his party won’t touch it?

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What is the KIDDIE TAX?

VITAL FOR PHYSICIAN PARENTS TO UNDERSTAND

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Do your children have income-generating assets in a custodial account?

If so, be sure you understand the so-called kiddie tax.

This law was passed to discourage wealthier individuals from transferring assets to their children to take advantage of their lower tax rates. The kiddie tax has seen many iterations but current rules tax a minor child’s unearned income—including capital gains distributions, dividends, and interest income—at the parents’ tax rate if it exceeds the annual limit ($2,200 in 2021).

The Kiddie Tax - Baker Holtz

The tax applies to dependent children under the age of 18 at the end of the tax year (or full-time students younger than 24) and works like this:

  • The first $1,100 of unearned income is covered by the kiddie tax’s standard deduction, so it isn’t taxed.
  • The next $1,100 is taxed at the child’s marginal tax rate.
  • Anything above $2,200 is taxed at the parents’ marginal tax rate.

CITE: https://www.r2library.com/Resource/Title/0826102549

So – If your child also has earned income, say from a summer job or legitimate work in your medical office or practice, the rules become more complicated.

To learn more, see IRS Publication 929

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PODCAST: On the Corporate Practice of Medicine Laws

IS PRIVATE EQUITY BUYING DOCTORS ILLEGAL?

By Eric Bricker MD

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The DUPONT Decomposition Equation for ROI

D.D.E. FOR HOSPITALS AND HEALTHCARE ORGANIZATIONS

DEM blue

By Dr. David E. Marcinko MBA CMP

[Editor-in-Chief] http://www.CertifiedMedicalPlanner.org

According to the Dupont Decomposition Equation – which involves the conglomeration of net operating income, revenues, expenses and average operating assets – ROI and economic profit is increased in three prioritized ways:

  1. Cost and expense reductions.
  2. Revenue increases [Rev]
  3. Reduced average operating assets [AOO]

Note: ROI = NOI / Rev X Rev / AOO

Cost and expense reductions

Although many hospitals have reduced expenses, postponed projects and put clinical or information technology projects on hold because of the MU conundrum, this may be unwise and quality may suffer. And, mental health care programs are almost always the first cost center to be reduced in tough times.

Upgrades today, especially with concurrent marketing and advertising promotions, may well be considered a strategic competitive advantage, and at bargain basement prices for those with cash or credit. This cost reduction is easy because it gives the biggest buck-bang in the ROI equation, and is the first line of ROI augmentation by savvy administrators and CEOs. It is also intuitive and wholly “wrung-out” in the marketplace, to date.

Revenue increases

On the other hand, revenues can usually be only incrementally increased by improving services like emergency care, urgent care, wellness, out-patient and/or surgical departments. This is the more difficult part of the equation and yields a positive, but lesser return in the ROI equation.

CITE: https://www.r2library.com/Resource/Title/0826102549

DuPont Formula: Learn More At Accounting Play

Three Modern Collections Rules for Hospitals

The following medical practice procedures will markedly increase upfront office collections:  

  • Train staff to handle exceptions. What is your policy if the patient payment is significant? Will you allow 25% payments—one today and three over the next three months? Communicate your policy to all staff. What will you do if a patient shows up without an insurance card? There will be other exceptions. Train employees to call the appropriate practice-management contact when an exception does not fit in the categories you provide and make sure those managers are responsive.
  • Understand that not everyone will shine in collections. The value of this new front-desk function should be reflected in job descriptions and wages. Track staff performance and hold employees accountable for collection goals. The most successful practices collect in the 90% range.
  • Provide professional signage that states your basic policy. “Payments are due at time of service.” Avoid typewritten, lengthy explanations taped to walls or desks that look like clutter.

Reduced average operating assets

Finally, any delay in updating facilities – while easy and may reduce operating assets – there is little ROI advantage and profit potential. Of course, facility asset upgrades mean borrowing funds through tax-exempt bonds – the main source of debt for most hospitals – and is currently difficult or impossible in this climate. Loans from banks, private investors, angels, venture capitalists or other financial institutions are similarly difficult to obtain. Thus, this part of the equation may often be neglected; as is the case now.

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What is the “SAVER’S CREDIT”?

By Dr. David E. Marcinko MBA CMP®

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Sponsor: http://www.CertifiedMedicalPlanner.org

The saver’s credit is a tax credit that’s intended to promote retirement savings among low- and moderate-income workers. It can reduce an eligible taxpayer’s federal income taxes when they save in a qualified retirement plan. It may be especially useful to medical students, nurses, interns, residents and fellows.

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IRS Releases Plan Limits for 2020 - Montgomery Retirement Plan Advisors

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In 2021, the maximum credit is worth $1,000 for individuals and $2,000 for married couples filing jointly, although it phases out for higher earners. To qualify for the credit, individuals must have an adjusted gross income of $32,500 or less. The income threshold for married couples is $65,000.

Because the credit is non-refundable, eligible taxpayers are able to use it to effectively reduce their tax bill to zero – but it cannot provide them with a tax refund.

IRS: https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-savings-contributions-savers-credit

CITE: https://www.r2library.com/Resource/Title/0826102549

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Over Heard in the DOCTOR’S LOUNGE

On “Hard Working” HMO Physicians

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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By Dr. David E. Marcinko MBA CMP®

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One of my favorite patients told me this anecdote as he recalled the story of the old man who spent a day watching his physician son treating HMO patients in the office. 

The doctor had been working at his usual feverish pace all morning, and although he was working hard, bitterly complained to his dad that he was not making as much money as he used to.

Finally, the old man interrupted him and said,

“Son, why don’t you just treat the sick patients?” 

The doctor-son looked annoyed at his father, and responded,

“Dad, can’t you see, I don’t have time to treat just the sick ones.”

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A Novel HYBRID Physician Reimbursement Model 2.0?

MODERN CONSIDERATIONS

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By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

EMERGING HYBRID PAYMENT MODELS

Current reimbursement structures involve the submission and payment of medical CPT® coded claims. But, some doctors feel they need to “up-code” to maximize revenue or “down-code” for fear of having a claim denied. Contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

CITE: https://www.r2library.com/Resource/Title/0826102549

This hybrid reimbursement system might use a two-payment structure.

For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.

The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.

Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar.

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INVITATIONS: https://wordpress.com/post/medicalexecutivepost.com/246863

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Three [3] Must Know Technical ROTH IRA RULES

ALERT FOR PHYSICIANS AND ALL INVESTORS

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1. You can trade actively in a Roth IRA

Some physician investors may be concerned that they can’t actively trade in a Roth IRA. But there’s no rule from the IRS that says you can’t do so. So you won’t get in legal trouble if you do.

But there may be some extra fees if you trade certain kinds of investments. For example, while brokers won’t charge you if you trade in and out of stocks and most ETFs on a short-term basis, many mutual fund companies will charge you an early redemption fee if you sell the fund. This fee is usually assessed only if you’ve owned the fund for fewer than 30 days.

2. Any gains are tax-free – forever

The ability to avoid taxes on your investments is an incredible benefit. You’ll be able to escape – perfectly legally – taxes on dividends and capital gains. Not surprisingly, this superpower makes the Roth IRA very popular, but to enjoy its benefits, you must abide by a few rules.

The Roth IRA limits you to a $6,000 maximum annual contribution (for 2021), and you won’t be able to withdraw earnings from the account until retirement age (59 1/2) or later and after owning the account for at least five years. However, you can withdraw your contributions to the account without being taxed at any time, but you won’t be able to replace those contributions later.

The Roth IRA offers a number of other benefits and retirement savers should look into it.

3. You can’t use margin in an IRA

Many traders use margin in their accounts. With a margin loan, the broker extends you capital to invest beyond what you actually own. It’s a useful tool, especially if you’re trading frequently. Unfortunately, margin loans are not available in IRA accounts.

For frequent traders the ability to trade on margin is not just about magnifying your returns. It’s also about having the ability to sell a position and immediately buy another. In a cash account (like a Roth IRA), you have to wait for a transaction to settle, and that takes a couple days. In the meantime you’re unable to trade with that money even though it’s credited to your account.

PLUS A FOURTH RULE

4. You don’t get to deduct losses

If you’re trading in a taxable brokerage account, you’ll get a tax write-off if you make a losing investment. Some investors even make sure they’re getting the largest write-off they can using a process called tax-loss harvesting. They scoop up that benefit and then even repurchase the stock or fund later (after 30 days) if they think it’s poised to rise in the future.

But if you’re trading in a Roth IRA, you won’t get the ability to write off losses. Changes to the tax code in 2017 eliminated the ability to claim any benefit from losses in an IRA account.

CITATION: https://www.r2library.com/Resource/Title/0826102549

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What is a Roth IRA? | Meridian Financial Partners

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INDUSTRIAL ORGANIZATION: For Hospitals, Clinics and Healthcare CXOs, CEOs, CMOs and CTOs, etc.

MANAGEMENT STRATEGIES, TOOLS TEMPLATES AND CASE STUDIES

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Reviews:

Hospitals and Health Care Organizations is a must-read for any physician and other health care provider to understand the multiple, and increasingly complex, interlocking components of the U.S. health care delivery system, whether they are employed by a hospital system, or manage their own private practices.

The operational principles, methods, and examples in this book provide a framework applicable on both the large organizational and smaller private practice levels and will result in better patient care. Physicians today know they need to better understand business principles and this book by Dr. David E. Marcinko and Professor Hope Rachel Hetico provides an excellent framework and foundation to learn important principles all doctors need to know.
―Richard Berning, MD, Pediatric Cardiology

… Dr. David Edward Marcinko and Professor Hope Rachel Hetico bring their vast health care experience along with additional national experts to provide a health care model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are, and, by applying the well-illustrated principles, improve the efficiency of the system without sacrificing quality patient care. … The health care delivery system is not an assembly line, but with persistence and time following the guidelines offered in this book, quality patient care can be delivered efficiently and affordably while maintaining the financial viability of institutions and practices.
―James Winston Phillips, MD, MBA, JD, LLM

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PURCHASE: https://www.amazon.com/dp/B00BC9IIUM?ref_=k4w_oembed_faGUzLlJ9ojLIx&tag=kpembed-20&linkCode=kpd

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FINANCIAL MANAGEMENT STRATEGIES: For Hospitals and Healthcare Organizations

TOOLS, TECHNIQUES, CHECKLISTS AND CASE STUDIES

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Reviews

Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies provides that blueprint.
David B. Nash, MD, MBA, Jefferson Medical College, Thomas Jefferson University

It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizations that physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters.
Neil H. Baum, MD, Tulane Medical School

ORDER: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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Activity Based Medical Cost Accounting and Management

NON-TRADITIONAL ACCOUNTING METHODS KNOWN IN THE BUSINESS COMMUNITY BUT NOT USED IN HOSPITALS OR HEALTH CARE ORGANIZATIONS

By Dr. David Edward Marcinko; MBA CMP® CPHQ

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Sooner or later – as a practicing physician – you will want to ascertain and then demonstrate the cost effectiveness of your medical care. By using the process of Activity Based Cost (ABC) Management, you will be able to do so.  

ALAS: But, if you’re using a traditional accounting system – like most all hospitals today that use the fictional “average wholesale cost” method – you won’t know a thing about your medical practice or clinic activity costs. Hence, again like most all hospitals, fees become simply vacuous.

Managerial Accounting Assignment Help in Australia

Here’s how: https://medicalexecutivepost.com/2007/12/15/activity-based-cost-medical-management/

HOW TO READ A SCIENTIFIC PAPER: https://medicalexecutivepost.com/2021/04/09/how-to-read-and-understand-a-scientific-paper/

DETAILED WHITE PAPERIN-PROGRESS [thru editing but before peer-reviewed publication]: https://healthcarefinancials.files.wordpress.com/2007/12/abcm.pdf

ASSESSMENT: Your thoughts are appreciated.

ORDER TEXTBOOK: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?s=books&ie=UTF8&qid=1287563112&sr=1-9

Product Details
Product Details

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The “BUSINESS” of Transformational Medical Practice Skills

[3rd] THIRD EDITION

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On Excess IRA and Roth IRA Contributions

BY DAN MOISAND CFP®

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See the source image

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READ HERE: https://www.msn.com/en-us/news/other/i-contributed-too-much-to-my-ira-and-roth-ira-%e2%80%94-what-now/ar-AANP1IP?li=BBnb7Kz

MORE: https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-topics-ira-contribution-limits

EDITOR’S NOTE: Colleague Dan Moisand contributed to our textbook on “Comprehensive Financial Planning Strategies for Doctors and Advisors.”

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PODCAST: Physician Relative Value Units?

HOW DOCTORS GET PAID!

By Eric Bricker MD

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PODCAST: Stark and AKS Final Rules

ANTI-KICKBACK STATUTE Overview and Impact

Do you want to learn more about the Stark Law and Anti-Kickback Statute Final Rules and how they impact your practice? Join us for a one-hour webinar, presented with Hancock Daniel.

Health Capital Topics Newsletter

By Health Capital Consultants, LLC

PODCAST: https://www.healthcapital.com/resources/stark-and-aks-final-rules-overview-and-impact

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Bundled Payment Model Success Unaffected by Type of Participation

BY HEALTH CAPITAL CONSULTANTS, LLC

HC Topics Banner Image

Bundled Payment Model Success Unaffected by Type of Participation


Historically, Medicare has offered value-based payment models to healthcare organizations on both a voluntary and a mandatory participation basis. Because voluntary participants could self-select into programs to reduce spending, it was assumed that they achieved greater savings than mandated participants, but until recently, no data had tested this.

However, a June 2021 study in the Journal of the American Medical Association (JAMA) found no difference in risk-adjusted episodic spending between voluntary and mandatory payment model participants. (Read more…) 

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HOSPITAL OPERATIONS: Organizations, Strategies, Techniques, Tools, Templates and Case Models

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PODCAST: Confessions of a Hospital Chief Financial Officer

HOSPITAL FINANCES REVEALED

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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The “Business of Medical Practice”

TRANSFORMATIONAL HEALTH 2.0 SKILLS FOR DOCTORS

Third Edition

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RELATED TEXTS: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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HOSPITALS: Management, Operations and Strategies

Tools, Templates and Case Studies

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COMPREHENSIVE FINANCIAL PLANNING STRATEGIES

For Doctors and Advisors

BOOK REVIEWS WITH FOREWORD

Reviews

Written by doctors and healthcare professionals, this textbook should be mandatory reading for all medical school students―highly recommended for both young and veteran physicians―and an eliminating factor for any financial advisor who has not read it. The book uses jargon like ‘innovative,’ ‘transformational,’ and ‘disruptive’―all rightly so! It is the type of definitive financial lifestyle planning book we often seek, but seldom find.
LeRoy Howard MA CMPTM,Candidate and Financial Advisor, Fayetteville, North Carolina

I taught diagnostic radiology for over a decade. The physician-focused niche information, balanced perspectives, and insider industry transparency in this book may help save your financial life.
Dr. William P. Scherer MS, Barry University, Ft. Lauderdale, Florida

This book was crafted in response to the frustration felt by doctors who dealt with top financial, brokerage, and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized for few, despite ever-changing needs. It is a must-read to learn why brokerage sales pitches or Internet resources will never replace the knowledge and deep advice of a physician-focused financial advisor, medical consultant, or collegial Certified Medical Planner™ financial professional.
―Parin Khotari MBA,Whitman School of Management, Syracuse University, New York

In today’s healthcare environment, in order for providers to survive, they need to understand their current and future market trends, finances, operations, and impact of federal and state regulations. As a healthcare consulting professional for over 30 years supporting both the private and public sector, I recommend that providers understand and utilize the wealth of knowledge that is being conveyed in these chapters. Without this guidance providers will have a hard time navigating the supporting system which may impact their future revenue stream. I strongly endorse the contents of this book.

―Carol S. Miller BSN MBA PMP,President, Miller Consulting Group, ACT IAC Executive Committee Vice-Chair at-Large, HIMSS NCA Board Member

This is an excellent book on financial planning for physicians and health professionals. It is all inclusive yet very easy to read with much valuable information. And, I have been expanding my business knowledge with all of Dr. Marcinko’s prior books. I highly recommend this one, too. It is a fine educational tool for all doctors.

―Dr. David B. Lumsden MD MS MA,Orthopedic Surgeon, Baltimore, Maryland

There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them.
―Dr. Jason Dyken MD MBA,Dyken Wealth Strategies, Gulf Shores, Alabama

I plan to give a copy of this book written
by doctors and for doctors’ to all my prospects, physician, and nurse clients. It may be the definitive text on this important topic.
―Alexander Naruska CPA,Orlando, Florida

Health professionals are small business owners who need to apply their self-discipline tactics in establishing and operating successful practices. Talented trainees are leaving the medical profession because they fail to balance the cost of attendance against a realistic business and financial plan. Principles like budgeting, saving, and living below one’s means, in order to make future investments for future growth, asset protection, and retirement possible are often lacking. This textbook guides the medical professional in his/her financial planning life journey from start to finish. It ranks a place in all medical school libraries and on each of our bookshelves.
―Dr. Thomas M. DeLauro DPM,Professor and Chairman – Division of Medical Sciences, New York College of Podiatric Medicine

Physicians are notoriously excellent at diagnosing and treating medical conditions. However, they are also notoriously deficient in managing the business aspects of their medical practices. Most will earn $20-30 million in their medical lifetime, but few know how to create wealth for themselves and their families. This book will help fill the void in physicians’ financial education. I have two recommendations: 1) every physician, young and old, should read this book; and 2) read it a second time!
―Dr. Neil Baum MD,Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, Louisiana

I worked with a Certified Medical Planner™ on several occasions in the past, and will do so again in the future. This book codified the vast body of knowledge that helped in all facets of my financial life and professional medical practice.
Dr. James E. Williams DABPS, Foot and Ankle Surgeon, Conyers, Georgia

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

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BUSINESS PLAN CONSTRUCTION: For Health Industry Modernity

FOR MEDICAL AND HEALTHCARE ENTREPRENEURS AND INNOVATORS

By Dr. David Edward Marcinko MBA MEd CMP®

I was asked by business schools and medical colleagues – and their bankers, CPAs and advisors – to speak about this topic several times last year before the pandemic.

Now, with the specter of M-4-A etc; it certainly is a vital concern to all young entrepreneurs, doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.

Now, with the specter of tele-health, tele-medicine, M-4-A etc; it certainly is a vital concern to all young doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.

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New Product Business Plan Sample [2021 Updated] | OGScapital

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READ: https://healthcarefinancials.files.wordpress.com/2017/08/mba-business-plan-capstone-outline.pdf

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Financial Management Strategies for Hospitals and Healthcare Organizations

TEXTBOOK RELEASE AND REVIEW

Reviews

Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint.
―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University

It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters.
―Neil H. Baum, MD, Tulane Medical School

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AGI: What it is – How it Works?

ADJUSTED GROSS INCOME

https://healthcarefinancials.files.wordpress.com/2018/06/david-edward-marcinko.png

BY Dr. DAVID EDWARD MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

The U.S. individual tax return is based around the concepts of Adjusted Gross Income (AGI) and Taxable Income (TI).  AGI is the amount that shows up at the bottom of page one of Form 1040, individual income tax return.  It is the sum of all of the taxpayer’s income less certain allowed adjustments (like alimony, one-half of self-employment taxes, a percentage of self-employed health insurance, retirement plan contributions and IRAs, moving expenses, early withdrawal penalties and interest on student loans).  This amount is important because it is used to calculate various limitations within the area of itemized deductions (e.g., medical deductions: 10 percent of AGI; miscellaneous itemized deductions: 2 percent of AGI). 

When a healthcare professional taxpayer hears the phrase “an above the line deduction”, the line being referenced is the AGI line on the tax return.  Generally, it is better for a deduction to be an above the line deduction, because that number helps a taxpayer in two ways.  First, it reduces AGI, and second, since it reduces AGI, it is also reducing the amounts of limitations placed on other deductions as noted above.

Obviously, if there is an above the line there is also a “below the line” deduction.  These below the line deductions are itemized deductions (or the standard deduction if itemizing is not used) plus any personal exemptions allowed. AGI less these deductions provides the taxable income on which income tax is actually calculated. All of that being said, it is better for a deduction to be an above the line deduction. Although this is a bit dry, it helps to understand the concepts in order to know where items provide the most benefit to the medical professional taxpayer.

                            PERSONAL TAXATION CALCULATIONS

Gross Income (all income, from whatever source derived, including illegal activities, cash, indirect for the benefit of, debt forgiveness, barter, dividends, interest, rents, royalties, annuities, trusts, and alimony payments-no more)

    Less non-taxable exclusions (municipal bonds, scholarships, inheritance, insurance

                                            proceeds, social security and unemployment income [full or

                                            partial exclusion], etc.).

Total Income

    Less Deductions for AGI (alimony, IRA contributions, capital gains, 1/2 SE tax,

                                               moving, personal, business and investment expenses, and

                                               penalties, etc.). 

Adjusted Gross Income (bottom Form 1040)

    Less Itemized Deductions from AGI, (medical, charitable giving, casualty,

involuntary conversions, theft, job and miscellaneous expenses, etc.), or

    Less Standard Deduction (based on filing status)

    Less Personal Exemptions (per dependents, subject to phase outs)

Taxable Income

   Calculate Regular Tax

      Plus Additional Taxes (AMT, etc.)

      Minus Credits (child care, foreign tax credit, earned income housing, etc.)

      Plus Other Taxes

Total Tax Due

YOUR THOUGHTS ARE APPRECIATED.

CITE: https://www.r2library.com/Resource/Title/0826102549

Thank You

***

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CASH FLOW ANALYSIS: Real Life ACO Accounting Example

ACCOUNTABLE CARE ORGANIZATION EXAMPLE

Touring with Marcinko | The Leading Business Education ...

BY DR. DAVID EDWARD MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.

Citation: https://www.r2library.com/Resource/Title/0826102549

Case Model

Now, suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.

Cost of Medical Services Provided (COMSP):

The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract.  Since gross margin is 35% of revenues, the COMSP is 65% or $65,000.  Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.

Assumptions

Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:

  • All income tax, salaries and Accounts Payable (AP) are paid at once.
  • Durable medical equipment inventory and pre-paid advertising remain constant.
  • Gains/losses on sale of equipment and depreciation expenses remain stable.
  • Gross margins remain constant.
  • The office is efficient so major new marginal costs will not be incurred.

Physician Reactions:

Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era.  Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:

1. Extend Account’s Payable

Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business

2. Reduce Accounts Receivable

According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.

The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.

3. Borrow with Short-Term Bridge Loans

Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.

4. Cut Expenses

While this is often possible, it has to be done without demoralizing the practice’s staff.

5.  Reduce Supply Inventories

If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.

6. Taxes

Do not stop paying withholding taxes in favor of cash flow because it is illegal.

Hyper-Growth Model:

Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses.  Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows!  Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.

ASSESSMENT: Your comments are appreciated.

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

CONTACT: Ann Miller RN MH

[Executive Director]

THANK YOU

***

Personal BUDGET Rules for Doctors

Personal Physician Budgeting Rules

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Budgeting is probably one of the greatest tools in building wealth. However, it is also one of the greatest weaknesses among physicians who tend to live a certain lifestyle. This includes living in an exclusive neighborhood, driving an expensive car, wearing imported suits and a fine watch, all of which do not lend themselves to expense budgeting. Only one in ten medical professionals has a personal budget. Fear, or a lack of knowledge, is a major cause of procrastination.

The following guidelines will assist in this microeconomic endeavor:

  1. Set reasonable goals and estimate annual income. Do not keep large amounts of cash at     home, or in the office. Deposit it in a money market account for safety and interest.
  1. Do not pay bills early, do not have more taxes withheld from your salary than you owe, and develop spending estimates and budget fixed expenses first. Fixed expenses are usually contractual, and may include housing, utilities, food, telephone, social security, medical, debt repayment, homeowner’ or renter’s insurance, auto, life and disability insurance, and maintenance, etc.
  1. Make variable expenses a priority. Variable expenses are not usually contractual, and may include clothing, education, recreational, travel, vacation, gas, entertainment, gifts, furnishings, savings, investments, etc.
  1. Trim variable expenses by 10-15 percent, and fixed expenses, when possible. Ultimately, all fixed expenses get paid and become variable in the long run.
  1. Use carve-out or set-asides for big ticket items and differentiate “wants from needs.”
  1. Know the difference between saving and investing. Savers tend to be risk adverse and     investors understand risk and takes steps to mitigate it.
  1. Determine shortfalls or excesses with the budget period.
  1. Track actual expenses.
  1. Calculate both income and expenses as a percentage of the total, and determine if there    is a better way to allocate resources. Then, review the budget on a monthly basis to determine if there is a variance. Determine if the variance was avoidable, unavoidable, or a result of inaccurate assumptions, and take needed corrective action.

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How to budget for medical expenses

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Verify Your Budget and Follow a Financial Plan

The process of establishing a budget relies heavily on guesswork, and the use of software or “apps”, that seamlessly track expenditures and help your budget and your financial plan become more of reality. Most doctors underestimate their true expenses, so lumping and best guesses on expense usually prove very inaccurate. Personal financial software and mobile phone applications make the verification of budgets easier. Once your personal accounts are setup, free apps like MINT.com will let give you a detailed report on where your money is going and the adjustments you must make. Few professions make larger contributions to the Internal Revenue Service than physicians and the medical profession. It is very important to categorize different budget categories not only to be proactive about your expenses, but also to accurately reflect the effect your different expenditures have on your real savings capability. All expense dollars are not equal.

For example, a mortgage payment, which is mostly interest expense in the early years, is likewise mostly tax deductible. Spending money on your family vacation is typically not tax deductible. Itemized deductions, which are deductions that a US taxpayer can claim on their tax return in order to reduce their Adjustable Gross Income (AGI), may include such costs as property taxes, vehicle registration fees, income taxes, mortgage expense, investment interest, charitable contributions, medical expenses (to the extent the expenses exceed 10% of the taxpayers AGI) and more.

Employing a qualified certified medical planneR® that utilizes a cash-flow based financial planning software program may help the physician identify their actual after-tax projected cash flow and more accurately plan their future.

ASSESSMENT: Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

SIMPLE: The “50-30-20” Budget Rule of Thumb

Try the 50/30/20 rule OF WANTS, NEEDS AND SAVINGS

By Dr. David Edward Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

There are varying opinions on how much of your total income should go toward savings and retirement goals each month. Moreover, the answer is likely to vary, depending on your full financial profile.

But if you’re looking for some basic KISS guidelines, consider applying the 50-30-20 rule, a budgeting method that allocates 50% of your income to essentials, like rent and bills, 30% to discretionary spending and 20% to savings.

Citation: https://www.r2library.com/Resource/Title/0826102549

Image shows a pie chart broken up into 50%, 30%, and 20%. Title reads: "The 50/30/20 Budgeting Rule." Under 50% says "Needs: groceries, housing, utilities, health insurance, car payment." Under 30% reads: "Wants: shopping dining out, hobbies." Under 20% says "Savings"

Your thoughts are appreciated.

THE RULE: https://www.thebalance.com/the-50-30-20-rule-of-thumb-453922

THANK YOU

ZERO BASED BUDGET: https://medicalexecutivepost.com/2021/05/24/the-zero-based-budget-for-physicians/https://medicalexecutivepost.com/2015/07/02/can-doctors-achieve-financial-independence-without-budgeting/

EPI BUDGET FACTS: https://www.epi.org/resources/budget/budget-factsheets/

NO BUDGETS: https://medicalexecutivepost.com/2015/07/02/can-doctors-achieve-financial-independence-without-budgeting/

HOUSEHOLD BUDGET: https://medicalexecutivepost.com/2013/10/07/on-setting-your-household-budget-ugh/

***

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

ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

***

TAX DEDUCTIONS: Home Ownership Simplified

Take Full Advantage Of These Tax Deductions

DR. DAVID EWARD MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

The housing market is HOT right now. Lumbar and wood is expensive. Inflation is emerging. So, owning a home can be very lucrative. Seriously, owning a home can not only give you a cheaper monthly payment than renting but in many cases, the tax benefits make the decision a no-brainer.

Citation: https://www.r2library.com/Resource/Title/0826102549

Home ownership falls for first time in a century - Telegraph

Here are a few of the larger deductions that you need to be sure to take:

Interest you pay on your mortgage: If you own a home and don’t have a mortgage greater than $750,000, you can deduct the interest you pay on the loan. This is one of the biggest benefits to owning a home versus renting–as you could get massive deductions at tax time. The limit used to be $1 million, but the Tax Cuts and Jobs Act of 2017 (TCJA) reduced the limit and made some clarifications on deducting interest from a home equity line of credit.

Property taxes: Another awesome benefit to owning a home is the ability to deduct your property taxes. Before TCJA, the rules were a little more flexible and you were able to deduct the entirety of your property taxes. Now things have a changed a bit. Under the new law, you can deduct up to $10,000. The deduction for state and local income taxes was combined with the deduction for state and local property taxes, too.

Tax incentives for energy-efficient upgrades: While most of the tax incentives for making energy-efficient upgrades to your home have gone away, there are still a couple worth noting. You can still claim tax deductions on solar energy–both for electric and water heating equipment, through 2021. The longer you wait, though, the less money you’ll get back. Here’s the percentage of equipment you can deduct, based on time of installation:

Between January 1, 2017, and December 31, 2019 – 30% of the expenditures are eligible for the credit
Between January 1, 2020, and December 31, 2020 – 26%
Between January 1, 2021, and December 31, 2021 – 22%

ASSESSMENT: But, is now the best time to buy a home? Your thoughts are appreciated.

Rent V. Buy: https://medicalexecutivepost.com/2017/03/14/the-apartment-rent-vs-home-buy-decision/

MDs: https://medicalexecutivepost.com/2012/02/15/is-home-renting-for-chumps/

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

HOSPITALS and Health Care Organizations

Management Strategies, Operational Techniques, Tools, Templates and Case Studies

Tex Book Review

Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today’s increasingly competitive health care market.

Offering practical experience and applied operating vision, the authors integrate Lean managerial applications, and regulatory perspectives with real-world case studies, models, reports, charts, tables, diagrams, and sample contracts. The result is an integration of post PP-ACA market competition insight with Lean management and operational strategies vital to all health care administrators, comptrollers, and physician executives. The text is divided into three sections:

  1. Managerial Fundamentals
  2. Policy and Procedures
  3. Strategies and Execution

Using an engaging style, the book is filled with authoritative guidance, practical health care–centered discussions, templates, checklists, and clinical examples to provide you with the tools to build a clinically efficient system. Its wide-ranging coverage includes hard-to-find topics such as hospital inventory management, capital formation, and revenue cycle enhancement. Health care leadership, governance, and compliance practices like OSHA, HIPAA, Sarbanes–Oxley, and emerging ACO model policies are included. Health 2.0 information technologies, EMRs, CPOEs, and social media collaboration are also covered, as are 5S, Six Sigma, and other logistical enhancing flow-through principles. The result is a must-have, “how-to” book for all industry participants.

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

What is the “5-100” Insurance Rule?

THE 5 -100 “Policy” Rule 

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

With any universal life insurance policy (and certainly all variable life policies), fluctuating rates of return, the actual timing of the premium payments, and potential internal policy changes by the insurance company, all contribute to results that will probably differ substantially from the original illustration. 

See the source image

RULE: The 5 – 100 Rule states that as a result of accounting for these elements, all initial projections of cash value beyond 5 years, will necessarily be 100 percent incorrect when compared to actuality. 

A prudent policy owner should therefore keep on top of any changes and react accordingly.  If a policy owner ignores his/her policy for even 5 years, any adverse changes could be so drastic as to make rectifying them very costly.

Citation: https://www.r2library.com/Resource/Title/0826102549

Your thoughts are appreciated.

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

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

***

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