PHYSICIANS BEWARE: Traditional Financial Planning “Rules of Thumb”

DOCTORS AND MEDICAL PROFESSIONALS BEWARE?

We ARE Different

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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  • While financial planning rules of thumbs are useful to people as general guidelines, they may be too oversimplified in many situations, leading to underestimating or overestimating an individual’s needs. This may be especially true for physicians and many medical professionals. Rules of thumb do not account for specific circumstances or factors occurring at a particular time, or that could change over time, which should be considered for making sound financial decisions.
  • Great Health Industry Resignation: https://medicalexecutivepost.com/2021/12/12/healthcare-industry-hit-with-the-great-resignation-retirement/

For example, in a tight job market, an emergency fund amounting to six months of household expenses does not consider the possibility of extended unemployment. I’ve always suggested 2-3 years for doctors. Venture capitalist lay-offs of physicians during the pandemic confirm this often criticized benchmark opinion of mine.

As another example, buying life insurance based on a multiple of income does not account for the specific needs of the surviving family, which include a mortgage, the need for college funding and an extended survivor income for a non-working spouse. Again a huge home mortgage, or several children or dependents, may be the financial bane of physician colleagues and life insurance.

CITE: https://www.r2library.com/Resource/Title/082610254

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EXAMPLES: Old/New Rules

  • A home purchase should cost less than an amount equal to two and a half years of your annual income. I think physicians in practice for 3-5 years might go up to 3.5X annual income; ceteras paribus.
  • Save at least 10-15% of your take-home income for retirement. Seek to save 20% or more.
  • Have at least five times your gross salary in life insurance death benefit. Consider 10X this amount in term insurance if young, and/or with several children or other special circumstances.
  • Pay off your highest-interest credit cards first. Agreed.
  • The stock market has a long-term average return of 10%. Agreed, but appreciated risk adjusted rates of return..
  • You should have an emergency fund equal to six months’ worth of household expenses. Doctors should seek 2-3 years.
  • Your age represents the percentage of bonds you should have in your portfolio. Risk tolerance and assets may be more vital.
  • Your age subtracted from 100 represents the percentage of stocks you should have in your portfolio. Risk tolerance and assets may still be more vital.
  • A balanced portfolio is 60% stocks, 40% bonds. With historic low interest rates, cash may be a more flexible alternative than bonds; also avoid most bond mutual funds as they usually never mature.

There are also rules of thumb for determining how much net worth you will need to retire comfortably at a normal retirement age. Here is the calculation that Investopedia uses to determine your net worth:

Compensation in the Physician Specialties: Mostly Stable - NEJM  CareerCenter Resources

RULES 72, 78 and 115: https://medicalexecutivepost.com/2022/01/30/the-rules-of-72-78-and-115/

INVITATION: https://medicalexecutivepost.com/2021/05/08/invite-dr-marcinko-to-your-next-big-event/

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HEALTHCARE: Top A.I. Companies to Watch!

By Bertalan Mesko MD PhD

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TOP ARTIFICIAL INTELLIGENCE COMPANIES IN HEALTHCARE TO KEEP AN EYE ON 

More and more companies set the purpose to disrupt healthcare with the help of artificial intelligence. Given how fast these companies come and go, it can prove to be hard to stay up-to-date with the most promising ones.

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

So, I collected the most prominent names currently on the market ranging from start-ups to tech giants to keep an eye on in the future.

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FAs & CPAs Wanted -BUT- Certified Medical Planners® Needed?

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Career Development, Products and Services for Medical Specificity

“The informed voice of a new generation of fiduciary advisors for healthcare”

SPONSOR: http://www.CertifiedMedicalPlanner.org 

CMP

FINANCIAL ADVISER WANTED: New York’s Belfer family, which gained riches from oil, is racking up quite an investing losing streak. They lost billions in Enron’s collapse and were clients of Bernie Madoff, and now it’s come to light that they were shareholders in FTX.

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CPAs WANTED: Just as tax season kicks off, US firms are facing a national shortage of accountants, forcing them to look overseas for workers to look over your W-2. More than 300k accountants and auditors have quit in the last two years, per the WSJ.

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CMPs NEEDED: The Certified Medical Planner® program was created in response to the frustration felt by doctors in small and mid-sized practices that dealt with top financial, brokerage and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized to few, despite ever changing needs.

Enter the CMPs

Learn why brokerage sales-pitches and/or internet resources will never replace the knowledge and deep advice of a collegial Certified Medical Planner® professional.

Letterhead CMP

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PODCAST: Medicare Advantage Plan Over Payments

A SYNOPSIS

By Eric Bricker

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PODCAST: Government Overpayments to Medicare Advantage Plans are a major problem.

CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.

Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.

The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.

However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.

When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.

Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.

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IRS TAX FILING: Joint or Separate for Married Couples?

INTUIT

By Staff Reporters

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Married couples have the option to file jointly or separately on their federal income tax returns. The IRS strongly encourages most couples to file joint tax returns by extending several tax breaks to those who file together.

In the vast majority of cases, it’s best for married couples to file jointly, but there may be a few instances when it’s better to submit separate returns.

READ HERE: https://turbotax.intuit.com/tax-tips/marriage/should-you-and-your-spouse-file-taxes-jointly-or-separately/L7gyjnqyM?dclid=CKzxz8Pzy_wCFeMBwQods3cDLQ

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PODCAST: Hospital Money Problems 2023

INFLATION AND COMPETITION

By Eric Bricker MD

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The U.S. Debt Ceiling

By Staff Reporters

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As the US just crashed into the $31.4 trillion debt ceiling as the Treasury Department began taking what it called “extraordinary measures” to prevent the government from defaulting on its debts and sparking an economic crisis.

These measures are a series of deep-cut accounting moves that allow the Treasury to continue making its payments. They include:

  • Suspending reinvestments into government funds for retired federal employees, such as the Civil Service Retirement and Disability Fund.
  • Selling existing investments in those funds to free up more outstanding debt.

And while these measures definitely aren’t ordinary…they probably aren’t so “extra,” either. The Treasury has resorted to them more than 12 times since 1985, including during the last debt-ceiling standoff in 2021.

Still, these steps amount to chugging water after eating a ghost pepper—the pain will return. Treasury Secretary Janet Yellen said her extraordinary measures will last through early June, giving lawmakers about five months to work out a deal to raise the debt ceiling.

NOTE: The US has never defaulted on its debt, but even the threat of it could be disastrous. The country’s first credit downgrade in history came during a debt-ceiling showdown in 2011.

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Wither STOCK SPLITS?

By Staff Reporters

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A stock split occurs when a company breaks up its existing shares to create a higher number of lower-value shares. Stock splits have the effect of reducing the trading price of a stock, which makes it more liquid and more affordable for investors.

Companies that engage in stock splits often have a nominally high share price, which is typically achieved by executing and innovating on the operating front. Companies within this list have high potential for a stock split, given their nominally high stock price.

CITE: https://www.r2library.com/Resource/Title/082610254

Last year, well over 200 companies announced and implemented stock splits. However, the type of split that excites investors most is a forward stock split. This is where the share price of a company is reduced and its outstanding share count increases by the same magnitude, Thus, there’s no change in market cap. Companies that enact forward stock splits are usually firing on all cylinders and out-innovating their competition.

Reverse: https://medicalexecutivepost.com/2022/10/08/what-is-a-reverse-stock-split/

As we go boldly forward into a new year, two stock-split stocks stand out as amazing values that can confidently be bought hand over fist. Alphabet and Amazon? Meanwhile, another widely owned stock-split stock looks to be worth avoiding in 2023. Tesla?

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PODCAST: Hospital Financial Cross – Subsidization

By Eric Bricker MD

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Hospital Profit Margin from Employers = 57%

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FEELING WEALTHY: How Much is [Really] Enough?

By Staff Reporters

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What does wealth mean to you?

In a recent survey by Edelman Financial Engines, 57% of respondents said they’d feel wealthy if they had $1 million in the bank. But for many people, that’s not enough.

Among those with $500,000 and $3 million in assets, 53% said it would take over $3 million in the bank for them to feel wealthy, and 33% said it would take over $5 million. Given that these are amounts some people will never even come close to amassing in their lifetimes, it may be hard to wrap your head around these answers.

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METAVERSE: In Banking and the Financial Services Industry

By Staff Reporters

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Practical applications in financial services

Among practical applications provided by the Metaverse, its ability to create virtual environments for people to connect may severely impact the financial industry. The employment of VR and AR during COVID-19 and remote work conditions enabled greater collaboration in teleconferencing where professionals used annotating, chatting and screen-sharing features, allowing them to work efficiently while not in the same physical space.

VR and AR can also be used by financiers in individual capacities, particularly with data visualization, aiding them in analyzing financial risks, providing more precise services to customers. This raises the bar on their expectations, stimulating competition and innovation in the market.

Moreover, virtual environments can be used in consumer-oriented manners. The creation of digital shopping environments in the Metaverse acts as a hub for companies to reach a wider range of consumers without geographical constraints, allowing for greater exposure. Such virtual shopping hubs can employ digital payment means so that transactions take place entirely within the realm of the Metaverse.

Through digital means, financial advisors can provision for greater convenience, signifying a shift in the industry, and broadening the scope of the services clients can be provided with, such as AR being used to simulate different financial scenarios so that customers can visualize them with ease. With the progression of the Metaverse in finance and banking, the next developments could see the creation of fully-digital bank branches, diminishing or perhaps eliminating the need for physical ones. Such client centric developments can either build upon existing consumer experiences or create entirely new ones.

A main attractive feature of using VR or AR is the ability to superimpose a wider range of information digitally, which mobile devices or computer screens would not accommodate. Thereby, complementing existing mobile banking apparatus, such as apps that showcase customers’ account balances or direct them to the nearest bank branches using AR.

CITE: https://www.r2library.com/Resource/Title/082610254

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Why are Banks Entering the Metaverse?

Some people are concerned about whether there is anything for banks to benefit from entering the metaverse. There are a host of new opportunities for banks in the metaverse. So, tet’s look at the most important ones

Firstly, they are working with the idea that being the early adopters by entering the field before others will give them an advantage over latecomers in the future. That is why they are investing in potentially strategic locations in the metaverse.

Secondly, some digital banks imagine that the metaverse has the potential for the banking industry to reinvent transactions for a three-dimensional (3D) world. That is why they are experimenting with it. The primary objective has been to learn new ways of meeting the needs of their customers who are crazy about trending technologies. With metaverse, it could be possible to enable customers to pay bills, check balances, and transfer money using VR or AR channels.

Thirdly, as the younger generations are becoming more attracted to crypto-friendly banksNFT marketplaces, and other blockchain-based platforms, digital banks are looking for unconventional ways to improve their brand image. So, a smart marketing strategy is to create the presence of their brands in the metaverse and win the hearts of their customers through their show of modernity.

Fourthly, the metaverse can offer new ways for banks to engage with their customers. A customer could stay at home and interact with an avatar concerning any business they have with their bank. This technology can be used to deliver personalized financial advice, product recommendations, and even financial planning.

Finally, entering the metaverse is a way for digital banks to pool highly talented employees. It makes them attractive to professionals such as data scientists, developers, and other IT experts who have been working in this developing field and are looking for job opportunities that can bring out the best in them. For example, the metaverse has the potential for use in on-boarding remote workers and training employees on safety and other aspects of their jobs using simulated environments.

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IRS: Tax Changes to Know for 2022

By Staff Reporters

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Here are eight things to keep in mind as you prepare to file your 2022 taxes

1. Income tax brackets shifted somewhat

There are still seven tax rates, but the income ranges (tax brackets) for each rate shifted slightly to account for inflation. For 2022, the following rates and income ranges apply:

Taxable income brackets

Tax rate  Single filers Married couples filing jointly (and qualifying widows or widowers)
10% $0 to $10,275$0 to $20,550
12%$10,276 to $41,775$20,551 to $83,550
22% $41,776 to $89,075$83,551 to $178,150
24%$89,076 to $170,050$178,151 to $340,100
32% $170,051 to $215,950$340,101 to $431,900
35% $215,951 to $539,900$431,901 to $647,850
37% $539,901 or more$647,851 or more

2. The standard deduction increased somewhat

After an inflation adjustment, the 2022 standard deduction increases to $12,950 for single filers and married couples filing separately and to $19,400 for single heads of household, who are generally unmarried with one or more dependents. For married couples filing jointly, the standard deduction rises to $25,900.

3. Itemized deductions remain essentially the same

For most filers, taking the higher standard deduction is more practical and saves the hassle of keeping track of receipts. But if you have enough tax-deductible expenses, you might benefit from itemizing.

  • State and local taxes: The deduction for state and local income taxes, property taxes, and real estate taxes is capped at $10,000.
  • Mortgage interest deduction: The mortgage interest deduction is limited to $750,000 of indebtedness. But people who had $1,000,000 of home mortgage debt before December 16, 2017 will still be able to deduct the interest on that loan.
  • Medical expenses: Only medical expenses that exceed 7.5% of adjusted gross income (AGI) can be deducted in 2022.
  • Charitable donations: The deductions for charitable donations are not as generous as they were in 2021. In 2022, the annual income tax deduction limits for gifts to public charities1 are 30% of AGI for contributions of non-cash assets—if held for more than one year—and 60% of AGI for contributions of cash.
  • Miscellaneous deductions: No miscellaneous itemized deductions are allowed.

4. IRA contribution limits remain the same and 401(k) limits are slightly higher

The traditional IRA and Roth contribution limits in 2022 remain the same as the prior year. Individuals can contribute up to $6,000 to an IRA, and those age 50 and older also qualify to make an additional $1,000 catch-up contribution. If you’re able to max out your IRA, consider doing so—you may qualify to deduct some or all of your contribution.

However, the 2022 contribution limits for 401(k) accounts have increased to $20,500. If you’re age 50 or older, you qualify to make an additional $6,500 catch-up contribution for this tax year as well.

5. You can save a bit more in your health savings account (HSA)

For 2022, the maximum you can contribute to an HSA is $3,650 for an individual (up $50 from 2021) and $7,300 for a family (up $100). People age 55 and older can contribute an extra $1,000 catch-up contribution.

To be eligible for an HSA, you must be enrolled in a high-deductible health plan (which usually has lower premiums as well). Learn more about the benefits of an HSA.

6. The Child Tax Credit is lower after a one-year bump

Tax credits, which reduce the tax you owe dollar for dollar, are normally better than deductions, which reduce how much of your income is subject to tax.

In 2021, the American Rescue Plan Act (ARPA) temporarily enlarged the Child Tax Credit. But in 2022, the credit returns to $2,000 per child age sixteen or younger. The credit is also subject to a phase-out starting at $400,000 for joint filers and $200,000 for single filers. For other qualified dependents, you can claim a $500 credit.

7. The alternative minimum tax (AMT) exemption is higher

Until the AMT exemption enacted by the Tax Cuts and Jobs Act expires in 2025, the AMT will continue to affect mostly households with incomes over $500,000. For 2022, the AMT exemptions are $75,900 for single filers and $118,100 for married taxpayers filing jointly. The phase-out thresholds are $1,079,800 for married taxpayers filing a joint return and $539,900 for all other taxpayers. (Once your income for the AMT hits the phase-out threshold, your AMT exemption begins to phase out at 25 cents for every dollar over the threshold.)

8. The estate tax exemption is even higher

The estate and gift tax exemption, which is indexed to inflation, rises to $12.06 million for 2022. But the now-higher exemption is set to expire at the end of 2025, meaning it could be essentially cut in half at that time if Congress doesn’t act.

The annual gift exclusion, which allows you to give money to your loved ones each year without incurring any tax liability or using up any of your lifetime estate and gift tax exemption, increases to $16,000 per recipient (up $1,000 from 2021).

Don’t get caught

Finally, if you’re age 72 or older, make sure you’ve taken your required minimum distribution (RMD) from your retirement accounts before the end of the year or else you face a 50% penalty on any undistributed funds (unless it’s your first RMD, in which case you can wait until April 1, 2023).

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Front Matter with Foreword by Jason Dyken MD MBA

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IRS: Lifetime Estate and Gift Tax Exemptions

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Remember, in 2023, do not trigger the US estate and gift tax. Last year’s inflation, the highest in decades, means married couples can now hand their heirs almost $26 million tax-free, $1.7 million more than in 2022 and $2.4 million more than in 2021.

The hike in the lifetime estate-and-gift tax exemption — adjusted for price growth annually by the Internal Revenue Service — is the largest since 2018, when the amount was doubled by Republican-passed legislation signed by former President Donald Trump the prior year. As a result, the individual exemption, which is easily shared between spouses, has rocketed to $12.9 million from $5 million in 2011.

But, richer Americans may be running out of time to pass on this much wealth. The exemption is slated to be cut in half in three years, when provisions of Trump’s tax law are set to expire. While even $26 million is a drop in the bucket for the ultra-rich, the exemption’s size shows why generational wealth transfers — estimated by research firm Cerulli to total almost $73 trillion in the US through 2045 — go largely untouched by the government.

Plus, financial advisors may use loopholes and leverage to multiply the amount of tax-free money available to heirs. 

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SHORT: Tesla Stock?

SHORT SALE

By Staff Reporters

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DEFINITION: Short selling involves borrowing a security whose price you think is going to fall from your brokerage and selling it on the open market. Your plan is to then buy the same stock back later, hopefully for a lower price than you initially sold it for, and pocket the difference after repaying the initial loan.

CITE: https://www.r2library.com/Resource/Title/082610254

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Good news for anyone who was busy shorting Tesla

Tesla’s stock plummeted more than 12% yesterday for its worst trading session in more than two years. The proximate cause: Though the EV manufacturer sent out a record 405,278 vehicles in the last quarter of 2022, it missed analyst expectations and its own growth goal for the year.

Tesla’s brutal selloff was the continuation of a dramatic downward trend: The most valuable automaker in the world lost 65% of its value in 2022.

And while it may be easy to pin the blame on CEO Elon Musk’s fascination with his shiny new toy, Twitter, the problems go beyond a distracted boss:

  • Production has slowed down due to Covid shutdowns in China.
  • Demand has cooled for its vehicles due to lower gas prices, interest rate hikes, and increased competition.
  • It has suffered from logistical issues that were at least partially to blame for its inability to deliver all of the vehicles that it produced.

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PODCAST: “All OR Nothing” Hospital Contracts

By Eric Bricker MD

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FINANCIAL RESOLUTIONS: For the New Year 2023

By Staff Reporters

Are you the kind of ME-P reader who makes resolutions on New Year’s Day? If so, here are five steps we encourage all investors to consider taking to boost your financial fitness at any time of the year; according to Charles Schwab & Company. So, why not resolve to take them right now? 

CITE: https://www.r2library.com/Resource/Title/082610254

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Resolution 1: Create a budget

Committing to a saving and investing program during your working years is generally the best way to boost your net worth and achieve many of life’s most important goals. Of course, first you’ll need to know how much money you’ve got to work with. That’s where a budget and net worth statement can help. Here’s how to think about them.

  • Budget and save. At a minimum, be sure to have a high-level budget with three things: how much you’re taking in after taxes, how much you’re spending, and how much you’re saving. If you’re not sure where your money is going, track your spending using a spreadsheet or an online budgeting tool for 30 days. Determine how much money you need to cover your fixed monthly expenses, such as your rent or mortgage and other living expenses, and how much you’d like to put away for other goals. For retirement, our rule of thumb is to save 10%–15% of pre-tax income, including any match from an employer, starting in your 20s. If you delay, the amount you may need to save goes up. Add 10% for every decade you delay saving for retirement. Once you commit to an amount, consider ways you can save automatically, such as through monthly direct deposits. 
  • Calculate your personal net worth annually. It doesn’t have to be complicated. Make a list of your assets (what you own) and subtract your liabilities (what you owe). Subtract the liabilities from the assets to determine your net worth. Don’t panic if your net worth declines when the market is struggling. What’s important is to see a general upward trend over your earning years. If you’re retired, you’ll want to plan an income and distribution strategy to help make your savings last as long as necessary and support other objectives.
  • Project the cost of essential big-ticket items. If you have a big expense in the near term, like college tuition or roof repair, put the money aside or increase your savings and treat that money as spent. If you know that you’ll need the money within a few years, keep it in relatively liquid, safe investments like short-term certificates of deposit (CDs), a savings account, or money market funds purchased within a brokerage account. If you choose to invest in a CD, make sure the term ends by the time you need the cash. If you have more than a few years, invest wisely, based on your time horizon.
  • Prepare for emergencies. If you aren’t retired, we suggest creating an emergency fund with three to six months’ worth of essential living expenses, set aside in a savings account. The emergency fund can help you cover unexpected but necessary expenses without having to sell more volatile investments.
  • Retired? Invest your living-expense money conservatively. Consider keeping 12 months of living expenses—after accounting for non-portfolio income sources like Social Security or a pension—in short-term CDs, an interest-bearing savings account, or a money market fund. Then consider keeping another two to four years’ worth of spending laddered in short-term bonds or invested in short-term bond funds as part of your portfolio’s fixed income allocation. You can use this money to cover expenses in the near term. Having a chunk of savings invested conservatively should allow you to invest a portion of your remaining savings for growth, at a level of risk appropriate for you, while reducing the chances you’ll be forced to sell more volatile investments (like stocks) in a down market.

Resolution 2: Manage your debt

Debt is neither inherently good nor bad—it’s simply a tool. It all depends on how you use it. For most people, some level of debt is a practical necessity, especially to purchase an expensive long-term asset to pay back over time, such as a home. However, problems arise when debt becomes more of a burden than a tool. Here’s how to stay in control.

  • Keep your total debt load manageable. Don’t confuse what you can borrow with what you should borrow. Keep the monthly costs of owning a home (principal, interest, taxes, and insurance) below 28% of your pre-tax income, and your total monthly debt payments (including credit cards, auto loans, and mortgage payments) below 36% of your pre-tax income.
  • Eliminate high-cost, non-deductible consumer debt. Try to pay off credit-card debt and avoid borrowing to buy depreciating assets, such as cars. The cost of consumer debt adds up quickly if you carry a balance. Consider consolidating your debt in a low-rate home equity loan or line of credit (HELOC), set a realistic budget, and implement a schedule to pay it back.
  • Match repayment terms to your time horizons. If you’re likely to move within five to seven years, you could consider a shorter-maturity loan or an adjustable-rate mortgage (ARM), depending on current mortgage rates and options. Don’t consider this if you think you may live in your home for longer or struggle to manage mortgage payment resets if interest rates or your plans change. We also don’t suggest that you borrow money under the assumption that your home will automatically increase in value. Historically, long-term home appreciation has significantly lagged the total return of a diversified stock portfolio. And, for any type of debt, have a disciplined payback schedule. Create a plan to pay off the mortgage on your primary home before you plan to retire.

Resolution 3: Optimize your portfolio

We all share the goal of getting better investment results. But research shows that it’s extremely difficult to always invest at the “perfect” time. So, create a plan that will help you stay disciplined in all kinds of markets. Follow your plan and adjust it as needed. Here are ideas to help you stay focused on your goals.

  • Focus on your overall investment mix. After committing to a savings plan, how you invest is your next most important decision. Have a targeted asset allocation—that is, strategically proportioned mix of stocks, bonds, and cash in your portfolio—that you’re comfortable with, even in a down market. Make sure it fits your long-term goals, risk tolerance, and time frame. The longer your time horizon, the more time you’ll have to potentially benefit from up or down markets.
  • Diversify across and within asset classes. Diversification can help reduce risk and can be a critical factor in helping you reach your goals. Mutual funds and exchange-traded funds (ETFs) are great ways to own a diversified basket of securities in just about any asset class.
  • Consider taxes.Place relatively tax-efficient investments, like ETFs and municipal bonds, in taxable accounts, and relatively tax-inefficient investments, like mutual funds and real estate investment trusts (REITs), in tax-advantaged accounts. Tax-advantaged accounts include retirement accounts, such as a traditional or Roth individual retirement account (IRA). If you trade frequently, do so in tax-advantaged accounts to help reduce your tax bill.
  • Monitor and rebalance your portfolio as needed. Evaluate your portfolio’s performance at least twice a year using a benchmark that makes sense for you. Remember, the long-term progress that you make toward your goals is more important than short-term portfolio performance. As you approach a savings goal, such as the beginning of a child’s education or retirement, begin to reduce investment risk, if appropriate, so you don’t have to sell more volatile investments, such as stocks, when you need them. 
  • Choose appropriate benchmarks. Lastly, your benchmark to measure investment performance should match your portfolio and your goals. Don’t be tempted to compare your portfolio to what performed best in the market last year or even a portfolio invested 100% in stocks. You should have a portfolio selected to best meet your goals, with an appropriate balance of potential return and risk as well. Progress toward your goals is more important than picking the top-performing stocks each year—which, for any investor, isn’t possible to predict.

Resolution 4: Prepare for the unexpected

Risk is a part of life, particularly in investments and finance. Your financial life can be upended by all kinds of surprises—an illness, job loss, disability, death, natural disasters, or lawsuits. If you don’t have enough assets to self-insure against major risks, make a resolution to get your insurance needs covered. Insurance helps protect against unforeseen events that don’t happen often but are expensive to manage yourself when they do. The following guidelines can help you prepare for life’s unexpected moments.

  • Protect against large medical expenses with health insurance. Select a health insurance policy that matches your needs in areas such as coverage, deductibles, co-payments, and choice of medical providers. If you’re in good health and don’t visit the doctor often, consider a high-deductible policy to insure against the possibility of a serious illness or unexpected health-care event.
  • Purchase life insurance if you have dependents or other obligations. First, take advantage of a group term insurance policy, if offered by your employer. Such programs don’t generally require a medical check and can be a cost-effective way to provide income replacement for dependents. If you have minor children or large liabilities that will continue after your death for which you can’t self-insure, you may need additional life insurance. Unless you have a permanent life insurance need or special circumstances, consider starting with a low-cost term life policy before a whole life policy.
  • Protect your earning power with long-term disability insurance. The odds of becoming disabled are greater than the odds of dying young. According to the Social Security Administration, a 20-year-old American has a 25% chance of becoming disabled before normal retirement age and a 13% chance of dying before retirement age.1 If you can’t get adequate short- and long-term coverage through work, consider an individual policy.
  • Protect your physical assets with property-casualty insurance. Check your homeowner’s or renter’s and auto insurance policies to make sure your coverage and deductibles are still right for you.
  • Obtain additional liability coverage, if needed. A personal liability “umbrella” policy is a cost-effective way to increase your liability coverage by $1 million or more, in case you’re at fault in an accident or someone is injured on your property. Umbrella policies don’t cover business-related liabilities, so make sure your business is also properly insured, especially if you’re in a profession with unique risks and aren’t covered by an employer.
  • Consider the pros and cons of long-term-care insurance. If you consider a long-term-care policy, look for a policy that provides the right type of care and is guaranteed renewable with locked-in premium rates. Long-term care typically is most cost-effective starting at about age 50 and generally becomes more expensive or difficult to find after age 70. You can get independent sources of information from your state insurance commissioner. A sound retirement savings strategy is another way to plan for long-term-care costs.
  • Create a disaster plan for your safety and peace of mind. Review your homeowner’s or renter’s policy to see what’s covered and what’s not. Talk to your agent about flood or earthquake insurance if either is a concern for your area. Generally, neither is included in most homeowner’s policies. Keep an updated video inventory of valuable household items and possessions along with any professional appraisals and estimates of replacement values in a safe place away from your home.

Consider storing inventories and important documents on a portable hard drive. It’s also a good idea to have copies of birth certificates, passports, wills, trust documents, records of home improvements, and insurance policies in a small, secure evacuation box (the fireproof, waterproof kind you can lock is best) that you can grab in a hurry in case you have to evacuate immediately. Make sure your trusted loved ones know about this file as well, in case they need it.

Resolution 5: Protect your estate

An estate plan may seem like something only for the wealthy. But there are simple steps everyone should take. Without proper beneficiary designations, a will, and other basic steps, the fate of your assets or minor children may be decided by attorneys and tax agencies. Taxes and attorneys’ fees can eat away at these assets and delay the distribution of assets just when your heirs need them most. Here’s how to protect your estate—and your loved ones.

  • Review your beneficiaries, especially for retirement accounts, annuities, and life insurance.The beneficiary designation is your first line of defense, to make your wishes for assets known, and ensure that they transfer to who you want quickly. Keep information on beneficiaries up-to-date to ensure the proceeds of life insurance policies and retirement accounts are consistent with your wishes, your will, and other documents.
  • Update or prepare your will. A will isn’t just about transferring assets. It can provide for your dependents’ support and care and help you avoid the costs and delays associated with dying without one. It can also spell out plans to repay debts, such as a credit card or mortgage. Keep in mind that a beneficiary designation or asset titling trumps what’s written in a will, so make sure all documents are consistent and reflect your desires. When writing a will, we recommend working with an experienced lawyer or estate planning attorney.
  • Coordinate asset titling with the rest of your estate plan. The titling of your property and non-retirement accounts can affect the ultimate disposition and taxation of your assets. Talk with an estate attorney or lawyer about debts and the titling of assets, such as a home, that don’t have a beneficiary designation, to make sure they reflect your wishes and are consistent with titling laws that can vary by state.
  • Have in place durable powers of attorney for health care. In these documents, appoint trusted and competent confidants to make decisions on your behalf if you become incapacitated.
  • Consider a revocable living trust. This is especially important if your estate is large and complex, and you want to spell out how your assets should be used in detail, or if you have dependent children and want to spell in detail how assets should be managed to support them, who will manage the assets, and other issues. A living trust may not be needed for smaller estates where beneficiaries, titling, and a will can be sufficient, but talk with a qualified financial planner or attorney to be sure.
  • Take care of important estate documents. Make sure a trusted and competent family member or close friend knows the location of your important estate documents.

Finally, remember you don’t have to do everything at once. There’s a lot you can do to improve your financial health by taking one step at a time and think of these resolutions as a checklist. This ME-P and our books and posts can help. Make some real progress on your journey this year. 

1Johanna Maleh and Tiffany Bosley. “Disability and Death Probability Tables for Insured Workers Who Attain Age 20 in 2022.” Social Security Administration, December 2022.

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CENTENE CORPORATION: Medicaid Over-Billing?

By Staff Reporters

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Centene Corporation showers politicians with millions as it courts contracts and settles over-billing allegations by Samantha Young, Andy Miller, and Rebecca Grapevine (Kaiser Health News)

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Somehow KHN made Medicaid over-billing sound sexy.

This deep dive into Centene, “the nation’s largest private managed-care provider for Medicaid,” shows how the company has maintained good relationships with politicians as it looked to keep its market share and settle over-billing allegations.

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: https://medicalexecutivepost.com/2021/11/12/podcast-centene-giant-medicaid-hmo/

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IRS: Best States for Minimizing Taxes in Retirement

By SMART ASSET

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If shrinking your tax liability is high on your list of priorities, a few states stand out. The winners in the list below either have no state income tax, no tax on retirement income, or a substantial discount on the taxes levied on retirement income. But that’s just the start.

CITE: https://www.r2library.com/Resource/Title/082610254

While several additional states have no state income tax, the states that made our list also have favorable sales, property, inheritance, and estate taxes.

  • Alaska
  • Florida
  • Georgia
  • Mississippi
  • Nevada
  • South Dakota
  • Wyoming

If those seven locations aren’t ideal, consider the next tier of tax-friendly states. Tax benefits aren’t quite as high as those above, but they do stand out in one specific category: no taxes on social security income.

That’s not to say they don’t make up for it in other areas, however. Washington State, for example, has no state income tax, but does have a 6.5% state sales tax. Still, it’s always beneficial to avoid income tax when possible.

  • Alabama
  • Arkansas
  • Colorado
  • Delaware
  • Idaho
  • Illinois
  • Kentucky
  • Louisiana
  • Michigan
  • New Hampshire
  • Oklahoma
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Texas
  • Virginia
  • Washington
  • West Virginia

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MEDICARE: Physician Payments Cuts?

By Health Capital Consultants, LLC

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Congress Overrides Some – But Not All – Medicare Physician Payment Cuts

On December 20, 2022, the U.S. Congress announced its deal to fund the federal government through 2023, averting an imminent government shutdown. The 4,155-page, $1.7 trillion spending bill spans a vast array of funding initiatives and other bipartisan measures, including a number of noteworthy healthcare provisions.

CITE: https://www.r2library.com/Resource/Title/082610254

Perhaps most significantly, Congress intervened in the impending cuts to the Medicare Physician Fee Schedule (MPFS), overriding some, but not all, of the payment reductions. This Health Capital Topics article will discuss the congressional measures to ameliorate the payment cuts to physicians in 2023, as well as the other healthcare provisions included in the omnibus spending bill. (Read more…)

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DAILY UPDATE: Christmas Tax Loss Harvesting and Lost Shareholder Wealth in 2022

By Staff Reporters

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Investors pulled a record $41.9 billion from equities last week to engage in tax-loss harvesting according to Bank of America. 

MORE: https://medicalexecutivepost.com/2022/11/25/more-tax-loss-harvesting/

Tax-loss harvesting is a strategy to lower investment taxes that involves selling securities at a loss to offset capital gains. BofA said investors in the past week also pulled out $10 billion from bonds.

CITE: https://www.r2library.com/Resource/Title/082610254

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Amazon.com Inc. has erased more shareholder wealth than any other publicly traded company in 2022. In total, investors in Amazon have lost $804.6 billion this year. The stock is down 48% in 2022.

Apple Inc. and Microsoft Corp. have also suffered larger market-cap declines than Tesla, by virtue of their sheer size.

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FTX SCANDAL: Who is John J. Ray III?

By Staff Reporters

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FTX’s New Chief Executive Officer?

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John J. Ray III (born January 1959) is an American attorney and insolvency professional. He specializes in recovering funds from failed corporations. He was appointed CEO of cryptocurrency exchange FTX in the aftermath of its November 2022 collapse.

MORE: https://financialservices.house.gov/uploadedfiles/hhrg-117-ba00-wstate-rayj-20221213.pdf

He previously served as chairman of Enron Creditors Recovery Corp., a company tasked with recovering creditor funds from Enron in the wake of its accounting scandal and subsequent collapse. He also worked on the bankruptcies of Nortel, Residential Capital, and Overseas Shipholding.

CITE: https://www.r2library.com/Resource/Title/082610254

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DAILY UPDATE: Markets Down Amid FOMC’s Monetary Policy

By Staff Reporters

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U.S. equities did an about-face and finished lower following the monetary policy decision from the Fed. The Central Bank increased the target for its benchmark interest rate by 50 basis points (bps), which was widely expected and a moderation from the 75-bp hikes over the past four meetings. However, in his presser Chairman Powell reiterated that the Committee still had a ways to go to reach its goals.

Treasury yields finished little changed in choppy trading after the Fed’s announcement, and the U.S. dollar was lower, while crude oil prices gained ground and gold traded to the downside.

Equity news was on the lighter side, as Delta Air Lines increased its Q4 earnings outlook and offered upbeat long-term guidance, while Lennox International issued a 2023 forecast that missed estimates.

On the economic front, mortgage applications snapped a two-week losing streak, and import prices moderated more than expected.

Asia finished mostly higher following yesterday’s favorable U.S. inflation report, while markets in Europe diverged as investors awaited today’s Fed decision, which will be followed by tomorrow’s announcements from the European Central Bank and Bank of England.

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Financial Deception in Healthcare

THIRTY EXAMPLES

By Eric Bricker MD

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

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PODCAST: Medical Utilization Management [UM]

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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RBP: The Rise of Reference Based Pricing & The Future of Health Care 

By Bill Rusteberg

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The New Payer You Never Heard Of 

For 35 years we have lived in the world of managed care. Consumers have been conditioned to believe networks of “preferred” providers ensure better access, better benefits, lower cost and convenient claim settlement.  

In the beginning managed care worked. Not all hospitals and physician groups were in networks and competition helped create cost savings for consumers and their employers. But over time consumers demanded more access and eventually almost all providers were “preferred” and in-network. Today less than 5% of all claims are out-of-network yet medical costs have increased. While professional providers are typically paid using managed care fee schedules, hospitals and other facilities are usually paid a percentage of whatever they charge, and over time, those charges have continued to increase.  

As a result, we are seeing the rise of Reference Based Pricing (RBP) claim reimbursement strategies. RBP strategies are gaining popularity with self-funded employer plans particularly as a way to bring more transparency and accountability to health care pricing. 

The new payer you never heard of are local employers breaking away from the status quo.  You will not see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?” 

What is Reference Based Pricing? 

RBP sets uniform provider payments relative to a benchmark. The most commonly used benchmark is the Medicare Fee Schedule, a widely known payment methodology. Because Medicare fee schedules are on the low end of provider reimbursement, RBP health plans typically add a margin to ensure fair and equitable payment and profits for medical care givers.  Margins can range from 120% to 150% of Medicare and more.  

PPO networks, on the other hand, set opaque pricing at an arbitrary number to which an arbitrary discount is applied. Instead of this top down approach, RBP health plans utilize a bottom up approach.  

In addition, employers are not privy to negotiated PPO rates while reimbursement allowances are transparent and clearly disclosed in RBP plans. This is one of several important distinctions between managed care pricing strategies and RBP.  

An extension of RBP may include detailed claim audit protocols to facility claims prior to claim settlement. These audits typically produce savings of 5 – 7%. Managed care contracts, on the other hand, typically prohibit or severely limit an employer’s right to audit claims, another important difference.  

The Growth of Reference Based Pricing 

While many readers may view this as something new, it’s simply another form of the indemnity plans that were common prior to the advent of managed care in the early 80’s.  

The first RBP health plan in Texas was established in 2008 in San Antonio. Since then the concept has gained national momentum and is growing most rapidly among mid-size self-funded employers. However, we are beginning to see larger employers such as the state of Montana adopting this strategy for their employee benefit program. The Oklahoma State Medical Association adopted RBP strategies for their member health plans several years ago and has since expanded their program offering to Texas medical providers. 

Medical Community Reaction 

Since inception of Reference Based Pricing plans (RBP) in San Antonio fifteen years ago, professional providers have generally accepted patients insured through these plans.  Professional providers, particularly primary care physicians, may earn more under this payment methodology than earned under many managed care contracts. In addition, RBP plans do not intrude on the physician-patient relationship as there are no contractual terms and conditions providers are bound to accept.  

Hospitals have generally remained opposed to RBP plans, yet few patients are turned away for care because reimbursement levels are fair and reasonable. In those rare instances a patient is turned away RBP plans often arrange a bundled cash payment at mutually agreed reimbursement levels that are often less than what the plan would have otherwise paid.    

Action Plan for Physicians and Their Administrators 

With the explosive grown of RBP plans, physicians and their administrators should establish an action plan for RBP patients or potential patients seeking their services. What transpires at the point of contact with a patient can be critical. A knowledgeable staff insures adequate controls in determining patient financial responsibility. Turning away patients is not always a good business practice and is unnecessary in cases where RBP payment parameters are within a practice’s normal scope of acceptance.  

Always check for network logos on the members’ I.D. card. When calling an unfamiliar health plan or TPA to verify eligibility and benefits, ask what provider network(s) the plan uses for physicians and hospitals.  

If the customer service representative says that there is no hospital or professional network or that the plan is “open access”, ask whether the plan pays hospitals and/or physicians based on a standard reference price or a fixed % of Medicare.  

Staff administration should pre-determine the minimum level of acceptable payment based on a % of Medicare. This will empower intake clerks, at the point of contact, to determine if a plan’s reimbursement level is adequate and approved by administration. This will also assist intake clerks in determining each patient’s responsibility. Some RBP plans clearly indicate the basis of claim payment on member’s I.D. cards, i.e., “Plan Pays XXX% of Medicare.” 

If procedures are regularly performed in a facility setting and there is a choice of hospitals or ambulatory surgery centers, staff should ask whether the plan has any direct contracts or has a good working relationship with any of the local facilities. Most RBP plans have established direct agreements with certain local providers or are interested in doing so.  

It takes very little effort to certify a patient’s financial ability to pay for services. Verification is a phone call away. Intake clerks should be trained to ask the right questions, applying the answers against pre-determined parameters of acceptance rather than reliance upon a list of “approved insurance plans.” Turning patients away at the front desk when their insurance coverage pays as much as or more than “approved” plans is poor business.  

Partnering With Employer Health Plans 

A professional provider would be wise to reach out directly to local employers adopting RBP plans to arrange direct agreements, especially when it is discovered an employer important to the practice has adopted RBP. A direct agreement with an employer sponsored health plan would eliminate balance billing and provide steerage. Typically direct RBP agreements are no more than one page in length and contain a 30 day out clause. There are no third party intermediaries involved. 

Some RBP plans allow professionals to name their price. A sharing arrangement between the health plan and plan member assures full payment based on a mutually agreed pricing benchmark. For example, a plan may set its claim exposure at 120% of Medicare. A professional provider may agree to accept 150% of Medicare. The 30% differential would be borne by the plan member in the form of a pre-set co-pay amount. There would be no co-pay through providers who have agreed to accept the plans benchmark pricing, in this example 120% of Medicare. A tiered co-pay strategy solves provider access issues, benefiting providers, patients and employer health plan budgetary constraints.  

The Future of Reference Based Pricing 

RBP strategies are a transitory phenomenon, a bridge serving as a basis for more change to come in a dynamic market.  

RBP health plans will continue to gain market share in the next several years as more independent third party administrators (TPAs) and insurance companies are offering RBP options with new entrants into the market almost monthly. 

Professional providers should understand that RBP is yet another way to pay health care claims and would be wise to acclimate to this kind of pricing. As the Medicare eligible population of the United States increases from 17% in 2015 to 23% in 2023, professional providers will see more patients at Medicare rates than ever before. The good news for professional providers is RBP plans generally pay more. 

There is good news for employers too. RBP plans give self-funded employers a powerful cost containment tool that can make health care more affordable for their employees.  

You can expect to see a growing number of patients insured through RBP plans seeking your services. It would be good business to understand this growing trend now in order to accommodate them. RBP will create opportunities for physician-led bundles and other direct contracting strategies that benefit local employers, giving you more control and save money for your patients.  

The Future 

Reference Based Pricing is a transitory phenomenon leading to something better for all stakeholders. We are seeing a new trend rising in health care financing that removes third party barriers between patients and their physicians. 

Removing third party intermediaries between providers and the patients they serve is the foundation on which to provide better benefits at a lower cost for health care consumers. Cash pay settlements at the point of service, in real time, will be a major component of that, getting back to the way care and doctor-patient relationships once were, without the intervention of an insurance company. 

Plan members will pay cash at the time of service through plan sponsored funding. Physicians will receive cash payment by way of pre-negotiated electronic super bill at the time of service. No claims filing and no chasing patient share required, saving providers both time and expense. Hospitals will be paid in full on day of service too, saving time and expense filing claims and chasing patient share. 

Community based health plans will adopt a cash pay network of medical caregivers. Access and delivery of care on a local, collaborative basis by mutually controlling costs in a direct relationship with one another as opposed to the indirect relationships we find in our current carrier-driven dynamic will be key to providing community members with responsive and affordable access to care.  

Community health plans will adopt Direct Primary Care as a key focal point for all subsequent care. Capitated rates will replace fee-for-service fee schedules. Primary care physicians will, for the first time in their careers, devote 100% of their working hours to treating patients, not burdened with EMR’s and other administrative functions at the beck and call of third party intermediaries.  

One example of a Community Health Plan is currently under development in central Texas. It will incorporate ER, Lab & Radiology, and direct primary care at a capitated rate of less than $125. A cash based reimbursement wrap for all other covered services through a cash pay provider network will cover remaining covered medical services.  

The reader may find this to be a pipe dream that will never happen. On the contrary, it’s happening now and it’s growing faster than a melting raspa on a scorching August afternoon in deep South Texas. It’s the new payer you’ve never heard of. 

CITE: https://www.r2library.com/Resource/Title/082610254

MORE: https://medicalexecutivepost.com/2022/09/26/podcast-reference-based-pricing-for-medical-facility-fees/

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What is Financial CARRIED INTEREST?

A TAX LOOPHOLE?

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

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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RMDs: Are You of IRS Taxation Age?

Stop 2020 – Restart 2021

By Staff Reporters

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CITE: https://www.r2library.com/Resource/Title/082610254

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Are You of RMD Age?
A Required Minimum Distribution (RMD) is an amount of money the IRS requires you to withdraw from most retirement accounts, beginning at age 72.
Due to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, RMDs were not required in 2020, but RMDs are required in 2021 and each year after. RMDs can be an important part of your retirement income strategy.

IRS: https://www.irs.gov/retirement-plans/retirement-plans-faqs-regarding-required-minimum-distributions

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PODCAST: Hospital Debt and Tax Exempt Bonds

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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IRS: Taxes, NFTs and Crypto-Currency

By Staff Reporters

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You have to report your crypto and NFT transactions to the IRS

While not technically new, for 2022 the IRS is making a more concerted effort to track cryptocurrency sales and trades. Whenever you sell or trade your crypto or purchase an item with crypto, you trigger a taxable event. Currently, crypto is taxed like property, making it subject to short- or long-term capital gains taxes. This also means you can report any crypto losses to help offset any gains. Since 2022 saw a drastic drop in the value of cryptocurrencies like bitcoin and ethereum, if you sold or traded your crypto at a loss, you may be able to reduce your tax bill by reporting your capital loss. The same goes for NFTs. 

And though the IRS will flag any unreported crypto gains, if you don’t report a loss that can lower your tax burden, the IRS won’t adjust your return on your behalf. “If you leave it off, it stays off,” said Steber. “Tax deductible losses from your virtual currency activity do have real consequences on your tax return, and can save you real dollars. So I always tell people, if you’ve got something that you don’t fully understand, you certainly should seek out guidance from a trained experienced tax professional.”

CITE: https://www.r2library.com/Resource/Title/082610254

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What is the “5-100” Insurance Rule?

THE 5 -100 “Policy” Rule 

BY DR. DAVID E. MARCINKO MBA CMP®

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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. 

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™

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STUDENT LOANS and State Taxes

By Staff Reporters

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If your student loans were forgiven, you may still owe state taxes

Though widespread federal student loan relief remains on hold, you may have received student loan forgiveness through the Public Service Loan Forgiveness program or another similar endeavor. if you had any balances forgiven in 2022, you won’t owe federal taxes on the canceled amount. That’s because of a provision tucked into the 2021 American Rescue Plan, preventing forgiven post-secondary education loans from federal taxation through 2025. 

However, there are a handful of states where forgiven loan balances may be taxed. IndianaMinnesotaMississippi and North Carolina have confirmed they will tax any student loan debt relief on your 2022 taxes. A few other states may as well, though the details are still being hammered out.

And, if you live in one of the states taxing forgiven student loans, you may be on the hook for county taxes on your debt relief, as well.

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PHYSICIAN PAYMENTS: The Financial Compensation Battle Continues

By Staff Reporters

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Paying paying doctors and medical providers for their services may seem simple on the surface, but it’s actually extremely complex. Enter two of the most commonly heard phrases in healthcare: “fee-for-service” and “value-based care,” two models insurers use to decide how much to pay providers. According to Healthcare Brew:

  1. Under a fee-for-service model, providers are paid for each individual service they perform, like a blood test or an X-ray, according to Jennifer Clawson, partner and director of value-based health systems at Boston Consulting Group. A service is provided, and the doctor gets a fixed fee for providing it. Simple enough.
  2. The value-based care model is a bit more complicated, as there are many types of value-based payments. What makes them “value-based” is that payers take patient outcomes into consideration, aka they consider the relative value. “The core of value-based care is ultimately, ‘How do I get a better outcome for less money?’” said Sam Hendler, managing director at private equity firm Thomas H. Lee Partners.

One type of value-based payment is called a bundled payment, Clawson said. Say you have a heart condition and need to get a stent put in. There are usually several providers involved in that process, e.g., a primary care doctor, cardiac surgeon, and anesthesiologist. An insurer gives the health system a set amount of money to cover everyone involved in the procedure, and the health system decides how to divvy it up.

Another type of value-based payment is called capitation, and there’s multiple types of capitation payments. It’s sort of like a bundled payment, but instead of insurers paying a set amount per procedure, they’re paying a set amount to cover an entire population of patients with a specific disease, like diabetes.

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IRS and [Temporary] Charitable Donations

By Staff Reporters

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Temporary charitable donation deductions have ended

Fewer filers may be able to claim charitable donation tax breaks for this tax year.

The expanded charitable cash contribution benefits that were offered in 2020 and 2021 have ended. The temporary suspension of the 60% AGI limit in 2020 and 2021 is now back, limiting the amount you can claim in charitable contributions.  

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What is Medical Claim Denial Management?

Of Healthcare Claims [What it is – How it works]

Dr. David Edward Marcinko MBA

[Editor-in-Chief]

NEU Dr. MarcinkoTypically, denied and rejected healthcare claims quickly surface as a source of multi-millions in revenue leakage and unnecessary expense for doctors, clinics and hospitals, etc.

Why?

Payers have been struggling with increased costs.  They thoroughly inspect claims for errors and have become adept at using their rules to deny and delay claims.

For example, Zimmerman reported the denied percentage of gross charges climbed from 4% in 2000 to 11% in 2011.  In contrast, providers typically lack the tools to aggressively manage current denied claims and prevent future ones.

Financial Recognition

Without denial tracking, an organization may not recognize the heavy financial impact of denied claims.

A HARA [Hospital Accounts Receivable Analysis] report indicates that bad debt and gross days are declining. However, a majority of providers write off denials as contractual allowance, distorting the numbers but not the resulting lower margins and reduced cash.

H*Works reported that the typical 350-bed hospital loses between $4 million and $9 million each year in earned revenue from denials and underpayments (assume $103 million annual gross revenue and 40% contractual allowance). Recouping lost revenue from denials and underpayments will, according to H*Works, increase an organization’s operating margin by 2.6%.

Industry estimates report that at least 50% of denials are recoverable and 90% are preventable with the appropriate workflow processes, management commitment, strong change leadership, and the correct technology. H*Works estimates that for a revenue capture of $3 million from denials and underpayments, the recovery infrastructure costs are only about 3%.

Product DetailsProduct Details

Assessment

With all this in mind, better management of rejections and denials, as well as the information necessary to resolve and prevent them, surfaces as probably the best strategy to improving financials. By streamlining the revenue cycle, managing rejections and denials proves to be less expensive and to provide faster returns than initiating new services.

Conclusion

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

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

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The “Middle Class” Defined?

By Staff Reporters

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What’s shrinking in size, overworked and woefully underpaid?

Did you know that only half of U.S. adults live in a household with an annual income of $52,000 to $156,000, the range it takes to be considered middle income, according to the Pew Research Center. That share is significantly lower than it was in 1971, when 61% of the nation’s adults qualified as middle income.

In 2022 — an era of historic inflation and a manic economy in which jobs are plentiful but wages are stagnant — more Americans are living paycheck to paycheck. And it’s affecting more than just their income.

“People judge whether or not they’re achieving the American dream by comparing their income and their lifestyle, or what their income can buy, to what they see around them,” says Isabel Sawhill, a senior fellow at the Brookings Institution.

On paper, middle-class household income has increased considerably in the last 50 years. Measured in 2020 dollars, the median salary of the U.S. workforce is 50% higher now ($90,131) than it was in 1971 ($59,934), primarily thanks to women’s increased participation in the workforce, says Sawhill, who’s a co-author of the Brookings report “A New Contract with the Middle Class.”

Those gains, however, pale in comparison to the 69% growth enjoyed by the wealthiest households. Elisabeth Jacobs, a deputy director at the research nonprofit Urban Institute, said in a 2021 Brookings panel that if middle incomes had grown at the same pace as the top 20% of earners over the past 50 years, a solidly middle-class family would average around $139,000 annually (post-tax).

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MORE: Tax Loss Harvesting

Tax Loss Harvesting

By Vitaliy Katsenelson, CFA

DEFINITION: https://medicalexecutivepost.com/2022/11/06/tax-loss-harvesting-what-it-is/

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Tax Lost Harvesting with Examples

I enjoy writing about taxes as much as I enjoy going to the dentist. But I feel what I am about to say is important. We – including yours truly – have been mindlessly conditioned to do tax selling at the end of every year to reduce our tax bills. On the surface it makes sense. There are realized gains – why don’t we create some tax losses to offset them?

Here is the problem. With a few exceptions, which I’ll address at the end, tax-loss selling makes no logical sense. Let me give you an example.

Let’s say there is a stock, XYZ. We bought it for $50; we think it is worth $100. Fourteen months later we got lucky and it declined to $25. Assuming our estimate of its fair value hasn’t changed, we get to buy $1 of XYZ now for 25 cents instead of 50 cents.

But as of this moment we also have a $25 paper loss. The tax-loss selling thinking goes like this: Sell it today, realize the $25 loss, and then buy it in 31 days. (This is tax law; if we buy it back sooner the tax loss will be disqualified.) This $25 loss offsets the gains we took for the year. Everybody but Uncle Sam is happy.

Since I am writing about this and I’ve mentioned above I’d rather be having a root canal, you already suspect that my retort to the above thinking is a great big NO!

In the first place, we are taking the risk that XYZ’s price may go up during our 31-day wait. We really have no idea and rarely have insights as to what stocks will do in the short term. Maybe we’ll get lucky again and the price will fall further. But we’re selling something that is down, so risk in the long run is tilted against us. Also, other investors are doing tax selling at the same time we are, which puts additional pressure on the stock.

Secondly – and this is the most important point – all we are doing is pushing our taxes from this year to future years. Let’s say that six months from now the stock goes up to $100. We sell it, and… now we originate a $75, not a $50, gain. Our cost basis was reduced by the sale and consequent purchase to $25 from $50. This is what tax loss selling is – shifting the tax burden from this year to next year. Unless you have an insight into what capital gains taxes are going to be in the future, all you are doing is shifting your current tax burden into the future.

Thirdly, in our first example we owned the stock for 14 months and thus took a long-term capital loss. We sold it, waited 31 days, and bought it back. Let’s say the market comes back to its senses and the price goes up to $100 three months after we buy it back. If we sell it now, that $75 gain is a short-term gain. Short-term gains are taxed at your ordinary income tax bracket, which for most clients is higher than their capital gain tax rate. You may argue that we should wait nine months till this gain goes from short-term to long-term. We can do that, but there are costs: First, we don’t know where the stock price will be in nine months. And second, there is an opportunity cost – we cannot sell a fully priced $1 to buy another $1 that is on fire sale.

Final point. Suppose we bought a stock, the price of which has declined in concert with a decrease of its fair value; in other words, the loss is not temporary but permanent.  In this case, yes, we should sell the stock and realize the loss. 

We are focused on the long-term compounding of your wealth. Thus our strategy has a relatively low portfolio turnover. However, we always keep tax considerations in mind when making investment decisions, and try to generate long-term gains (which are more tax efficient) than short term gains. 

We understand that each client has their unique tax circumstances. For instance, your income may decline in future years and thus your tax rate, too. Or higher capital gains may put you in a different income bracket and thus disqualify you from some government healthcare program.

We are here to serve you, and we’ll do as much or as little tax-loss selling as you instruct us to do. We just want you to be aware that with few exceptions tax-loss selling does more harm than good.

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Over Heard in the DOCTOR’S LOUNGE

On “Hard Working” HMO Physicians

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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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PODCAST: Healthcare Finance [Recorded Live] Q and A Session

By Eric Bricker MD

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PODCAST: Medical Billing Charge Abuse by Radiologists

By Staff Reporters

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DAILY UPDATE: New IRS 1099-K Reporting Rule

By Staff Reporters

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IRS

The IRS just noted that there are no changes made to the taxability of income but only in the reporting rules for Form 1099-K. Taxpayers are still required to report all income on their tax return unless it is excluded by law. This is whether they receive a Form 1099-NEC, Nonemployee Compensation; Form 1099-K; or any other information return.

Previously businesses would generally receive a 1099-K tax form only when their gross payments exceeded $20,000 for the year and the business conducted at least 200 transactions.

According to the new 1099-K rule, the gross payments threshold has been lowered to just over $600 for the year with the transactions threshold no longer applying. Now a single transaction exceeding $600 can trigger a 1099-K. This includes transactions through credit cards, debit cards, banks, PayPal, Uber, Lyft, and other third-party payment settlement entities.

The 1099-K form includes information about the payment processor and the company receiving payments, and a monthly breakdown of total payments, among other information.

According to the IRS, the lower information reporting threshold and the summary of income on Form 1099-K will make it easier for taxpayers to track the amounts received.

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SBF: Apologizes as FTX Scrambles to Live

By Staff Reporters

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Following his crypto exchange’s epic implosion, FTX boss Sam Bankman-Fried (SBF) said he was sorry for mistakes he made, and pledged to “give anything I have to” in order to raise the $4 billion in capital FTX needs to avoid bankruptcy.

As the SEC bear down on the company, shady activities are coming to light: FTX loaned its affiliated firm, Alameda Research, ~$10 billion worth of customer assets to fund high-risk bets, per the WSJ.

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ROBINHOOD: The Brokerage Collapses?

By Staff Reporters

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Shares of Robinhood, the brokerage, plummeted by 15% as FTX was acquired to save it from collapsing. Sam Bankman-Fried bought a 7.6% stake in May in Robinhood, a brokerage meant to attract Millennial investors who sought to invest in cryptocurrencies.

But Bankman-Fried, the founder of FTX, a popular cryptocurrency exchange, faced even larger hurdles that investors were not aware of. 

Robinhood  (HOOD) – Get Free Report shares tumbled on Nov. 8, falling by as much as 15.54% in mid-day trading to $10.22 a share as Binance, the crypto behemoth, said it would acquire FTX, which was once its rival due to a “liquidity crunch.”

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PODCAST: Accounting Deception in Health Care

Examples of Exploitation and Deception?

BY ERIC BRICKER MD

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PODCAST: Health Insurance Carrier Contracting

By Eric Bricker MD

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