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[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]
Front Matter with Foreword by Jason Dyken MD MBA
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Filed under: Book Reviews, CMP Program, Financial Planning, iMBA, Inc., Insurance Matters, Practice Management, Risk Management | Tagged: david marcinko, Financial Planning, Risk Management | Leave a comment »
The Primary versus Secondary Stock Markets
By Dr. David E. Marcinko MBA
http://www.CertifiedMedicalPlanner.org
The purchase of common stock in an IPO (initial public offering) is facilitated through the use of members an investment bank underwriting syndicate or selling group. This is known as the primary market and the proceeds of sale go directly to the issuing company.
Six months later however, if a doctor wants to sell his shares, this would be accomplished in the secondary market. The term secondary market refers to trading in outstanding issues as the proceeds do not go to the issuer, but to the current owner of the securities, such as the physician investor.
Therefore, the secondary market provides liquidity to doctors who acquired securities in the primary market. After a doctor has acquired securities in the primary market, he wants to be able to sell the securities at some point in the future in order to acquire other securities, buy a house, or go on a vacation. Such a sale takes place in the secondary market. The medical investor’s ability to convert the asset (securities) into cash is heavily dependent upon the secondary market.
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Assessment
All investors would be hesitant to acquire new securities if they felt they would not subsequently have the ability to sell the securities quickly at a fair price in the secondary market.
Conclusion
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Filed under: CMP Program, iMBA, Inc. | Tagged: primary market, secondary market | Leave a comment »
Tombstone Advertising and the Securities Prospectus
By Dr. David E. Marcinko MBA CMP™
Despite certain SEC restriction, some idea of potential demand for a new securities issue can be gauged and have a bearing on pricing decisions.
For example, as CEO of a medical instrument company, or interested investor, would you rather see a great deal of interest in a potential new issue or not very much interest?
There is however, one kind of advertisement that the underwriter can publish during the cooling off period. It’s known as a tombstone ad. The ad makes it clear that it is only an announcement and does not constitute an offer to sell or solicit the issue, and that such an offering can only be made by prospectus. SEC Rule 134 of the 1933 Act itself, refers to a tombstone ad as “communication not deemed a prospectus” because it makes reference to the prospectus in the ad. Tombstones have received their name because of the sparse nature of details found in them. However, the most popular use of the tombstone ad is to announce the effectiveness of a new issue, after it has been successfully issued. This promotes the success of both the underwriter, as well as the company.
Since distributing securities involves potential liability to the investment bank, it will do everything possible to protect itself. So, near the end of the cooling off period, a meeting is held between the underwriter and the corporation. It is known as a due diligence meeting. At this meeting they both discuss amendments that are going to be necessary to make the registration statement complete and accurate. The corporate officers and the underwriters sign the final registration statement. They have civil liability for damages that result from omissions of material facts or misstatements of fact. They also have criminal liability if the distribution is done by use of fraudulent, manipulative, or deceptive means. Due diligence takes on a whole new meaning when incarceration from a half-hearted underwriting effort; can occur. The investment bank strives to ensure that there have been no material changes to the issuer or the terms of the issue since the registration statement was filed.
Again, as a physician, how would you feel if you were an investment banker raising capital for a new pharmaceutical company that had developed a drug product that was highly marketable. But, on the day after the issue was effective, there was a major news story indicating that the company was being sued for patent infringement? What effect do you think that would have on the market price of this new issue? It would probably plunge. How could this situation have been prevented? The due diligence meeting is more than a cocktail party or a gathering in a smoke filled room. Otherwise, the company would require specially trained people, to do a patent search lessening the likelihood of this scenario. At the due diligence meeting, work is done on the preparation of the final prospectus, but the investment bank does not set the public offering price or the effective date at this meeting. The SEC will eventually set the effective date for the registration and it is on that date that the final offering price will be determined.
Once the SEC sets the effective date, sales may be executed and money can be accepted by the investment bank. It is at this time that the final prospectus, similar to the red herring but without the red ink and with the missing numbers, is issued. A prospectus is an abbreviated form of the registration statement, distributed to purchasers, on and after the effective date of the registration. It is not the same as the registration statement. A typical registration statement consists of papers that stand more than a foot high; rarely does a prospectus go beyond 40 or 50 pages. All purchasers will receive a final prospectus and then it becomes permissible for the underwriter to provide sales literature.
Two Requirements
In addition to the requirement that a prospectus must be delivered to a purchaser of new issues no later than with confirmation of the trade, there are two other requirements which physicians, medical professionals and healthcare executive investors should know.
90-day: When an issuer has an initial public offering (IPO), there is generally a lack of publicly available material relating to the operations of that issuer. Because of this, the SEC requires that all members of the underwriting group make available a prospectus on an IPO for a period of 90 days after the effective date.
40-day: Once an issuer has gone public, there are a number of routine filings that must be made with the SEC so there is publicly available information regarding the financial condition of that issuer. Since additional information is now available, the SEC requires that, on all issues other than IPOs, any member of the underwriting group must make available a prospectus for a period of 40 days after the effective date.
Assessment
In the event that the investment bankers misgauged the marketplace, and the issue moves quite slowly, it is possible that information contained in the prospectus would be rendered obsolete by the SEC. Specifically, the SEC requires that any prospectus used more than 9 months after the effective date, may not have any financial information more than 16 months old. It can however, be amended or stickered, with updated information, as needed.
Conclusion
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Filed under: CMP Program, iMBA, Inc., Investing | Tagged: certified medical planner, David E. Marcinko, Securities Prospectus, Tombstone"Ad | Leave a comment »
By Staff reporters
Our New Book Release
http://www.CertifiedMedicalPlanner.org
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Harvard Medical School
Boston Children’s Hospital – Psychiatrist
Yale University
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Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
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Filed under: Book Reviews, CMP Program, Risk Management | Tagged: certified medical planner, CMP Program, Medical Risk Management for Advisors, Risk Management, Risk Management for Doctors | Leave a comment »
By Rick Kahler MSFS CFP®
The Department of Labor’s groundbreaking new Fiduciary Rule may change the legal responsibilities of advisors who sell financial products for consumers’ retirement accounts.
Financial services industry pundits aren’t sure whether the new rule is a giant step in the right direction or a successful dodging of a bullet by Wall Street.
Original Intent
The original intent was to require those selling financial products for retirement plans to act as fiduciaries—advisors required to put clients’ interests ahead of their own.
One proposed provision was a “restricted asset list” which would have banned the sale of high-commission products like private REITs and annuities to IRAs and other retirement plans. Wall Street brokers were “expecting a punch in the face that would force a dramatic overhaul of how they dealt with their customers,” notes Joshua Brown, CEO of Ritholtz Wealth Management, in an April 6 article at Fortune.com.
As adopted, the final rule allows financial salespeople to still sell all the controversial illiquid high-commissioned products they currently sell, as long as the brokerage firm can document the product is in the client’s best interest. Brown says this amounts to a “love tap.”
The Pundits
Bob Veres, editor of Inside Information, sees the new Fiduciary Rule as still a big win for consumers and fiduciary advisors. In an April 8 column, he writes, “professional financial planners and advisors have achieved a victory, and the Wall Street and independent broker-dealer service models have been dealt a blow.”
Veres argues that the new fiduciary duty to act in the client’s best interest will by itself preclude financial salespeople from justifying the sale of high-commissioned products in IRAs. He also points out that salespeople will no longer be allowed to receive “fat commissions” for recommending annuities and non-traded REITS, and therefore are unlikely to recommend these products.
Financial planner and writer Michael Kitces [a friend of this ME-P and advocate of iMBA’s online Certified Medical Planner® fiduciary focused professional charter education certification program] suggests the DOL’s concession allowing the current questionable financial products to still be purchased by IRAs may be “a brilliantly executed strategy of conceding to the financial services industry the exact parts that didn’t actually matter in the long run . . . yet keeping the key components that mattered the most,” the fiduciary duty to the client.
MORE: http://www.CertifiedMedicalPlanner.org
Brown believes salespeople will continue recommending higher-cost products “so long as a justification can be made for their being recommended (quality, performance, etc.).”
He adds, “Advisors will still be able to sell the proprietary products of their own firm so long as they can enunciate the reason why these products are in their customers’ “best interests” – a hurdle whose height will probably be adjusted on a case-by-case basis as no one really knows what it means yet.”
Kitces contends the new law will ultimately give the consumer the power through the courts to define what is and isn’t in their best interests. He points out:
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“In other words, while the DOL fiduciary rule didn’t outright regulate what Wall Street can and cannot do, it did change the legal standard by which those actions will be judged and ensure that eventually the courts will have the opportunity to rule on these fiduciary conflicts.”
While the new rule only applies to retirement assets, Veres and Brown see it as a step toward requiring a fiduciary standard for all investment advice. I tend to agree.
Assessment
Since so many small investors hold retirement accounts, applying a fiduciary standard to those investments may help more consumers understand the difference between fiduciary advisors and product salespeople. As the industry moves toward full compliance with the rule by the April 2017 deadline, we may see an increase in consumer demand for financial advisors who put clients’ interests first.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
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Filed under: CMP Program, Ethics, Investing, Risk Management | Tagged: Bob Veres, certified medical planner, DOL's New Fiduciary Rule, Michael Kitces, rick kahler, Ritholtz Wealth Management | 2 Comments »
By staff reporters http://www.CertifiedMedicalPlanner.org
EXIT FEE-FOR SERVICE MEDICINE
[Some Pundits say … Bye-Bye]
Continuing the health insurance industry’s march further away from fee-for-service medicine, UnitedHealth Group UNH +0.81% (UNH) will increase value-based payments to doctors and hospitals by 20 percent in 2015 to “north of $43 billion.”
UnitedHealth, considered a barometer for the health insurance industry given its size, is rapidly departing from the traditional fee-for-service approach that can lead to overtreatment and unnecessary medical tests and procedures.
http://www.BusinessofMedicalPractice.com
Value-based pay is tied to health outcomes, performance and quality of care provided. UnitedHealth’s pronouncements are in keeping with its previously stated commitment to increase payments that are tied to value-based arrangements to $65 billion by the end of 2018. Value-based payments come in a variety of forms.
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They include: pay-for-performance programs, patient-centered medical homes and accountable care organizations [ACOs], a rapidly emerging care delivery system that rewards doctors and hospitals for working together to improve quality and rein in costs.
Source: Bruce Japsen, Forbes
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
[Best Practices from Leading Consultants and Certified Medical Planners™]
Harvard Medical School
Boston Children’s Hospital – Psychiatrist
Yale University
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Filed under: CMP Program, Health Insurance | Tagged: fee-for-service medicine | 2 Comments »
[By staff reporters] http://www.CertifiedMedicalPlanner.org
The Three Basic Duties
A cash-based medical practice or direct care provider has these basic duties:
A breach of any of these duties that causes harm to a patient can result in a malpractice suit. While the first two duties are important, it is the duty to render good quality medical care that is the basis for most malpractice lawsuits. The breach of this duty is most likely to result in a serious patient injury. The prevention of such negligent injuries is the responsibility of the individual provider, but it also basic to the institution’s quality control program.
From the individual provider’s point of view, quality control involves continuing education, attention to detail, and retrospective review of the course of the provider’s patients. The process is only loosely structured and is usually poorly documented. This lack of formal structure is less important for the individual provider because the provider’s actions are judged only within the context of the injured patient in question (although previous actions may be used to negate claims of accidental injury).
Assessment
And so, the legal questions is whether the care rendered the injured patient was negligent. It is not relevant to the case if the provider carried out an effective personal quality control program.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Harvard Medical School
Boston Children’s Hospital – Psychiatrist
Yale University
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Filed under: CMP Program, Ethics, Professional Liability, Risk Management | Tagged: CMP Program | 6 Comments »
[By Dr. David Edward Marcinko CMP® MBA MBBS]
http://www.CertifiedMedicalPlanner.org
The Real Notion of Teams
I HATE teams. There I said it. Now; I repeat. I hate team sports, teams in medicine and especially teams in financial planning. I am NOT a team player; most doctors are independent minded and not team players.
On the other hand, my wife says that I am most assuredly a team player. But, that I just select my teams very carefully. She is much smarter than I; so perhaps she is correct!
Why I Rue the Hospital “Team-Based Medicine” Approach to In-Patient Care
Financial Planning
In financial planning, there seems to be a fixation … that a team is a financial planner [certified; or not] and an attorney; nice-but a couple and not really a team in the true sense of group development as first proposed by Bruce Tuckman PhD, in 1965.
In his model, Tucker maintained that four phases are all necessary and inevitable in order for the team to grow, to face challenges, to tackle problems, to find solutions, to plan work, and to deliver results [Forming – Storming – Norming – Performing].
Later, he added Adjourning to successfully complete the task and break up the team. Timothy Biggs PhD further added the Re-Norming stage to reflect a period where the team re-assembles, as needed. This put the emphasis back on the ME Inc or physician team leader – as too many ‘diplomats’ in a leadership role may prevent the team from reaching full potential.
Source: http://infed.org/mobi/bruce-w-tuckman-forming-storming-norming-and-performing-in-groups/
A Metaphor
This is why “team” must be more than a metaphor. It deserves more than lip service. Delivering client-centered, coordinated financial planning services and products demands true collaboration–a fully integrated team engaged in practices that involve each member at the top, highest and best use of their licensure and education; optimizing their contributions and maximizing their impact on the well being of the client [Boyer Model of Education].
In this context, board Certified Medical Planners™ may play a lead role going forward; along with other like-minded and educated professionals.
Unfortunately, the ranks of CMPs™ while growing; are still painfully small. But, in addition to true expertise, they link physician clients with appropriate providers and resources throughout the holistic professional life/practice planning continuum. They focus on the doctor-client’s totality — emotional, financial, risk and business management and psyche. As fiduciaries at all times; They advocate for the doctor client to connect him/her to the necessary resources, professional advisors and consultants who need to have their voices heard. Such successful, high-functioning financial planning teams give each member a voice.
The medical professional must be an active participant; not a passive bystander. This is not the norm in financial planning today where doctors are urged to hire a team quarterback. But, the NFL-QB is not a generalist at all; his arm is special and unlike all other teams players. He/she is unique, skilled and exceptional. A franchise player!
Past not Prologue
Fortunately, past is not prologue in the era of transparency, information at your fingertips, tablet PCs, Skype® and smart phones. To succeed in the hyper competitive new era of health reform requires education, involvement and active participation.
In short, a new model of physician focused advisor. No longer is there a free lunch of passivity for medical professionals; either as doctors or advisory clients themselves.
For financial planning in the new era of healthcare reform, and robo-advisors, successful doctors will assume the mantle of self-quarterback themselves.
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[Go Team Go]
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ME Inc., or Going it Alone – but with a Team
The physician, nurse, or other medical professional should easily recognize that there are a vast array of opportunities, obstacles, and pitfalls when it comes to managing one’s finances.
Still, with some modicum of effort, the basic aspects of insurance, investments, taxes, accounting, portfolio management, retirement and estate planning, debt reduction, asset protection and practice management can be largely self-taught. After all, it is NOT rocker science.
After all, anyone can purchase the exact same financial planning software that legions of FAs use, and there are many iterations on the market, as well. This concept is not unlike patients, using Dr. Google. No license required.
And TAMPs, relegate FAs to the role of “asset gather”; or should I say salesman/woman.
Why Physician-Investors Must Understand TAMPs
Informed Patient [Client]
So, an informed patient or client is ideal; is it not?
Yet, it is realized that nuances and subtleties can make a well-intentioned plan fall short. The devil truly is in the details. Moreover, none of these areas can be addressed in isolation. It is common for a solution in one area to cause a new set of problems in another.
Hourly Model
Accordingly, most health care practitioners would be well served to hire [independent, hourly compensated and prn] financial help.
Unlike some medical problems, financial issues may not cause any “pain” or other obvious symptoms. Medical professionals tend to have far more complex financial situations than most lay people. Despite the complexities of the new world of health reform, far too many either do nothing; or give up all control totally, to an external advisor. This either/or mistake can be costly in many ways, and should be avoided.
In reality, and at various time in their careers, the medical professional needs a team comprised of at least a financial analyst [CFA], lawyer, management consultant, risk manager [PhD actuary or insurance counselor] and accountant. At various points in time, each member of the team, or significant others, will properly assume a role of more or less importance, but the doctor must usually remain the “quarterback” or leader; in the absence of a truly informed other, or Certified Medical Planner™.
This is necessary because only the doctor [client] has the personal self-mandate with skin in the game, to take a big picture view. And, rightly or wrongly, investments dominate the information available regarding personal finance and the attention of most physicians. One is much more likely to need or want to discuss the financial markets with their financial advisor than private letter rulings by the IRS, or with their estate planning attorney or tax accountant.
So, while hiring for expertise is a good idea, there is sinister way advisors goad doctors into using all their retail services; all of the time. That artifice is – the value of time. Don’t fall for this out sourcing gambit!
How Doctors Pay for Wealth Management Services
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[Not Going it Alone]
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Assessment
True integrated physician focused and financial planning is at its core a service business, not a product or sales endeavor. And, increasingly money is more likely to be at the top of the list for providers as the healthcare environment is contracting.
So, eschewing the quarterback model of advice, and choosing to self-educate thru these new book and elsewhere, may be one of the best efforts a smart physician can make.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]
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Filed under: CMP Program, Ethics, Financial Planning, iMBA, Inc., Practice Management | Tagged: Dr. Marcinko, financial planning team, physician focused financial planning, team healthcare | 1 Comment »
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[Dr. David Edward Marcinko CMP™ MBA MBBS]
http://www.CertifiedMedicalPlanner.org
EDITOR-IN-CHIEF
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In SECTION ONE, of our newest textbook, on medical practitioner personal risk management issues, let us all recall the Canadian physician Sir William Osler MD, one of the founders of Johns Hopkins Hospital in my hometown of Baltimore Maryland, and where I played stickball in the parking lot as a kid. He left a sizeable body of wisdom that has guided many physicians in the practice of medicine. So, allow me to share with you some of that accumulated wisdom and the quotes that have served me well over the years.
From Dr. Osler, I learned the art of putting myself in the patient’s shoes. “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’ Realize, so far as you can, the mental state of the patient, enter into his feelings.” Osler further stresses that we should “scan gently (the patient’s) faults” and offer the “kindly word, the cheerful greeting, the sympathetic look.”1
“In some of us, the ceaseless panorama of suffering tends to dull that fine edge of sympathy with which we started,” writes Osler in his famous essay “Aequanimitas.”2 “Against this benumbing influence, we physicians and nurses, the immediate agents of the Trust, have but one enduring corrective — the practice towards patients of the Golden Rule of Humanity as announced by Confucius: ‘What you do not like when done to yourself, do not do to others.’”
Medicine can be both art and science as many physicians have discovered. As Osler tells us, “Errors in judgment must occur in the practice of an art which consists largely of balancing probabilities.”2 Osler notes that “Medicine is a science of uncertainty and an art of probability” and also weighs in with the idea that “The practice of medicine is an art, based on science.”3,4
Osler emphasized that excellence in medicine is not an inheritance and is more fully realized with the seasoning of experience. “The art of the practice of medicine is to be learned only by experience,” says Osler. “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”5
Finally, some timeless wisdom on patient care came from Osler in an address to St. Mary’s Hospital Medical School in London in 1907: “Gain the confidence of a patient and inspire him with hope, and the battle is half won.”6
Osler has also imparted plenty of advice on the business of medicine. In “Aequanimitas,” Osler says there are only two types of doctors: “those who practice with their brains, and those who practice with their tongues.”7
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In a valedictory address to medical school graduates at McGill University, Osler suggested treating money as a side consideration in a medical career.8 “You have of course entered the profession of medicine with a view of obtaining a livelihood; but in dealing with your patients let this always be a secondary consideration.”
“You are in this profession as a calling, not as a business: as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man,” explains Osler in the address to St. Mary’s Hospital Medical School.6 “Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.”
It is not easy for doctors to combine a passion for patient care, a knowledge of science and the maintenance of business, according to Osler in the British Medical Journal.9 “In the three great professions, the lawyer has to consider only his head and pocket, the parson the head and heart, while with us the head, heart, and pocket are all engaged.”
While some aspects of practice may fall short or be devoid of appropriate financial remuneration, the giving of one’s time, expertise and experience in improving patient outcomes and the quality of their lives may be the greatest gift. “The ‘good debts’ of practice, as I prefer to call them … amount to a generous sum by the end of each year,” says Osler.9
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http://www.BusinessofMedicalPractice.com
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By Render S. Davis MHA
By David Edward Marcinko
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And so, as you read and reflect on the chapter of SECTION ONE, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.
Dr. David Edward Marcinko; CMP™ MBA MBBS [Hon]
[Chief Executive Officer]
iMBA Inc., Norcross, GA
References
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[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]
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Filed under: "Doctors Only", CMP Program, Ethics, Financial Planning, iMBA, Inc., Risk Management | Tagged: CMP, CMP Program, David E. Marcinko, Financial planning MDs, medical risk management, Render Davis | Leave a comment »
By Dr. David Edward Marcinko MBA CMP™
To be sure, physicians and Financial Advisors are aware that there is a sometime need to recommend a LTCI policy to clients. Of course, in such cases, it is a good idea to work with a low load provider (or the physician or client’s agent).
The Need?
Yet, most LTCI policies are sold by insurance agents for big commissions; not bought, and that most statistics used to sell LTCI policies are fear-based and half-truths. I know, as I was a licensed insurance agent for more than a decade.
Even the Department of Health and Human Services [DHHS] gets into the fear mongering on their website quoting that “about 70 percent of people over age 65 require some type of long-term care services during their lifetime”
Source: http://www.longtermcare.gov/LTC/Main_Site/Planning/Index.aspx
Department of Health and Human Services
This may be a deceptive statistic as it omits the length of long-term care needed in these 70% of cases. And, it is not 3+ years in all these cases [our estimate is closer to 2.5]. With the stamp of approval by the Supreme Court of the United States SCOTUS on the PP-ACA, we may be looking at social LTCI in the US like other social medicine countries and give up on private LTCI insurance altogether.
Other Countries
Germany introduced mandatory long-term care insurance in 1995. Japan and France also have a LTCI tax funded insurance plan. And, the poor utilization and growing risks associated with long-term care insurance, are leading a growing number of insurance agents, financial advisors and Certified Medical Planners™ to recommend alternatives to their clients.
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Assessment
To be a thought-leader ahead of the curve, the newest aging trend is away from LTCI and toward sheltering at home – living at home and dying at home. Perhaps, this is the way it should be.
Dying should not be a for-profit industry.
http://www.CertifiedMedicalPlanner.org
More:
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]
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Filed under: CMP Program, Ethics, Health Insurance, iMBA, Inc., Research & Development, Retirement and Benefits, Touring with Marcinko | Tagged: David E. Marcinko, long term care insurance, LTCI | 2 Comments »
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By Dr. David Edward Marcinko MBA CMP™
http://www.CertifiedMedicalPlanner.org |
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*** IntroductionMuch has been written, said and opined on this ME-P and elsewhere on financial advisory fees, commissions and other means of rumination. So, what method is really best for the physician or other client? Full service, discounted fee for service, AUMs, commissions, wrap fees, ETFs, load or no-load mutual funds, annuities, stocks or individual bonds, etc? Oh! Did I forget the current [higher] fiduciary standard versus [lower] suitability conundrum? And now, the latest fad is the … Robo-Advisor service. Of course, the very need for any sort of “professional” financial advisor is often questioned by the DIYer. The Need According to some research however, a financial advisor can help improve an investor’s net portfolio returns over time by building a portfolio with low-cost investments, minimizing taxes, and serving as an investing coach during volatile times in the market. Source: Francis M. Kinniry Jr., Colleen M. Jaconetti, Michael A. DiJoseph, and Yan Zilbering, 2014. Putting a value on your value: Quantifying Vanguard Advisor’s Alpha. Valley Forge, Pa.: The Vanguard Group. For a copy of the research paper, visit vanguard.com/advisorvalue ***
*** The Vanguard Personal Advisor Services With a new offering from Vanguard Personal Advisor Services, you’ll purportedly work with a financial advisor who’s a Certified Financial Planner® professional. Your dedicated advisor will:
Assessment And, just as you’d expect from Vanguard, the cost for this service is low, about one-third the industry average. But alsa, no such relationship exists for medical professionals from a Certified Medical Planner™ Source: PriceMetrix, 2013. The industry average fee is 0.99% annually of assets under management compared with Vanguard’s annual cost of only 0.30% of assets under management. For a copy of the complete report, go to pricemetrix.com. Advisor fees may differ depending on the type and nature of the services offered. More:
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Full Disclosure: I am not affiliated with Vanguard Advisory Services in any way.
Conclusion
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Front Matter with Foreword by Jason Dyken MD MBA
“BY DOCTORS – FOR DOCTORS – PEER REVIEWED – FIDUCIARY FOCUSED”
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Filed under: Career Development, CMP Program, iMBA, Investing | Tagged: certified medical planner, Vanguard Personal Advisor Services | Leave a comment »
BUT … It’s still all about CONSUMERISM!
[By Dr. David Edward Marcinko MBA MBBS [Hon] CMP™]
http://www.CertifiedMedicalPlanner.org
There is a major variable, dominant in any marketplace that pushes an economy in a forward direction. It is called consumerism.
This became apparent while I was waiting in a doctor colleague’s office one recent afternoon.
Scenario:
The front office receptionist, who appeared to be about 21 years old, was breaking for lunch and her replacement, and appeared not much older, came over to assist.
Realizing the propensity for a long wait, one was taken by the size of waiting room and the number of patients coming in and out of the office. [Americans consume healthcare and a lot of it].
There was another notable peculiarity. The sample prescription bags being carried out the door were no match for the bags under everyone’s eyes, including the doctor’s. The office staff was probably working overtime, if not two jobs, and the doctor was working harder and faster in a managed care / ACA system.
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Why?
So they all could afford to buy and voraciously consume for their children and themselves. Americans indeed work longer hours than any other industrialized nation.
Assessment
Additionally, as women female medical professionals entered the workforce in unprecedented numbers, the stock markets reached an all time high in 2015, even as money was spent at a feverish pace as the Federal Reserve pumped out money in inflammatory fashion.
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Conclusion
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8
Filed under: CMP Program, Financial Planning, Investing | Tagged: certified medical planner, CMP, CONSUMERISM, David Edward Marcinko, economics, financial planing | 3 Comments »
Annual Medscape Findings
[By Staff Reporters]
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[By Hope R. Hetico RN MHA CMP™]
[By Dr. David Edward Marcinko MBA CMP™]
http://www.CertifiedMedicalPlanner.org
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A 2003 Survey of Dental Practices reported net income from dentistry-related sources. Dentists differ from physicians in that 90% are in private practice.
In 2002, the average practitioner’s net income was $174,350. The average dental specialist’s net was $291,250. These figures represent a 0.7% and a 5.8% increase over 2001, respectively. Net income rose steadily since 1986, when general dentists made an average of $69,920 and specialists an average of $97,920.
But, by 2010, according to PayScale.com, the average general dentist earned $98,276 – $157,437; a decreasing trend allocated as follows.
| Salary | $92,689 – $147,682 |
| Bonus | $1,996 – $19,727 |
| Profit Sharing | $1,038 – $27,514 |
| Commissions | $480.74 – $32,500 |
Source: http://www.ada.org/prof/resources/pubs/dbguide/newdent/income.asp#private
Source: http://www.payscale.com/research/US/Job=Dentist/Salary
According to Salary.com, the median salary for strictly office-based chiropractors was $78,994 in 2005; while Collegegrad.com reported the median annual earnings of a salaried chiropractor as $65,330 in 2002; with the middle 50% earning between $44,140 and $102,400.
The U.S. Bureau of Labor Statistics estimated chiropractors earned an average salary of $84,020 in 2004. A Chiropractic Economics survey in 2005 suggested mean salary at $104,363.
Another survey, for 2007, in Chiropractic Economics is available here: http://www.chiroeco.com/article/2007/Issue8/images/CES&ESurvey2007.pdf
And, a range of $44,511 – $82,826 was reported in 2010 by PayScale.com, allocated as follows:
| Salary | $42,106 – $78,129 |
| Bonus | $1,008 – $10,205 |
| Profit Sharing | $973 – $8,139 |
| Commission | $750 – $10,113 |
| Total PayXTotal Pay combines base annual salary or hourly wage, bonuses, profit sharing, tips, commissions, overtime pay and other forms of cash earnings, as applicable for this job. It does not include equity (stock) compensation, cash value of retirement benefits, or the value of other non-cash benefits (e.g. healthcare). | $44,511 – $82,826 |
Source: http://www.payscale.com/research/US/Job=Chiropractor/Salary
The salary range for a podiatrist, or Doctor of Podiatric Medicine, in 2006 was reported as $128,000 to $292,000 according to http://www.allied-physicians.com/salary_surveys/physician-salaries.htm.
This robust growth was likely due to expanded education, training, and general allopathic and osteopathic acceptance by the medical community, as well as by insurance companies, employers, patients and various governmental agencies and third party payers.
Increased surgical sub-specialization, in-patient hospital and ambulatory out-patient surgical center activity were also positive compensation factors.
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Conclusion
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Filed under: Career Development, CMP Program, iMBA, Practice Management | Tagged: doctor compensation, physician salary | 5 Comments »
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http://www.CertifiedMedicalPlanner.org
If you own a clinic or medical practice or business and need to diversify your investment portfolio, consider establishing an ESOP. ESOP’s are the most common form of employee ownership in the U.S. and are used by companies for several purposes, among them motivating and rewarding employees and being able to borrow money to acquire new assets in pretax dollars. In addition, a properly funded ESOP provides you with a mechanism for selling your shares with no current tax liability. Consult a specialist in this area to learn about additional benefits.
Have you provided for a succession plan for both management and ownership of your medical practice, clinic or business in the event of your death or incapacity? Many business owners or physician-executives wait too long to recognize the benefits of making a succession plan. These benefits include ensuring an orderly transition at the lowest possible tax cost. Waiting too long can be expensive from a financial perspective (covering gift and income taxes, life insurance premiums, appraiser fees, and legal and accounting fees) and a non-financial perspective (intra-family and intra-company squabbles).
These entity forms should be considered for both tax and non-tax reasons.
Compensation can only be deducted if it is reasonable. Recent court-decisions have allowed physician executives or business owners to deduct compensation when (1) the corporation’s success was due to the shareholder-employee, (2) the bonus policy was consistent, and (3) the corporation did not provide unusual corporate prerequisites and fringe benefits.
COLI can be a tax-effective tool for funding deferred executive compensation, funding clinic or company redemption of stock as part of a succession plan, and providing many employees with life insurance in a highly leveraged program. Consult your insurance and tax advisers when considering this technique.
If you have no more than 100 employees and no other qualified plan, you may set up a Savings Incentive Match Plan for Employees (SIMPLE) into which an employee may contribute up to $12,500 per year if you’re under 50 years old and $15,500 a year if you’re over 50 in 2015. As an employer, you are required to make matching contributions. Talk with a benefits specialist to fully understand the rules and advantages and disadvantages of these accounts.
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If you are self-employed and want to deduct contributions to a new Keogh retirement plan for this tax year, you must establish the plan by December 31st. You don’t actually have to put the money into your Keogh(s) until the due date of your tax return. Consult with a specialist in this area to ensure that you establish the Keogh or Keoghs that maximize your flexibility and your annual contributions.
Businesses and medical practices may be able to expense up to $25,000 in 2015 for equipment purchases of qualifying property placed in service during the filing year, instead of depreciating the expenditures over a longer time period. The limit is reduced by the amount by which the cost of Section 179 property placed in service during the tax year 2015 exceeds $200,000.
If you are self-employed (or are a partner or a 2-percent S corporation shareholder-employee) you may deduct 100 percent of your medical insurance premiums for yourself and your family as an adjustment to gross income. The adjustment does not reduce net earnings subject to self-employment taxes, and it cannot exceed the earned income from the business under which the plan was established. You may not deduct premiums paid during a calendar month in which you or your spouse is eligible for employer-paid health benefits.
If you are a sole proprietor, an active partner in a partnership, or a manager in a limited liability company, the net earned income you receive from the entity may be subject to self-employment taxes.
Minimum distributions from qualified retirement plans and IRAs must begin by April 1 of the year after the year in which you reach age 70½. The amount of the minimum distribution is calculated based on your life expectancy or the joint and last survivor life expectancy of you and your designated beneficiary. If the amount distributed is less than the minimum required amount, an excise tax equal to 50 percent of the amount of the shortfall is imposed.
Minimum distributions are generally required at age seventy and one-half, but you are allowed to delay the first distribution until April 1 of the year following the year you reach age seventy and one-half. In subsequent years, the required distribution must be made by the end of the calendar year. This creates the potential to double up in distributions in the year after you reach age 70½. This double-up may push you into higher tax rates than normal. In many cases, this pitfall can be avoided by simply taking the first distribution in the year in which you reach age 70½.
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Employers of household employees must withhold and pay social security taxes annually if they paid a domestic employee more than $1,900 a year in 2015 (same as 2014). Federal employment taxes for household employees are reported on your individual income tax return (Form 1040, Schedule H). To avoid underpayment of estimated tax penalties, employers will be required to pay these taxes for domestic employees by increasing their own wage withholding or quarterly estimated tax payments. Although the federal filing is now required annually, many states still have quarterly filing requirements.
Although nondeductible IRAs are not as advantageous as deductible IRAs, you still receive the benefits of tax-deferred income. Note, the income thresholds to qualify for making deductible IRA contributions, even if you or your spouse is an active participant in a employer plan, are increasing.
The $100,000 income test for converting a traditional IRA to a ROTH IRA was permanently eliminated in 2010, allowing anyone to complete the conversion.
You can withdraw all or part of the assets from a traditional IRA and reinvest them (within 60 days) in a Roth IRA. The amount that you withdraw and timely contribute (convert) to the Roth IRA is called a conversion contribution. If properly (and timely) rolled over, the 10 percent additional tax on early distributions will not apply. However, a part or all of the distribution from your traditional IRA may be included in gross income and subjected to ordinary income tax.
Caution: You must roll over into the Roth IRA the same property you received from the traditional IRA. You can roll over part of the withdrawal into a Roth IRA and keep the rest of it. However, the amount you keep will generally be taxable (except for the part that is a return of nondeductible contributions) and may be subject to the 10 percent additional tax on early distributions.
In certain situations, filing separately may save money for a married couple. If you or your spouse is in a lower tax bracket or if one of you has large itemized deductions, filing separately may lower your total taxes. Filing separately may also lower the phase out of itemized deductions and personal exemptions, which are based on adjusted gross income. When choosing your filing status, you should also factor in the state tax implications.
If you choose self-employment over a second job to earn additional income, avoid the hobby loss rules if you incur a loss. The IRS looks at a number of tests, not just the elements of personal pleasure or recreation involved in the activity.
A number of tax planning strategies can be implemented soon after death. Some of these, such as disclaimers, must be implemented within a certain period of time after death. A number of special elections are also available on a decedent’s final individual income tax return. Also, review your will as the estate tax laws are influx and your will may have been written with differing limits in effect. In 2015, estates of $5,430,000 (up from $5,340,000 in 2014) are exempt from the estate tax with a 40 percent maximum tax rate (made permanent starting in tax year 2013).
A $1,000 tax credit is available for each dependent child (including stepchildren and eligible foster children) under the age of 17 at the end of the taxable year. The child credit generally is available only to the extent of a taxpayer’s regular income tax liability. However, for a taxpayer with three or more children, this limitation is increased by the excess of Social Security taxes paid over the sum of other nonrefundable credits and any earned income tax credit allowed to the taxpayer. For 2015 (as in previous years), the income threshold is $3,000.
For more information concerning these financial planning ideas, please call or email us.
More: Enter the CMPs
ABOUT DR. GARY L. BODE MSA CPA CMP™ [Hon]
Dr. Gary L. Bode was Chief Executive Officer of Comprehensive Practice Accounting, Inc., a firm specializing in providing tax solutions to medical professionals. Originally, he was a board certified podiatrist and managing partner of a multi-office medical practice for a decade before earning his Master of Science degree in Accounting from the University of North Carolina. He then served as Chief Financial Officer [CFO] for a private mental healthcare facility. Today, Dr. Bode is a nationally known Certified Public Accountant, financial author, educator, and speaker. Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings, and innovative financial accounting as well as proactive tax positioning and tax return preparation for healthcare facilities. He has been quoted in Newsweek.
Channel Surfing the ME-P
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Conclusion
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* 8
Filed under: Accounting, CMP Program, Events-Planner, Financial Planning, Practice Management, Taxation | Tagged: certified medical planner, Child Tax Credit, corporate owned life insurance, ESOP, financial planning for MDs, Gary Bode, medical practice management, Roth IRA, Section 179 expensing, SIMPLE retirement plan | 1 Comment »
Our Newest Text Book-in-Production
http://www.CertifiedMedicalPlanner.org
[By Ann Miller RN MHA]
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Skills Needed
If you are a physician, nurse, accountant, attorney, medical risk manager or healthcare executive, we need you.
Form below or contact us for details to peer-review, etc. MarcinkoAdvisors@msn.com
Assessment
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Conclusion
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[Companion Text Book]
Filed under: CMP Program, Experts Invited, Insurance Matters, Professional Liability, Risk Management | Tagged: CMP Program, malpractice, malpractice insurance, medical liability, medical risk management, www.CertifiedfMedicalPlanner.org | 2 Comments »
By Eugene Schmuckler PhD MBA MEd CTS [Academic Provost]
About the Medical Executive-Post
We are an emerging online and onground community that connects medical professionals with financial advisors and management consultants.
We participate in a variety of insightful educational seminars, teaching conferences and national workshops. We produce journals, textbooks and handbooks, white-papers, CDs and award-winning dictionaries. And, our didactic heritage includes innovative R&D, litigation support, opinions for engaged private clients and media sourcing in the sectors we passionately serve.
Through the balanced collaboration of this rich-media sharing and ranking forum, we have become a leading network at the intersection of healthcare administration, practice management, medical economics, business strategy and financial planning for doctors and their consulting advisors. Even if not seeking our products or services, we hope this knowledge silo is useful to you.
In the Health 2.0 era of political reform, our goal is to: “bridge the gap between practice mission and financial solidarity for all medical professionals.”
More: Letterhead.iMBA_Inc.
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Enter the Certified Medical Planners™
There is no certification program, course of study or professional designation for FAs who wish to enter the lucrative financial planning space serving physicians and healthcare professionals.
That’s why the R&D efforts of our governing board of physician-directors, accountants, financial advisors, academics and health economists identified the need for integrated personal financial planning and medical practice management as an effective first step in the survival and wealth building life-cycle for physicians, nurses, healthcare executives, administrators and all medical professionals.
Now – more than ever – desperate doctors of all ages are turning to knowledge able financial advisors and medical management consultants for help. Symbiotically too, generalist advisors are finding that the mutual need for extreme niche synergy is obvious.
But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now!
Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.
Video: http://vimeo.com/84247360
An Interview with Bennett Aikin AIF®
Physician-Investors and the “F” Word
More:
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Conclusion
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Filed under: "Doctors Only", Career Development, CMP Program, Experts Invited, Health Economics, iMBA, Inc., Investing, Portfolio Management, Practice Management | Tagged: certified medical planner, fiduciary, Financial Planning, Institute Medical Business Advisors, medical practice management | 1 Comment »
A Case Model Example
[By Dr. David Edward Marcinko MBA]
http://www.CertifiedMedicalPlanner.org
Just as the field of medicine continuously changes, so too does the field of endowment management.
Endowment managers continue to increase their knowledge of the science and expand their skill in the art.
However, successful endowment managers will continue to focus on the areas that they can control in order to minimize the risk of the areas they cannot.
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So, here is a case model to show you how it is done.
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More:
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: CMP Program, iMBA, Inc., Investing, Portfolio Management | Tagged: Dr. David Edward Marcinko MBA CMP™, hospital endowments, Investing, Portfolio Management | 2 Comments »
Confidence Eluded
By Shikha Mittra MBA CFP® AIF® http://www.feeonlynetwork.com/Shikha-Mittra
According to a survey from the Employee Benefit Research Institute [EBRI] and Greenwald & Associates; nearly half of workers without a retirement plan were not at all confident in their financial security, compared to 11 percent for those who participated in a plan, according to the 2014 Retirement Confidence Survey (RCS).
Retirement Money
In addition, 35 percent of workers have not saved any money for retirement, while only 57 percent are actively saving for retirement. Thirty-six percent of workers said the total value of their savings and investments—not including the value of their home and defined benefit plan—was less than $1,000, up from 29 percent in the 2013 survey. But, when adjusted for those without a formal retirement plan, 73 percent have saved less than $1,000.
Debt
Debt is also a concern, with 20 percent of workers saying they have a major problem with debt. Thirty-eight percent indicate they have a minor problem with debt. And, only 44 percent of workers said they or their spouse have tried to calculate how much money they’ll need to save for retirement. But, those who have done the calculation tend to save more.
Shifting Demographics
The biggest shift in the 24 years has been the number of workers who plan to work later in life. In 1991, 84 percent of workers indicated they plan to retire by age 65, versus only 9 percent who planned to work until at least age 70. In 2014, 50 percent plan on retiring by age 65; with 22 percent planning to work until they reach 70.
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Physician Statistics
Now, compare and contrast the above to these statistics according to a 2013 survey of physicians on financial preparedness by American Medical Association [AMA] Insurance.
The statistics are still alarming:
Assessment
More:
Conclusion
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Filed under: CMP Program, Retirement and Benefits | Tagged: AMA, certified medical planner, Employee Benefit Research Institute, Greenwald & Associates, Retirement Confidence Survey, retirement planning, Shikha Mittra | 3 Comments »
What it is – How it works?
By TIMOTHY J. McINTOSH; MBA, MPH, CFP®, CMP™ [Hon]
Similar to private equity or venture capital, peer-to-peer lending [aka person-to-person lending, peer-to-peer investing and social lending] is the practice of lending money to unrelated individuals without the benefit a traditional financial intermediary like a bank or financial institution. P2P lending takes place online using various platforms and credit checking tools.
And, it has been in existence for about a decade.
Here are some important characteristics:
More:
Assessment
The Author
Timothy J. McIntosh is Chief Investment Officer and founder of SIPCO. As chairman of the firm’s investment committee, he oversees all aspects of major client accounts and serves as lead portfolio manager for the firm’s equity and bond portfolios. Mr. McIntosh was a Professor of Finance at Eckerd College from 1998 to 2008. He is the author of The Bear Market Survival Guide and the The Sector Strategist. He is featured in publications like the Wall Street Journal, New York Times, USA Today, Investment Advisor, Fortune, MD News, Tampa Doctor’s Life, and The St. Petersburg Times. He has been recognized as a Five Star Wealth Manager in Texas Monthly magazine; and continuously named as Medical Economics’ “Best Financial Advisors for Physicians since 2004. And, he is a contributor to SeekingAlpha.com., a premier website of investment opinion. Mr. McIntosh earned a Bachelor of Science Degree in Economics from Florida State University; Master of Business Administration (M.B.A) degree from the University of Sarasota; Master of Public Health Degree (M.P.H) from the University of South Florida and is a CERTIFIED FINANCIAL PLANNER® practitioner. His previous experience includes employment with Blue Cross/Blue Shield of Florida, Enterprise Leasing Company, and the United States Army Military Intelligence.
Conclusion
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Filed under: CMP Program, Experts Invited, Investing, Risk Management | Tagged: certified medical planner, Lending Club, Peer-to-Peer Lending, Prosper, SIPCO, Timothy J. McIntosh | 1 Comment »
Are Consumers Losing Ethical Ground?
By Rick Kahler MS CFP™ http://www.KahlerFinancial.com
Suppose one of my clients has his heart set on using half of his retirement account to buy each of his grandchildren a new car.
Or, a physician-client in a panic over falling markets wants to sell all her stocks and buy gold. What is my responsibility as their financial planner? How far should planners go to try to keep clients from making serious financial mistakes?
Just as with the patient engagement, it’s important for planners to respect clients’ competence and ability to make their own life decisions. Client-centered planners also need to remember that the goal is to help clients get what they want, not what the planner might want or think the client should want.
On the other hand, should a planner stand idly by and watch someone walk off what the planner perceives as the edge of a financial cliff?
Potential Answers?
Part of the answer to this dilemma stems from a planner’s legal obligation. Most advisors who sell financial products have no fiduciary duty and are not legally required to put their customers’ interests first. Fiduciary advisors, which include those who are fee-only, do have a legal obligation to act in their clients’ best interests.
Fiduciary Responsibility
Doctors, clergymen and attorneys are fiduciaries. But, what is the legal responsibility of a fiduciary financial planner who believes clients are about to do themselves financial harm?
Example:
Let’s say I have a client who is about to do something that may be viewed by a court of law as “extreme” or “imprudent.” (An example would be putting all his money into one asset class like gold, cash, penny stocks, etc.) At the minimum, I would need to protect myself by carefully fulfilling my legal responsibilities. This would include making certain I emphasized to the client that, given the research and data available, his actions could hurt him financially. I also would want to be sure the client fully understood and took responsibility for his actions.
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In terms of the broader aspect of what financial planners owe to their clients, meeting this legal obligation is not enough. In my view, fiduciary planners’ obligation to put clients’ interests first includes an ethical responsibility to do no harm. Sometimes this ethical and legal responsibility requires planners to give clients information they may not want to hear.
As we focus on the clients’ goals and help them carry out their wishes, part of our role is to make sure they have all the information they need. This gives us a responsibility to educate ourselves so the advice we offer is as sound as we can make it. We also need to do whatever we can to help clients hear and understand that advice.
Clients who are hovering on the edge of a financial cliff are typically about to act out of strong emotions such as fear. They often can’t take in financial advice until they are able to move through that fear. It only makes things worse if financial advisors shame clients, bully them, or abandon them to their fears. The challenge for planners is to help clients reach a more rational place so they can gather additional information and make decisions that will serve them well.
Industry Update is Not Good – Give Up the ‘Fiduciary’ Fight
According to industry pundit Bob Veres, so-called Financial Advisors need to face a hard truth – Independent Registered Investment Advisors [RIAs] have lost this round.
But, we already told you so on this ME-P.
Fortunately, there are other better ways to set yourself in the medical ecosystem.
The Certified Medical Planner™ Designation
A Certified Medical Planner™ is a fiduciary at all times.
More:
Assessment
With the right kind of support, clients are almost always able to get past the fear that is pushing them to make imprudent decisions. Providing such support by working with clients’ emotions and beliefs about money, perhaps with the help of a financial therapist or financial coach, is well within a financial planner’s ethical responsibility. Our role is not merely to do no harm. It is also to use all the tools we have to help clients act in their own best interests.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: CMP Program, Ethics, Financial Planning | Tagged: Accredited Investment Fiduciary, certified medical planner, CMP™ Course, fiduciary accountability, fiduciary advisor, financial planners, Rick Kahler CFP®, www.CertifiedMedicalPlanner.org | Leave a comment »
[By Vicki Rackner MD]
Attention Physician Focused Financial Advisors
If you are a financial advisor who would like to acquire more physician clients, consider these facts:
The Survey
How can YOU build trust and be found by more physician prospects? Here are some steps. Trust is an abstract concept. It begs the question: Trust to do what? I asked my physician colleagues and friends, “When you say you trust your financial advisor, what do you mean?”
Here are some of the answers:
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Take steps to build rapport and trust – Be authentic
Tell the story of how and why you came to offer financial advice to physicians.
Here are a few examples from my own clients:
More Tips:
Keep your promises
As my grandmother said, “Keep every promise you make, and only make promises you can keep.”
Conduct yourself like a physician
What does your personal physician do to win your trust? Do the same!
Be consistent
Conservative physicians may need to be exposed to you and your message six to ten times before they take action. Do you have lists of prospects and clients? Have you built an automated way of delivering something of value to them on a regular basis?
Quote other physicians
The most influential person in a physician’s life is another physician. If a physician offers a great idea or a best practice, ask permission to share this pearl of wisdom with other physicians. You want to be known as the financial advisor who rubs shoulders with physician leaders.
Regularly ask
Ask MD prospects and clients, “How can I do better?”
Take steps to be found
Physicians find financial advisors in much the same way you find a personal physician. You begin with someone you trust. Like me, most physicians turn to their own colleagues for names of financial advisors.
Address painful problems that need to be fixed TODAY
Busy people tend to put off problems that are asymptomatic today, even when they know the neglected problems will lead to pain in the future. Retirement is years away for most physicians. However, they seek relief from the acute financial pain of ObamaCare today.
Partner with experts and offer solutions to the problems of falling reimbursements, rising practice costs and heavier tax burdens. When physicians have more money to invest, they build wealth more quickly.
Interview key physician opinion leaders
Ask top physicians how ObamaCare impacts their day-to-day practice and their plans for the future. Uncover specific active problems. These are all opportunities for you. A key physician could introduce you to many physicians.
Listen to physicians
Active listening builds trust. Further, when you express true curiosity in others, they will want to learn about you.
Go to places physicians gather
Offer to speak at medical meetings about topics that the key physician opinion leaders identify. Submit articles for association publications. Join conversations on social media if that’s where your physician prospects gather.
What this means for you
Here’s why you may want to build trust and be found among physicians: you can mine the treasures in the medical market.
Assessment
Enter the Certified Medical Planners
About the Author
Vicki Rackner MD, author, speaker and President of Targeting Doctors, helps financial advisors accelerate their practice growth by acquiring more physician clients. She calls on her experience as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and nationally-noted expert in physician engagement to offer a bridge between the world of medicine and the world of business.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: Career Development, CMP Program | Tagged: Build Trust with Physicians, certified medical planner, CMP™ Course, Vicki Rackner MD | 3 Comments »
A Dimensional Fund Advisors Survey
By Rick Kahler MS CFP® http://www.KahlerFinancial.com
In this ME-P, I will focus on the three least important things investors want to know. The rankings came from a survey of investors, funded by Dimensional Fund Advisors, conducted in March 2014 by Advisor Impact.
All three deserved to be much higher on the list. In my experience, they are what most physicians and all investors really need to know.
The factors
These three factors are:
Drilling Down and Going Granular
Some of these factors may seem difficult to understand, but they do matter. Give your financial advisor a chance to explain them; it can help you become a more informed investor.
This factor could be better addressed by asking about the specific factors that influenced historic performance of the security over various long-term economic climates. True, looking at the past performance of an investment is never a guarantee of future performance.
Yet, if the historical periods evaluated contain a variety of economic conditions (high inflation, various economic cycles, various political influences, etc.) and long-term holding periods (at least 10 years or more), looking backward may give you a reasonable idea of what future performance might look like.
Most investors will cognitively agree they fully understand that most investments that carry any chance of real (after inflation) significant long-term return will fluctuate. I say “cognitively” because, once that fluctuation happens on the downside, all cognitive understanding sometimes goes out the window and the emotional brain takes control.
One way of internalizing the potential fluctuation of an investment is to ask about its volatility. Specifically, it’s standard deviation. This measure of the amount of variation from the average is something an advisor can easily find out for almost every bond, stock, and mutual fund. Take the standard deviation times three, then subtract that number from the average return. This is the amount of value over one year your investment could drop (or rise) in 99% of all years. Stated conversely, there is only a 1% chance your investment would drop further in any one year.
I recently sent back a shirt that hung on me like a tent. While it would have been perfect for a larger guy, it was not a fit for me. Investments are similar. While some are perfect matches for one portfolio, they can be lethal in another. An over-allocation to emerging market stocks may make perfect sense for a newborn, but it could be a retirement disaster for a 90-year-old.
Assessment
It’s important to ask why an investment belongs in your portfolio. You want investments (asset classes) that complement one another by tending to fluctuate independently of each other.
In an ideal balance of investments, when some decrease in value the other half increase an equal or greater amount, and all of them earn a real return over time.
Conclusion
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Filed under: CMP Program, Investing, Portfolio Management | Tagged: Advisor Impact, Dimensional Fund Advisors, investing risks, Portfolio Management, Rick Kahler CFP® | Leave a comment »
Dear ME-P Readers and Subscribers,
Employed physicians who use professional financial advisors v.s. physician financial do-it-yourself-ers):
Did you know the following:
Did you also know:
Here are some other key survey findings:
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What this means for you
These finding affirm the intuitively obvious: experts get better results than dabblers.
Patients get the best medical outcomes when they work with physicians whom they trust; physicians get the best financial results when they work with financial advisors whom they trust; as a fiduciary advisor.
Assessment
Enter the Certified Medical Planners
About the Author
Vicki Rackner MD, author, speaker and President of Targeting Doctors, helps financial advisors accelerate their practice growth by acquiring more physician clients. She calls on her experience as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and nationally-noted expert in physician engagement to offer a bridge between the world of medicine and the world of business.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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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Filed under: CMP Program, Retirement and Benefits | Tagged: certified medical planner, How Physicians Prepare for Retirement, retirement planning, Vicki Rackner MD | 1 Comment »
Why Physicians Need Financial Advisors Now!
[By Vicki Rackner MD]
http://www.CertifiedMedicalPlanner.org
I recently attended a surgical meeting. Most conversations with my physician colleagues turned to the same singular topic: physicians’ new financial reality.
And the message is, “It hurts!”
Physicians’ Financial Plans
Financially savvy physicians execute thoughtful retirement plans. Yet, today about half of surveyed physicians are behind where they would like to be in retirement preparedness. Further, today only about half of physicians work with professional financial planners.
As a physician myself, I understand why smart physicians fail to take smart financial action. We physicians dedicate ourselves to the alleviation of pain and suffering of others. Retirement is a distant personal concern that does not cause immediate financial pain today. We put it off.
Lesson from My Dentist
Years ago my dentist recommended that I undergo a procedure to replace a filling. He explained that the filling material put in my mouth about 40 years ago tends to pull from the tooth over time and allow new cavities to form.
As much as I like my dentist, I actively avoid spending time in his dental chair. I put off the recommended filling replacement year after year. That is, of course, until I experienced vague throbbing from that tooth. I rearranged my schedule so I could tend to this small problem before it became a much bigger problem. Who wants a root canal!
For physicians retirement planning is like that proactive filling replacement. We understand that without action there will be problems down the road. However, the threat of a problem in the distant future does not propel many like myself to action today.
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The ObamaCare [PP-ACA] Opportunity for Financial Advisors
ObamaCare is the source of acute financial pain for physicians. It’s the financial toothache. Practicing physicians are looking at:
Physicians’ Wants and Needs
As a financial advisor, you know that physicians NEED a retirement plan. Kids need to eat their broccoli, too. It’s good for them.
Physicians WANT a plan to help them achieve the personal, professional and financial goals that drew them to a career in medicine. Engaging physicians by address their ObamaCare plan is about as hard as getting kids to eat ice cream.
What This Means for You
Today physicians actively seek experts to help them create their ObamaCare plans.
Financial advisor are winning new physician clients. As Seattle Seahawks quarterback Russell Wilson asks, “Why not you?”
If you want to work with more physician clients, this is your moment! Seize it. You have a chance to join the high-performing financial advisors mining the treasures in the medical market.
Assessment
Should wish to learn more here’s a video that addresses 4 questions:
About the Author
Vicki Rackner MD is an author, speaker and consultant who offers a bridge between the world of medicine and the world of business. She helps businesses acquire physician clients.
VIDEO: https://www.youtube.com/watch?v=CeCyidc4JP8&feature=player_embedded
Enter the Certified Medical Planners™
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: Career Development, CMP Program, Experts Invited, Financial Planning, Retirement and Benefits | Tagged: ACA, certified medical planner, CMP™ Course, ObamaCare, Physicians' Financial Plans, PP-ACA, Vicki Rackner MD, Why Physicians Need Financial Advisors Now | 8 Comments »
A Real-Life Case Model
By Ann Miller RN MHA
http://www.CertifiedMedicalPlanner.org
As a generic financial advisor, how would you answer this client prospect’s inquiry?
QUESTION: I’m a 47 year old MD – Can you help me?
TRADITIONAL ANSWER: I am a stock-broker [aka financial advisor] or insurance agent, and I sell financial products and insurance policies on a commission basis.
What do you want to buy?
CURRENT ANSWER: I am a financial planner, and I charge a percentage amount on the assets I “manage” for you. But, I have a minimum portfolio amount.
So how much money do you have to invest?
DEEP NICHE ANSWER: Yes! I am a fully CERTIFIED MEDICAL PLANNER™ practitioner. I understand holistic financial planning for medical professionals and current health industry tumult. And, as an informed fiduciary – with transparent fees – I can help with your medical practice, business and/or personal financial planning matters.
When can we meet to discuss your needs?
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ENTER THE CMPs
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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Filed under: "Ask-an-Advisor", Career Development, CMP Program, Financial Planning | Tagged: certified medical planner, CMP Program, CMP™ Course, Financial Planning | 3 Comments »
Including Policy Checklist
By Dr. David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org
The Basic Premise 101
Could you continue to support your family and pay your bills if you were unable to work for any length of time because of illness or injury? If you were to become disabled, do you know how much money would be coming in each month and from what sources?
The Checklist
As a doctor I covered the ER, and was an insurance agent, for almost a decade. But, I reformed and am now a Certified Medical Planner™ and B-school professor. And, I know that every disability insurance policy has different features.
The following checklist will help you compare policies you may be considering:
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[Back When I Covered the ER]
[Copyright David Edward Marcinko and iMBA Inc., All rights reserved. USA]
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Other Items
More: More on Disability Insurance for Physicians
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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Filed under: CMP Program, Insurance Matters, Risk Management | Tagged: certified medical planner, david marcinko, disability insurance | 1 Comment »
A Critical Life Skill?
[By Rick Kahler MS CFP® http://www.KahlerFinancial.com]
In today’s complex world of technology, regulations, and finance, a critical life skill is finding advisors and service providers we can trust.
Few of us know how to repair a laptop, grasp the details of income tax regulations, or understand the nuances of selecting the best mutual fund.
We must rely on others to help us out.
Trust Owed
In the legal sense, there are very few people who “owe” us their trust. Certainly, those selling us goods owe us accuracy and honesty. When I buy a 48-ounce bottle of 100% pomegranate juice from Safeway, I expect it to contain exactly 48 ounces and be 100% pomegranate juice, not a blend of pomegranate, grape, and apple. However, I cannot trust Safeway to know whether the health claims behind pomegranate juice are accurate or whether I can find it cheaper elsewhere.
Sales People
In a similar fashion, salespeople for appliances, cars, or cable service have one basic goal, to sell products to their customers. They owe us honesty about the costs, features, and condition of their wares. But it is up to us to research products and decide whether they are good values for us.
Professionals
Professionals in some fields give unbiased advice about certain products or services as they relate specifically to you. In a legal sense, such professionals do owe you trust. They have a “fiduciary” duty to be your advocate. The law requires a professional held to a fiduciary duty to work solely in the consumer’s interest. Examples of such professionals are physicians, attorneys, accountants, trustees, trust officers, and most real estate consultants.
When a professional has a fiduciary duty to you, you are called a client. When a professional is selling you a product or service, you are a customer.
Conflicts of Interest
One of the primary issues affecting how easily fiduciaries can advocate for you is their level of freedom from a conflict of interest. At times a potential conflict of interest can be so significant that a fiduciary will decline the engagement. Attorneys, for example, will turn you down if you want to sue someone they have represented in the past. The past association may cloud their ability to effectively advocate for you.
Compensation
One of the greatest potential conflicts of interest is how you compensate the fiduciary. Typically, paying a flat or hourly fee is the easiest way to insure there is no compensational conflict. Compensating a fiduciary with commissions almost always carries some type of potential conflict. The greater the compensation from a commission, the greater the potential conflict.
Example:
For example, Real Estate Agent A acts as a buyer’s broker with a fiduciary duty to a buyer, who pays her an hourly fee plus 1% of any amount that the final purchase price is reduced from the list price. Agent B, also a fiduciary buyer’s broker, is only compensated by a commission if there is a sale. Which agent has the larger potential conflict of interest? Without a question, Agent B. He may face a situation where his client’s interest would be best served by a sale with a lower commission or even no sale at all. Advocating for his client would mean a direct financial loss for Agent B.
To minimize such potential conflicts, in most states real estate agents are required to clearly disclose fees and get clients’ written acknowledgement. Unfortunately, the total fees charged by investment advisors, and whether you are their customer or a client, is seldom clear, often even when the advisor assures you that you will be a client. Many advisors don’t know the difference.
More:
Sponsor:
Assessment
What can you do to protect yourself? Next time I will give you a five-minute solution.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: CMP Program, Ethics, Financial Planning | Tagged: certified medical planner, Conflicts of Interest, fiduciary | 5 Comments »
We don’t plan to fail – We fail to plan
[By Dr. David Edward Marcinko MBA CMP™]
http://www.CertifiedMedicalPlanner.org
Our newest textbook COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will shape the physician-focused financial planning landscape for the next-generation of Health 2.0 medical professionals and their financial advisors.
Why Now?
We created this innovative textbook because the healthcare industry is rapidly changing and the financial planning ecosystem has not kept pace. Traditional insurance-commission and sales-driven generic advice is yielding to a new breed of deeply informed fiduciary advisor, and educated consultant, or Certified Medical Planner (CMP™). Internet and social media of the last decade demonstrates that medical providers are becoming accustomed to the need for knowledgeable advice. And so, financial planning is set to be transformed by “market disruptors” that will soon make an impact on the $2.8 trillion healthcare marketplace for those financial advisers serving this sector.
We are at the leading edge of this positive disruption — also known as niche based Financial Planning 2.0 — that over time will see today’s command-controlled financial services industry becomes a wide open academic marketplace. And, a growing cadre of specialty entrants is poised to shake up the industry drawing billions of dollars in revenue from traditional broker-dealer organizations while building lucrative new markets.
For example, an iMBA Inc survey points to the growing need for financial advisors to serve current and future medical professionals thanks to their eagerness to seek premium financial planning solutions from non-traditional sources and providers; like the online Certified Medical Planner™ charter designation program. The industry is ripe for a shakeup and physician focused financial planning will soon have its own new brands. We aim to be among the first-movers and top tier names in the industry.
How We Are Different?
COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will change this niche industry sector by following eight important principles.
1. First, we have assembled a world-class editorial advisory board and independent team of contributors and reviewers and asked them to draw on their experiences in contemporaneous healthcare focused financial planning. Like many of their physician and nurse clients, each struggles mightily with the decreasing revenues, increasing costs, automation, SEC scrutiny and higher physician-client expectations in today’s competitive financial advisory and technological landscape. Yet, their practical experience and physician focused education, knowledge and vision is a source of objective information, informed opinion and crucial information to all consultants working with doctors and medical professionals in the financial services field.
2. Second, our writing style allows us to condense a great deal of information into one volume. We integrate bullet points and tables; pithy language, prose and specialty perspectives with real world examples and case models. The result is an oeuvre of integrated financial planning principles vital to all modern physicians and allied healthcare professionals.
3. Third, to the best of our knowledge, this is the first peer-reviewed book of its type, as we seek to follow traditional medical research and journal publishing guidelines for best practices. We present differing viewpoints, divergent and opposing stake-holder perspectives, and informed personal and professional opinions. Each chapter has been reviewed by one to three outside independent reviewers and critical thinkers. We include references and citations, and although we cannot rule out all biases, we do strive to make them transparent to the extent possible.
4. Fourth, our perspective is decidedly from the physician-client side of the equation. More specifically, as consultants to medical professionals, we champion the physician-investor over the financial advisor. And, to the extent that both sides ethically succeed; we hope all concerned “do well – by doing good”. This is unique in the fee and commission driven financial services industry. Much like the emerging patient-centered care initiative in medicine, we call it client-centered advice.
5. Fifth, it is important to note that deep specificity and niche knowledge is needed when advising physicians and healthcare providers. And so, we present information directly from that space, and not by indirect example from other industries, as is the unfortunate norm. Medical case models, healthcare industry examples, and anecdotal insights from the Over Heard in the Doctor’s Lounge, and Over Heard in the Advisor’s Lounge features, are also included. Finally, personalized financial planning for all medical professionals is our core, and only focus.
6. Sixth, this textbook represents an academic template for about 25 percent [125/500 credit hours] of the Certified Medical Planner™ chartered professional online certification program curriculum. It is useful for those studying, auditing, or considering matriculation for this prestigious designation mark.
7. Seventh, we include a glossary-of-terms specific to the text, a list of comprehensive advice sources, and three illustrative physician-specific financial plan examples additionally available by separate order.
8. Finally, as editor, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed texts like this one should be a relic of the past; from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite. Applied physician focused personal financial planning literature, from informed fiduciary sources, is woefully sparse; just as a plethora of generalized internet information makes that material less valuable to doctor clients.
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A Seminal Work
And so, rest assured that COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will become a seminal book for the advancement of personal financial planning and related personal micro-economic principles in this niche ecosystem.
In the years ahead, we trust these principles will enhance utility and add value to your book. Most importantly, we hope to increase your return on investment by some small increment.
If you have any comments or would like to contribute material or suggest topics for future editions please contact me.
More:
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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Filed under: Book Reviews, CMP Program, Financial Planning, iMBA, Inc., Touring with Marcinko | Tagged: certified medical planner, CMP™ Course, david marcinko, Financial Planning | 2 Comments »
UPCOMING: Our Newest Major Textbook Release
[By Ann Miller RN MHA]
Release: February 19th, 2015 by Productivity Press, Inc
744 Pages | 43 Illustrations
Editor(s): Dr. David Edward Marcinko MBA CMP™ and Professor Hope Rachel Hetico RN MHA CMP™
Features:
Summary
Drawing on the expertise of multi-degreed doctors, and multi-certified financial advisors, COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS[Best Practices from Leading Consultants and Certified Medical Planners™]will shape the industry landscape for the next-generation as the current ecosystem strives to keep pace. Traditional generic products and sales-driven advice will yield to a new breed of deeply informed financial advisor, or Certified Medical Planner™.
The profession is set to be transformed by “cognitive-disruptors” that will significantly impact the $2.8 trillion healthcare marketplace for those financial consultants serving this challenging sector. There will be winners and losers. The text which contains 24 chapters, and champions healthcare providers while informing financial advisors, is divided into four sections compete with glossary of terms, CMP™ curriculum content, and related information sources:
Using an engaging style, the book is filled with authoritative guidance and health care–centered discussions, to provide tools and techniques to create a personalized financial plan using professional advice. Comprehensive coverage includes topics likes behavioral finance, medical risk management, Modern Portfolio Theory (MPF), the Capital Asset Pricing Model (CAP-M) and Arbitrage Pricing Theory (APT); as well as insider insights on commercial real estate; High Frequency Trading platforms and robo-advisors; the Patriot and Sarbanes–Oxley Acts; hospital endowment fund management, ethical wills, divorce and other special situations.
The result is a codified “must-have” book, for all health industry participants, and those seeking advice from the growing cadre of financial consultants and Certified Medical Planners™ who seek to “do well – by doing good”, dispensing granular physician-centric financial advice: Omnia pro medicus-clientis.
RAISING THE BAR
CERTIFIED MEDICAL PLANNER™
“The informed voice of a new generation of fiduciary advisors for healthcare”
[Omnia pro medicus-clientis]
More:
Conclusion
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Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
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8
Filed under: "Advisors Only", "Doctors Only", Book Reviews, Breaking News, Career Development, CMP Program, Financial Planning | Tagged: certified medical planner, CMP, david marcinko, Financial Planning, hope hetico | 6 Comments »
Ken is a hospital administrator and financial consultant for the Tseung Kwan O Hospital, in Hong Kong. He speaks English, Cantonese, Mandarin and Chinese.
Assessment
Link: http://www.CertifiedMedicalPlanner.org
Conclusion
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OUR NEWEST BOOK:
Filed under: CMP Program, Experts Invited, Financial Planning | Tagged: certified medical planner, CMP Program, Ken Chi Yeung | 4 Comments »
Understanding the Nexus Between Fame and Quality
[By Rick Kahler CFP®] http://www.KahlerFinancial.com
The Case … For?
When a financial advisor, someone with a radio or television show, or an author of financial books becomes well-known, it’s easy to assume you can trust that person’s advice. This isn’t necessarily the case.
Recently I was selected by an Internet community site called moneytips.com as one of their top 50 “social influencers.” This is a list of professionals in the areas of wealth and personal finance who use social media and other Internet tools effectively.
Among the top three on this list are Dave Ramsey and Suze Orman, whose books and advice include a great deal of solid information to help people get out of debt, manage money well, and provide for the future. Many others in the top 50 are respected financial journalists and advisors.
The Case … Against?
However, the list also includes a few advocates for high-risk investment methods, proponents of dubious get-rich-quick schemes, and purveyors of poorly researched advice. Those who put together the list focused on how well people established a presence on the Internet and used technology to communicate. That’s an assessment completely unrelated to the question of whether the advice or information being communicated was worthwhile.
Financial Planning
Financial planning, just like any other field, has a solid core of practitioners who quietly and ethically serve their clients. It also has its gurus, its outstanding marketers, and its fringe practitioners with extreme ideas. The challenge for consumers is not to assume fame and quality always go together.
Linking Fame and Quality?
Here are a few suggestions for keeping a balanced perspective about famous or familiar financial faces:
1. Knowing about a professional isn’t the same as knowing a professional. Everyone you know may have heard of Noted Local Advisor. That’s not the same as being able to recommend him or her. Get recommendations first-hand, from people who actually are clients of a firm or have used someone’s plan or advice. Ask specific questions about what they’ve done and how it worked for them.
2. Yes, there are shortcuts to building wealth, but they come with very high risks. For most of us, the best ways to build wealth are gradual and even boring: saving part of every paycheck, living on less than we earn, and investing for the long term in a well-diversified portfolio of different asset classes. It’s natural to wish for an easier, faster way, but that desire can make you more vulnerable to high-risk schemes and even scams.
3. Even if a method of building wealth is perfectly legitimate and works for others, it still may not be a good fit for you. If you’re a reclusive introvert, for example, sales is probably not your best path to success.
4. Apply the same common sense and skepticism to financial products or wealth-building methods that you would use anywhere else. For example, you probably don’t assume that a car’s advertised gas mileage is what you’ll actually get under real-world conditions. In the same way, it’s a good idea to assume that your real-world results from a proposed investment or business will be lower than the advertised numbers.
5. Don’t assume every financial guru is a crook. Many reputable professionals can teach you a great deal about money. Your job is to learn the financial basics so you can evaluate them with some educated skepticism.
More:
Assessment
And always keep in mind that a product or idea is not the same thing as the selling of that product or idea. The true genius of some financial “experts,” after all, is marketing.
Conclusion
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Filed under: CMP Program, Ethics, Experts Invited, Financial Planning | Tagged: certified medical planner, CMP, Dave Ramsey, Enter the Financial Advisory Gurus, financial advice, financial planners, Mike Kitces, Rick Kahler CFP®, stock-brokers, Suze Orman | 1 Comment »
By Dr. David Edward Marcinko MBA CMP™
Recognizing the risk that market volatility represents to long-term portfolio health, investment accounts and endowment funds utilize a variety of methods to calculate periodic payouts.
More:
Conclusion
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Filed under: CMP Program, Portfolio Management | Tagged: certified medical planner, CMP, David E. Marcinko, Endowment Management, Portfolio Payout Methods | 1 Comment »
[A SPECIAL R&D REPORT FOR THE ME-P]
By David K. Luke MIM, MS-PFP, CMP™ [Certified Medical Planner™]
Website: http://www.networthadvice.com
There has been a lot of speculation since the words “Affordable Care Act” were first whispered years ago on how the various sectors in the Health Care Industry would fare under such legislation. I proposed that a good indicator would be to look at the performance of the individual health care sector stocks on the first trading day after the election.
(See With Obama Election Win, “Mr. Market” Weighs in on the ACA Equity Winners and Losers by David K. Luke on November 16, 2012).
Link: With Obama Election Win “Mr. Market” Weighs in on the ACA Equity Winners and Losers
The day after Pres. Obama’s reelection on Wednesday, November 7, 2012 the stock market was down over 2% as measured by the S&P 500 and the Dow Jones Industrial Average (DJIA). The common reason given was increased doubt that the impending “fiscal cliff” issue, which was splitting the House and the Senate, would be resolved. There was however, another big concern on investor’s mind: the future of the Affordable Care Act. While the election was close when measured by the popular vote with President Obama earning 51.06% versus Mitt Romney with 47.20%, the electoral vote showed a hands-down Obama victory with 332 versus 206 votes. Investors voted with their pocketbooks with that first trading session following the election showing certain healthcare sectors up in price, other healthcare sectors with moderate returns, and certain healthcare sectors down in price.
Disparate Health Care Sector Returns
It is interesting to look back now over a year and a half later and see how accurate those investor votes were on that first day of realization that health care reform was continuing forward at a much faster pace now that President Obama would be serving a second term. Keeping in mind that the day was a very negative day as a whole in the stock market, a number of healthcare sectors were up in price. This group includes Hospital Stocks and Medicaid HMOs. Note the phenomenal one-day returns (in a down 2% market!) on the sample stocks in these two groups:
Hospital Stocks
Medicaid HMOs
Such positive returns on a big down day in the market indicates investors assessing these healthcare sectors being good investments under an Obama presidency and a positive outlook for the implementation of the Affordable Care Act. The other up sector on that day was the Drug Wholesalers, up almost 1% on that negative day. (See “Selected Health Care Performance” Chart – below).
The market had a tepid response to the Pharmacy Benefit sector, as well as the Generic Pharmacy, Testing Labs, and Big Pharma. In my sample group, these sectors were down -.4%, -7%, -1.7%, and -1.4% respectively. It is important to note however that these sectors while slightly positive or barely negative still performed better than the general market that day.
Two Sectors
But, the two healthcare sectors that the stock market severely punished with the voting of substantially more sellers than buyers by investors on that first post-election day were the Medical Device Companies (down 2.5% in the sample group) and the Medicare Part D Companies (down 4.7% in the sample group). The thought at the time was that Medical Device Companies, facing an impending medical device excise tax of 2.3% on the sale of most medical devices in the United States, would be devastated, and that Medicare Part D Companies would face severe profit constraints with tighter-fisted government regulations imposed by the ACA.
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The Retro-Specto-Scope
In hindsight, investors were correct on two out of the three predictions based on stock market prices on the various healthcare sectors. Hospital Stocks, Medicaid HMOs, and Drug Wholesalers, the leading sectors indicated to be winners with the impending implementation of the ACA, are up 69.8%, 63.6% and 76.5% respectively in the sample groups since November 7, 2012. This remarkable and closely parallel return for these three sectors seemed to prove that the stock market on November 7, 2012 correctly picked the three winning health care sectors! The S&P 500 index for the same time is up 32.02%, a nice return for 1 ½ years but about half the return of these apparently huge benefactors of the ACA. The healthcare sectors that investors felt less positive about (but more positive than the general stock market) on that first postelection day were Pharmacy Benefit Companies, Generic Pharmacy Companies, Testing Labs, and Big Pharma. These four health care sectors are up 43.8%, 40.5%, 6.4%, and 20.5% respectively. Again, in terms of ranking the sectors, these four sectors performed in line based on the comparative returns of the other healthcare sectors.
Wisdom of Crowds
Amazingly, it appears that the emotional Mr. Market predicated quite accurately on Wednesday, November 7, 2012, in one day of trading, not just which health sectors would be good investments for the near future, but the actually ranking of the future performance of the sectors! It seems as though the stock market, as one large voting machine, precisely dissected the over 20,000 pages + of resulting legislation created from the original 906 pages (pdf here) of the PPACA law and distilled it down to profits and losses with the resulting winners and losers in the health care industry in one trading session.
Two [2] Big Misses
Investors however were way off on their concerns about Medical Device Companies and Medicare Part D Companies. The two sample groups were up 71.3% and 66.4% in the time of November 7, 2012 to May 19, 2014 respectively, more than double the S&P 500 for the same period, and in line with the best performing sectors! This is spite of the fact that stock sample of these two groups were the two worst performers on post-election day trading. What happened?
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The “Medical Device Excise Tax” Fable and the “Private Insurers Will Control Costs” Fairy Tale
Wall Street has sharpened their pencils in the last year and a half and realized they have gravely underestimated the profit potential of the Medical Device makers and the Managed Care Health Insurers, in spite of the ACA. Based on stock price performance of the sample group of major players in the past 18 months, fewer sectors look as profitable as the Medical Device Industry and the Medicare Part D Industry. What happened?
The Medical Device industry states that the tax will cost the US “tens of thousands of jobs” and that those jobs will be shipped overseas. A number of issues that are involved here however refute these claims (http://www.factcheck.org/2013/10/boehner-and-the-medical-device-tax/. It appears that any targeted reductions were not related to the implementation of the tax, which became effective January 1, 2013, in spite of heavy protest by the industry. Medical technology continues to have a bright future regardless of the tax.
The notion that the “Affordable” Care Act will help reign in the rampant cost increases of Medicare’s “Part D” program seem to be elusive. Private insurers have done a poor job of keeping drug prices down, especially when compared to the discounts the government gets for Medicaid. Medicare Part D companies wield significant influence on Capitol Hill, and impending steeper discounts look unlikely.
Everybody Wins, Except …
Before the ACA implementation, about 85% of Americans had health insurance. Currently with an additional 7 million Americans with health insurance thanks to Obamacare, an additional 2.2% of Americans now have coverage, or about 87% of all Americans. How can such a slight increase in new health care consumers be responsible for such large anticipated profits in the health care sector? It cannot. Wall Street is telling us that the new health law is not about new customers, but about increased profit margins for the health care industry. I can draw three conclusions:
THE CHART [Research and Development]
Selected Health Care Sector Stock Performance Random Sampling of Publically Traded Companies From President Obama Re-election Date to Present
Conclusion
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Filed under: Breaking News, CMP Program, Drugs and Pharma, Experts Invited, Investing, Portfolio Management | Tagged: ACA, Affordable Care Act., CMP Program, david luke, Health Care Industry, Healthcare Sectors, hospital stocks, Investing, medicaid HMOs, Pharmacy Benefit sector, www.CertifiedfMedicalPlanner.org | 3 Comments »
By Eugene Schmuckler PhD MBA MEd CTS
[Academic Provost iMBA Inc., and the CMP™ Online Charter Certification Program]
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CERTIFIED MEDICAL PLANNER™ CHARTERED PROFESSIONAL DESIGNATION AND CERTIFICATION PROGRAM DESCRIPTOR AND CURRICULUM
A Working-White Paper
[Enter the Informed Voice of a New Generation of Fiduciary Advisors for Healthcare]
As the financial planning industry grows, and quality information is available on the internet, medical professionals have more access to information than ever before. At the same time, the growing number of consulting generalists – leads to a troubling counter trend – more financial advisors means less differentiation to being a financial advisor. Perhaps this is the reason for the embarrassing number of, valid and specious, financial industry certifications in existence today?
Enter the Institute of Medical Business Advisors, Inc and its’ life-long learning Certified Medical Planner™ initiative.
FOCUS ON LIFE-LONG LEARNERS
The INSTITUTE OF MEDICAL BUSINESS ADVISORS [iMBA] INC., provides a team of experienced, senior level educators and consultants, led by Chief Executive and Medical Officer – Dr. David Edward Marcinko FACFAS MBA CMP™ and Chief Academic Officer and Dean – Eugene Schmuckler PhD MBA M.Ed CTS, to construct individually focused curricula for Life-Long Learners [LLLs]. This curriculum is used throughout all phases of Certified Medical Planner™ program matriculation. iMBA Inc., and its staff of teaching professionals, have decades of experience and didactic repute, supported by an unsurpassed in-bound research library, to augment knowledge of the integrated healthcare and financial services environment.
Thus, the iMBA Inc., team provides superior online education in an asynchronous, cost-effective manner, by focusing on academic solutions for the unique needs of each adult-learner. This vast niche network of cognitive and human resources ensures that the Certified Medical Planner™ instructional team maintains the highest level of current and future competence regarding industry trends to serve as the foundation for each adult-learner e-engagement.
Link: Down Load Free White Paper Enter the CMPs
More: Mike Kitces; MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC, CASL
What Comes After CFP Certification? Finding Your Niche Or Specialization With Post-CFP Designations
Conclusion:
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure. Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
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Filed under: CMP Program, iMBA, Inc. | Tagged: certified medical planner | 1 Comment »
And … Can it be Quantified?
[By Staff Reporters]
How much of a boost in net returns can financial advisors add to client portfolios? According to Vanguard Brokerage Services®; maybe as much as 3%?
The Study
In a recent paper from the Valley Forge, PA based mutual fund and ETF giant, Vanguard said financial advisors can generate returns through a framework focused on five wealth management principles:
• Being an effective behavioral coach: Helping clients maintain a long-term perspective and a disciplined approach is arguably one of the most important elements of financial advice. (Potential value added: up to 1.50%).
• Applying an asset location strategy: The allocation of assets between taxable and tax-advantaged accounts is one tool an advisor can employ that can add value each year. (Potential value added: from 0% to 0.75%).
• Employing cost-effective investments: This component of every advisor’s tool kit is based on simple math: Gross return less costs equals net return. (Potential value added: up to 0.45%).
• Maintaining the proper allocation through rebalancing: Over time, as investments produce various returns, a portfolio will likely drift from its target allocation. An advisor can add value by ensuring the portfolio’s risk/return characteristics stay consistent with a client’s preferences. (Potential value added: up to 0.35%).
• Implementing a spending strategy: As the retiree population grows, an advisor can help clients make important decisions about how to spend from their portfolios. (Potential value added: up to 0.70%).
Source: Financial Advisor Magazine, page 20, April 2014.
The Fine-Print
But, Vanguard notes that while it’s possible all of these principles could add up to 3% in net returns for clients, it’s more likely to be an intermittent number than an annual one because some of the best opportunities to add value happen during extreme market lows and highs when angst or giddiness [fear and greed] can cause investors to bail on their well-thought-out investment plans.
More: http://www.CertifiedMedicalPlanner.org
Assessment
Most retail financial services products are designed to enhance the well-being of the Financial Advisor and/or vendor at the expense of clients. The clients get only the leftovers. Of course, no one tells them that secret. They have to figure it out for themselves. As the old line goes, “Where are the customers’ boats?”
Source: Rowland, M: Planning Periscope [Where Advisors are the Clients]. Financial Advisors Magazine; page 36, April 2014
Conclusion
Are doctors different than the average investors noted in this essay?
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8
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Filed under: CMP Program, Experts Invited, Interviews, Portfolio Management | Tagged: financial advisors, How Much is a Financial Advisor Worth?, Investing, investment advisor, www.CertifiedMedicalPlanner.org | 4 Comments »
Post-CFP® Subject Matter Expertise
By Ann Miller RN MHA [iMBA Inc., Executive Director]
Mike Kitces MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC an uber-financial services blogger over at www.Kitces.com had this to say about us in a recent essay: Finding Your Niche Or Specialization With Post-CFP Designations
The News Essay
CMP (Certified Medical Planner) – The CMP™ designation was created by Dr. David Edward Marcinko MBA CMP™ [reformed CFP®] and the team at the Institute of Medical Business Advisors, Inc., (who also produced the “Financial Planning Handbook for Physicians and Advisors“). It is intended for advisors who aim specifically to serve physicians and the medical community. Content focuses not only on the insurance and investment issues relevant to physicians, but also provides an understanding of the business of medical practices themselves so advisors can help work with their physician clients to have more successful businesses as well.
CMP™ Practitioner Testimonials
I am happy to give my unbiased, unpaid opinion on the CMP™ program to anyone considering the course.
David K. Luke MS-PFP, MIM, CMP™ [Net Worth Advisory Group]
9980 South 300 West, Suite 110 Sandy, Utah 84070
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CMP™ Practitioner Testimonials
I am in favor and support the CMP™ program and curriculum … but just like any other academic curriculum, it is an “accretive academic” program rather than an instant “change of life” program. I use the material that I learned on a regular basis, but I cannot say that I use it every day. You will be more able to “talk-the- talk” of the physicians if you have completed the CMP™ curriculum. I would do it again!
Savant recently hired a physician, Dr. Brian Knabe MD as an advisor. He is leaving the medical field, transitioning out, and entering the field of financial services. He has enrolled in this curriculum. Let me know if you wish to discuss.
Thomas A. Muldowney MSFS CFP® ChFC CLU CRC CMP® AIF®
[Savant Capital Management, Inc®]
190 Buckley Drive – Rockford, IL 61107 Tel 815-227-0300 – Fax 815-226-2195
Assessment:
Link: What Comes After CFP Certification? Finding Your Niche Or Specialization With Post-CFP Designations
Visit: www.CertifiedMedicalPlanner.org
Visit: Enter the CMPs
Conclusion
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Filed under: CMP Program, iMBA | Tagged: CMP Program, CMP™ Course, savant capital management, www.CertifiedMedicalPlanner.org | 1 Comment »
A Fruitful or Futile Endeavor?
[By Dr. David Edward Marcinko MBA CMP™
Some medical professionals, or their financial advisors, believe they are “smarter than the market” and can time when to jump in and buy stocks or sell everything and go to cash.
A Tale of Two Physician Investors
Wouldn’t it be nice to have the clairvoyance to be out of stocks on the market’s worst days and in on the best days? Consider these two doctors.
The Good Stats
Using the S&P 500 Index, our agile imaginary MD investor managed to steer clear of the worst 12.42% annualized return (including reinvestment of dividends and capital gains) during a recent 20+ years time frame, sufficient to compound a $10,000 investment into $107,100.
The Bad Stats
But, what about another unfortunate DO investor that had the wonderful mistiming to be out of the market on the best day of each year. This ill-fated investor’s portfolio returned only 4.31% annualized from Jan. 1992-March 2012, increasing the $10,000 portfolio value to just $23,500 during the 20 years.
Assessment
The design of timing markets may sound easy, but for most all investors it is a losing strategy: http://www.CertifiedMedicalPlanner.org
Conclusion
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Take the Medical-Economics poll, and let them know what you think about the pending ICD-10 delay. » Click here to Vote
Filed under: CMP Program, Investing | Tagged: CMP™ Course, David E. Marcinko, market timing | 3 Comments »
A Fiduciary Moniker?
[By Dr. David Edward Marcinko MBA CMP®]
Investment fiduciaries and professionals are constantly exposed to legal and practical scrutiny — it comes from multiple directions and for various reasons.
And, it is likely that complaints and/or lawsuits alleging investment mismanagement will continue to increase.
Although some of these allegations may be justified, many can be avoided by having clear knowledge of who constitutes a fiduciary and what is required of one.
AIF® Designation Training
The AIF Designation Training and designation help mitigate this liability by instructing in practices that cover pertinent legislation and best practices. The Accredited Investment Fiduciary® (AIF®) designation represents a thorough knowledge of and ability to apply the fiduciary practices.
And, did you know that all Certified Medical Planners® are fiduciaries for their clients? http://www.CertifiedMedicalPlanner.org
Assessment
So all FAs, feel free to check em’ out at: http://www.fi360.com/
More:
Conclusion
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Filed under: CMP Program, Ethics, Investing | Tagged: AIF® Designation, CMP™ Course, fiduciary, prudent man rule, suitability rule | Leave a comment »
Discerning the “Best Emerging Practices” in Financial Planning for Doctors and Health Professionals
http://www.CertifiedMedicalPlanner.org
By Ann Miller RN MHA AdviceforDoctors@Outlook.com
[ME-P Executive Director]
The Medical Executive-Post occasionally fact-checks and codifies the posts and comments of our readers, subscribers and other experts in order to present them in book form. This is a form of academic, or cognitive, crowd-sourcing. It might also be called a form of private Wikipedia styled information gathering. We may use it to create new books, up-date prior books, or fill in the gaps of books-in-progress.
Book Reviewers
And so, we are requesting informed [MD-DO-DDSs] doctors and [FA, CFP, CPA, CMP, PhD, CFA or MBA] related folks, or other knowledgeable readers and subscribers to review the Table of Contents of our current project, now under review. We wish to ensure no important topics of interest are omitted for modernity. Editorial writing and assistance will be provided.
www.CertifiedMedicalPlanner.org
Our ME-P Book Review Format:
An easy to follow, and typical book review format, usually starts with the preliminaries such as stating the title of the book, its author, place of publication, publisher, date of publication, and the number of pages. This is completed by us.
What follows next is the making of an introduction to at least give the readers a preview of the review. It is sometimes followed by background information of the book in order to set out criteria in judging a book.
This includes the author’s basic information such as the era in which he wrote the book, or how it relates to his life experience.
Then it is followed by writing a short summary of the content or text of a novel, history book, or any other type of book.
Testimonials, Too!
Crafting a brief, 2-3 sentence, informal testimonial is also needed.
Assessment
This is highly confidential peer-reviewed styled publishing; do not disclose material. MarcinkoAdvisors@msn.com
Conclusion
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DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Filed under: Book Reviews, CMP Program, iMBA, Inc. | Tagged: certified medical planner, CMP™ Course, financial advisor, Financial Planning | 2 Comments »
Understanding the Difference
By Dr. David Edward Marcinko MBA CMP™
GOAL: To understand the difference between fiduciaries and non-fiduciaries, examine the SEC conduct rules.
Stock-Brokers (non-fiduciaries) are subject to FINRA Conduct Rule 2310(a) which reads:
In recommending to a customer the purchase, sale or exchange of any security, a member shall have reasonable grounds for believing that the recommendation is suitable for such customer upon the basis of the facts, if any, disclosed by such customer as to his security holdings and as to his financial situation and needs.
A fiduciary follows a higher standard of conduct:
A fiduciary duty is an obligation to act in the best interest of another party. A fiduciary obligation exists whenever the relationship with the client involves a special trust, confidence and reliance on the fiduciary to exercise his discretion or expertise in acting for a client. A person acting in a fiduciary capacity is held to a high standard of honesty and full disclosure in regard to the client and must not obtain a personal benefit at the expense of the client.
Five primary responsibilities as a fiduciary to clients are:
More:
Assessment
Conclusion
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DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Filed under: CMP Program, Investing | Tagged: CMP™ Course, fiduciary advisor, financial advisors, SEC, stock-brokers, www.CertifiedMedicalPlanner.org | 6 Comments »
By Ann Miller RN MHA [ph-770-448-0769]
[Executive-Director]
Dear Stock Brokers, IBs and Securities Analysts,
Greetings from the Institute of Medical Business Advisors, in Atlanta, Georgia.
Historical Review
As you may know, we released: Financial Planning Handbook for Physicians and Advisors, some time ago. It has enjoyed much success and acclaim in the medical and financial service sectors.
Recently, we have been asked to produce the next edition of this book for our target market of physicians, nurses, medical professionals, healthcare administrators – and those in the financial services sector who target this large and fertile, but rapidly changing niche market.
Why Now?
Urgency for the update has been prompted by ARRA, HI-TECH, the flash-crash of 2008 and the day-crash of 2011; by social, macro-economic and demographic changes; by political fiat and especially the PP-ACA.
Our medical colleagues are frustrated, afraid and fearful for their financial futures. They WANT informed advice.
Thus, true integrated financial planning information that targets this market – very expertly and specifically – is greatly needed.
The Invitation
And so, we ask if you are interested in contributing an updated vision of an existing book chapter.
Not to worry – The original MS-WORD® chapter files are archived and available for use. We will forward it to you, upon assignment acceptance.
And, we are again fortunate that our Editor-in-Chief will be Dr. David Edward Marcinko FACFAS MBA CMP™ along with Professor Hope Rachel Hetico RN MHA CMP™ serving as Managing Editor.
They opined at a recent interview for the ME-P.
” … We have entered into an emerging era in the financial planning ecosystem. It is a new era where one size does not fit all; and off-the-shelf financial products and mass sales customization is no long adequate for physicians and medical professionals; or their related generic financial planners or wire-house advisors.
It is a period of rapid change, shifting reimbursement paradigms and salary reductions that focus the healthcare industrial complex on pay-for-performance [P4], compensation for value and quality care; rather than procedures performed and quantity of care.
All must learn to do more with less professionally; and plan their personal financial lives more efficiently than ever before. Mistakes will be more difficult to overcome and the wiggle room that high income earning physicians, nurses and medical professionals used to enjoy is being narrowed by demographic, economic, social, technological and political fiat.
This emerging financial planning analog follows the health industry’s fiscal metamorphosis …”
Style Instructions
The look and feel, format and style, and font and size of the book will remain the same. We use endnotes, not foot notes; and include mini-case reports or illustrative case models. It will be a major text; not a handbook.
Timeline for submission is about 3 months. Additional time is available, if needed, for a comprehensive update. But, we are trying to avoid running too far along into 2014 in order to avoid income tax season and the related time constraints on all concerned.
A Pleasure – Not Burden
This should be a pleasurable project for you; and not anxiety provoking.
So, if you are a medically focused and experienced financial advisor with an: MBA, CFP®, PhD, MD, DDS, MSA/MS, CPA, RN, CMP®, DO, JD and/or CFA degree or designation, etc; please let me know if you are interested in updating and revising our chapters. OR, authoring a new to the world chapter.
Your Payback
In return for your conscientious industry, you will receive a complimentary edition of the entire textbook; be listed on this ME-P as thought-leader with related book advertising content attributed to you; and given e-exposure to our almost 600,000 readers and ME-P subscribers …. Such the deal!
And, you will be added to our roster of experts for potential referrals, interviews, pod-casts and other marketing efforts
Assessment
Regardless of your decision, we remain apostles promoting your core vision of physician focused financial planning whenever possible.
Or, you may suggest another possible author- writer-expert contributor; if you wish.
Just let me know; ASAP [MarcinkoAdvisors@msn.com]
Thank you.
ANN
ANN MILLER RN MHA
[Executive-Director]
INSTITUTE OF MEDICAL BUSINESS ADVISORS, INC.
Suite #5901 Wilbanks Drive
Norcross, Georgia, 30092-1141 USA
[Ph] 770.448.0769
DICTIONARIES: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
NOTICE: This invitation is not for all readers of the ME-P. It is a privilege invitation intended for those who possess the needed credentials, as decided by us, with an inclination to serve. We reserve the right to accept or reject contributors, and content, at our own non-disclosed discretion.
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Filed under: "Advisors Only", Career Development, CMP Program, Financial Planning, iMBA, Inc., Investing, Portfolio Management, Recommended Books, Retirement and Benefits, Taxation | Tagged: About iMBA Inc., authors needed, certified medical planner, CMP, Dr. David Marcinko, financial planning for doctors, hope hetico, invitation | 18 Comments »
Well-intentioned attempts to protect consumers backfire?
By Rick Kahler CFP® http://www.KahlerFinancial.com
Integrity. Trustworthiness.
A commitment to clients’ best interests. These are all essential qualities for any advisor you entrust with your financial affairs.
One clue to financial planners’ trustworthiness is the certifications they hold. Designations such as CFP® (Certified Financial Planner) and Chartered Financial Consultant (ChFC) require adhering to certain professional standards and codes of ethics.
The organizations that maintain these standards safeguard the integrity of their professional designations and especially the well-being of consumers who seek out their members’ services. Yet sometimes, their well-intentioned attempts to protect consumers can backfire.
New Rules
The CFP® Board recently adopted new rules meant to prevent financial planners from calling themselves “fee-only” while still receiving commissions by selling financial products through separate companies. Now, CFP®s and members of their families can no longer own an interest in financial service companies that earn commissions if they wish to brand themselves as “fee only.”
This would be good, except the Board has cast its net so wide that it is catching the dolphins along with the sharks. It defines “financial service company” too broadly, including real estate firms, mortgage companies, and property management companies. It also illogically focuses on what clients could pay and what the planner could receive, rather than what clients do pay and what the planner does receive.
Example:
I have a minority interest in and occasionally receive dividends from a real estate brokerage and a property management firm. While I do maintain a license as a real estate broker, I am not active in the business. Because I could potentially receive a commission for selling real estate and because I do receive dividends, I’ve been told by a representative of the CFP® Board that I can no longer call myself “fee only” and must advertise myself as a “fee and commission” financial planner.
This would dishonestly insinuate I sell mutual funds, life insurance, or annuities. “Fee-only,” which to consumers means I sell no financial products, is much more accurate.
Disgruntled Calls Growing
I’ve received calls from other CFP®s affected in similar ways by the new rules.
Example:
One is a young fee-only planner who does not sell any financial products or own a portion of any company that does. Yet, he recently married a woman who owns a minority interest in her family’s property casualty insurance company. She holds an insurance license but does not work in the business. Because she, a “related party,” could legally receive commissions, her husband can no longer hold himself out as a “fee-only” CFP® and must list himself as a “fee and commission” planner.
Is the CFP-BOD, and the CFP® mark, in Jeopardy? [VOTE]
If a financial planner’s clients pay only fees and do not purchase financial products like mutual funds, insurance, and annuities from a related company, the CFP® Board needs to designate the planner as “fee only.” The same applies to planners who maintain financial services licenses (as those in Illinois must if they give insurance advice) but do not receive commissions. The CFP® Board should not consider companies that offer services unrelated to financial planning, such as selling and managing real estate or originating mortgages, as financial services companies.
I understand and fully support the CFP® Board’s intent to stop those who were abusing the brand of “fee only.” Yet the Board’s rules in their present form will only devalue the CFP® designation.
Assessment
It appears the only way I can continue to honestly advertise my practice as “fee-only” is to terminate as a CFP®. What’s most important for me is to be seen as a fiduciary planner, working with integrity in the best interest of my clients. I won’t dishonestly brand myself as a “fee and commission” planner to keep my CFP® designation.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
Filed under: Breaking News, Career Development, CMP Program | Tagged: certified financial planner, CFP Board, Chartered Financial Consultant, ChFC, Rick Kahler CFP® | 10 Comments »
And … Why the American Medical News was Shuttered after 50 Years!
[Some Musing on our Eighth Anniversary]
Ann Miller RN MHA
[Executive-Director]
According to well known healthcare industry journalist Kevin B. O’Reilly, a dramatic drop in medical-publishing revenues caused the recent closure of the American Medical News, effective with a final edition of the newspaper published just last month.
Published for more than five decades, AMNews was hit hard by industrywide trends. The newspaper’s revenue fell by two-thirds during the last decade, as reported by Thomas J. Easley, senior vice-president and publisher of periodic publications for the American Medical Association [AMA].
Unsustainable financial losses forced the move despite the newspaper’s editorial quality, the AMA’s senior management reportedly said. But, the Association’s other news operations will be enhanced.
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How we survive!
We’ve been online for eight years now. We have a skeleton staff, a scalable business model, an almost free distribution model, no print analog, and a tiny electronic advertising revenue stream.
Oh, let’s not forget some brilliant essayists, contrarian contributors, insightful commentators and controversial opinions that are often the elephant in the virtual room.
Our gratitude to you all is without limits.
So, how else do we do it?
Interestingly – Our print books are good, better and best sellers. We’ve been releasing one major, semi-peer reviewed text each year …. and sales are brisk. And, we are now negotiating to begin our next and ninth volume for 2014-15. We maintain our own copy-rights, perform in-house editing, seek out the best contributing authors, and reduce the cost of numerous channels of distribution. How do we do it, year after year? In a word, professional crowdsourcing.
Our consulting business is increasingly robust, too. Cudos to healthcare reform, managed care, and the PP-ACA!
And … another thing
I ask again. How do we do it? How do we stay in business?
Here are some more ways to help-us, do just that:
Bottom Line Eight Years Out
The ME-P is an austere … Labor of Love.
Please support us: Support the “Medical Executive-Post”
Printable Donation Form: Printable Donation Form
Electronic Donations: www.e-junkie.com/ecom/gb.php?c=cart&i=641232&cl=109140&ejc=2
Multi-Year Pledge Form: Multi-Year Pledge
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Assessment
So, does the demise of the American Medical News really say anything at all about the ME-P; in addition to the future of domestic medicine? How do we avoid the same fate? Please tell us. Question Everything … Trust No One … Paddle your Own Canoe … Keep the Faith!
Conclusion
Your thoughts and comments on this ME-P are appreciated. Did the AMNews forget the aphorism; No margin – No Mission?
Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
Filed under: CMP Program, iMBA, Inc., Marketing & Advertising, Op-Editorials, Touring with Marcinko | Tagged: AMA, american medical association, American Medical News, certified medical planner, CMP, institute of medical business advisors, Kevin B. O'Reilly, medical executive post, Thomas J. Easley | Leave a comment »
Book Reviews, with Testimonial, by ME-P Founding Publisher Dr. David Edward Marcinko MBA CMP®
PRESS RELEASE!
August 23, 2013 – CRC Press / Productivity Press is pleased to announce the publication of Accountable Care Organizations: Value Metrics and Capital Formation authored by nationally recognized healthcare expert, Robert James Cimasi. This dynamic book explores the historical background and evolution of the highly anticipated ACO model which is rapidly expanding since its adoption as part of the Affordable Care Act, commonly referred to as Obama Care. The book describes the basis for the development of value metrics and capital formation analyses that are foundational to assessing capacity for change in healthcare organizations considering the development of an ACO, as well as, the current efficacy of the model.
Book Reviews
“Bob Cimasi has done it again. As a thought leader in contemporary healthcare matters, his new book, Accountable Care Organizations: Value Metrics and Capital Formation, establishes and explains, in plain terms, the operational and financial DNA and genomic construct and understanding for any organization considering the development and operations of an ACO…a must read and resource for any healthcare industry executive.”
-Roger W. Logan, MS, CPA/ABV, ASA, Senior Vice President of Phoenix Children’s Hospital
“Accountable Care Organizations is the first comprehensive text on capital formation and value metrics for this new healthcare business model… I can think of no one more qualified to write it than Bob Cimasi at Health Capital Consultants … it is destined to become a classic work … read, review, refer, and profit by this valuable resource.”
-Dr. David Edward Marcinko MBA CMP® of the Institute of Medical Business Advisors, Inc Atlanta, GA
“As both a healthcare management educator and as a consultant who has worked on health and professional services transactional advisory work for many years, I applaud the ambitious undertaking of Bob Cimasi’s latest book, Accountable Care Organizations: Value Metrics and Capital Formation. Cimasi’s description of the complex history and evolution of the US health system provides a useful framework for students and professionals who may lack a detailed background in the field. This should help them better understand both how we have arrived at the ACO approach, and how it might work. This addressing capital and valuation information is also uncommon in the literature on ACOs. It should provide a valuable contribution to the field, especially given that a some surveys of healthcare leaders have pointed to access to capital and to a lesser but still important degree, agreement on valuation, as concerns as they consider acquisitions, mergers, and other affiliations towards forming/joining ACOs or similar organizations to help deal with the changing reimbursement and competitive environment.”
-R. Brooke Hollis, MBA/HHSA, Executive Director, Sloan Program in Health Administration, Cornell University and Managing Member, Hollis Associates Acquisition Advisors, LLC
The book examines the Four Pillars of Value in the Healthcare Industry: regulatory, reimbursement, competition and technology in addressing the value metrics of ACOs, including requirements for capital formation, financial feasibility, and economic returns. It focuses the discussion of non-monetary value on a review of aspects of population health within the context of such objectives as improved quality outcomes and access to care. It also examines the positive externalities of the ACO model, including results for third parties outside the basic construct of the ACO contracts shared savings payments. The potential role and opportunities for consultants in assisting their provider clients in the consideration, development, implementation, and operation of an ACO are also discussed.
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About the Author:
Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP® is CEO of Health Capital Consultants (HCC), a nationally recognized healthcare financial and economic consulting firm headquartered in St. Louis, Missouri, since 1993. Cimasi has more than 30 years of experience in serving clients in over 45 states, with a professional focus on the financial and economic aspects of healthcare service sector entities including feasibility analysis and forecasting; valuation consulting and capital formation services; healthcare industry transactions including joint ventures, mergers, acquisitions, and divestitures; certificate-of-need and other regulatory and policy planning consulting; and, litigation support and expert testimony.
Mr. Cimasi has served for many years as faculty in both an academic and professional basis for continuing education courses, and he has provided testimony before federal and state legislative committees and has served as an expert witness in numerous court cases. He is a nationally known speaker on healthcare industry topics, the author of several books, including A Guide to Consulting Services for Emerging Healthcare Organizations (John Wiley & Sons, 1999), The U.S. Healthcare Certificate of Need Sourcebook (Beard Books, 2005), The Adviser’s Guide to Healthcare (AICPA, 2010), and Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services (John Wiley & Sons, 2013), as well as numerous chapters, published articles, research papers and case studies, and is often quoted by healthcare industry press.
Source: HealthShareTV
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Filed under: Book Reviews, CMP Program, Health Economics | Tagged: Accountable Care Organizations, ACO, ACOs, certified medical planner, Cimasi, CMP™ Course, Health Capital Consultants LLC | 5 Comments »
Q&A With Dr. Brian Knabe of Savant Capital Management
By Ann Miller RN MHA
Brian Knabe MD CFP® CMP® is a former medical physician turned financial advisor at Savant Capital Management, a fee-only wealth management firm.
Here, he discusses the smartest moves for spine surgeons at various stages in their careers to ensure an enjoyable retirement.
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More
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Filed under: "Ask-an-Advisor", Breaking News, CMP Program, Retirement and Benefits | Tagged: "Ask-an-Advisor", brian knabe, healthcare reform, retirement plan, retirement planning, savant capital management, spinal surgeon, spine surgery | 2 Comments »
Understanding the “whole hospital exception” to the Stark laws
By Dr. David Edward Marcinko MBA CMP®
www.CertifiedMedicalPlanner.org
This was a big week for healthcare reform, wasn’t it? Some provisions of the PP-ACA requiring the employer mandates were delayed another year; until January 1, 2015.
But, before passage of the ACA in 2010, the “whole hospital exception” to the Stark law allowed physicians to have an ownership interest in a hospital to which those physicians refer patients, provided the physician is invested in the whole hospital and not a subdivision of the hospital, with no limitations as to the amount or extent of physician ownership, on either an aggregate or individual basis.
Prohibitions
Now, according to colleague Robert James Cimasi MHA, AVA, ASA, MCBA, CMP®, of www.HealthCapital.com, The ACA completely prohibits physician-owned hospitals which were not Medicare-certified by December 31, 2010.
[1] The ACA allows hospitals with a provider agreement prior to December 31, 2010 to continue Medicare participation if they meet the following four criteria: (1) located in a county with a population growth rate of at least150% the state’s population growth over the last 5 years; (2) have Medicaid inpatient admission percentage of at least the average of all hospitals in the county; (3) located in a state with below-national-average bed capacity; and, (4) have bed occupancy rate greater than state average. [2]
Grandfathered
A very limited number of physician-owned hospital existing in 2010 met or were close to meeting all 4 of criteria.[3] The Reconciliation Act provided a limited exception to the ACA growth restrictions for grandfathered physician owned hospitals that treat the highest percentage of Medicaid patients in their county (and are not the sole hospital in a county).[4]
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Assessment
Based on these provisions, the 2010 healthcare reform legislation will likely have a considerable negative impact on physician-owned hospitals, in terms of impeding development of new hospitals and expansion of existing hospitals.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Health Dictionary Series: http://www.springerpub.com/Search/marcinko
Practice Management: http://www.springerpub.com/product/9780826105752
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
[1] “Section-by-Section Analysis with Changes Made by Title X and Reconciliation included within Titles I-IX,” Democratic Policy Committee, http://dpc.senate.gov/healthreformbill/healthbill96.pdf (Accessed 5/24/2010).
[2] “Section-by-Section Analysis with Changes Made by Title X and Reconciliation included within Titles I-IX,” Democratic Policy Committee, http://dpc.senate.gov/healthreformbill/healthbill96.pdf (Accessed 5/24/2010).
[3] “Healthcare Reform: A Brief Analysis on How it Impacts ASCs and Physician-OwnedHospitals – 10 Observations”, By Scott Becker, Leigh Page, and Rob Kurtz, Becker’s Hospital Review, http://www.beckersorthopedicandspine.com/news-a-analysis/legal-a-regulatory/1193-healthcare-reform-abrief- analysis-on-how-it-impacts-ascs-and-physician-owned-hospitals-10-observations (Accessed 5/20/10).
[4] “Section-by-Section Analysis with Changes Made by Title X and Reconciliation included within Titles I-IX,” Democratic Policy Committee, http://dpc.senate.gov/healthreformbill/healthbill96.pdf (Accessed 5/24/2010).
Filed under: CMP Program, Health Economics, Practice Management | Tagged: ACA, CMP, Dr. David Marcinko, physician owned hospitals, Reconciliation Act, robert james cimasi, Stark law, www.CertifiedfMedicalPlanner.org | 2 Comments »
Call for Guest Medical Executive-Posts!
By Ann Miller RN MHA
[Executive-Director]
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Now that we’ve wrapped up our newest textbook, we thought it would be fun to keep everybody writing to share your best posts and comments with our ever-growing online community.
### We’re open to all kinds of related subjects on the business of medical practice, healthcare economics and finance, HIT and personal financial planning and investing for doctors and all medical professionals. ### So, if you’d like to comment or be a featured guest on our blog, or know of a great post we should feature or re-print, just let us know by emailing me! BROADCAST yourself.
www.CertifiedMedicalPlanner.org### |
Filed under: Book Reviews, CMP Program, iMBA, Inc. | Tagged: certified medical planner, CMP, Medical Executve-Post | 4 Comments »
One Expert’s Opinion
By Ann Miller RN MHA
[Managing Editor]
The ME-P and nation recently celebrated National Hospital Week for 2013. And so, what better time than now to ask health economist and financial expert Robert James Cimasi MHA, ASA, AVA, CMP for his take on the industry outlook. www.HealthCapital.com
History Background and Overview
The U.S. Healthcare Delivery System is facing what is perhaps its greatest challenge in the expected demand for increased health services from the aging of the “baby-boom” generation, the fastest-growing segment of the population.
The enactment of healthcare reform in March 2010, requiring increased insurance coverage requirements for individuals and employers, will also increase patient demand for hospital inpatient and outpatient services in the coming years.
Hospital Industry
The hospital industry continues to face many challenges in the changing healthcare environment, including workforce shortages, rising healthcare costs to provide care, and difficulty acquiring needed capital. With consistent financial stresses, hospitals in some areas appear to be struggling.
However, general acute-care hospitals recorded record high profits of $35.2 billion in 2006, an increase of over 20% from 2005. Total net revenues for general acute-care hospitals were $587.1 billion, resulting in an average profit margin of 6% (the highest since 1997, when the average profit margin was 6.7%).
While the demand for healthcare continues to rise, the site of service also continues to evolve as more procedures are performed on an outpatient basis and by freestanding facilities rather than by inpatient acute care hospitals. As evidence of this trend, the number of freestanding ambulatory care surgery centers increased from 2,864 in 2000 to 5,197 in 2006.
U.S. healthcare costs are again increasing after their rate of growth slowed in the mid-1990s.
In 2009, total national health expenditures (NHE) in the U.S. grew to $2.5 trillion, a 5.7% increase from 2008. Meanwhile, the nation’s gross domestic product (GDP) shrank by 1.1%, and as a result, NHE increased from 16.2% to 17.3% of the GDP: the largest one-year increase-in history. Additionally, healthcare spending has been projected to grow to 19.6% by 2016. The potential impact of the 2010 healthcare reform legislation to reduce rising healthcare expenditures is yet uncertain.
According to a 2002 study conducted by the Blue Cross and Blue Shield Association (BCBSA), inpatient costs are responsive to hospital market organization. Each 1% increase in for-profit hospital market share is associated with a 2% increase in inpatient expenditure per person. Conversely, each 1% increase in network hospital market share corresponds to a 1% decrease in inpatient expenditures.
Risk Sharing
As healthcare costs again continue to rise faster than inflation in the overall economy in 2013, driven by advances in technology and treatment (as well as the growing baby-boomer population), pressures to reduce costs, such as those included in the ACA will result in a changed paradigm for healthcare delivery.
Reimbursement mechanisms are increasingly designed to control costs and access, and hospitals must continually adjust to deal with increasing pressure to contain reimbursement and utilization levels; ie., share financial risks.
The Marketplace
The healthcare marketplace continues to experience dramatic change as the business of healthcare becomes increasingly competitive, particularly in the outpatient ancillary services arena. Providers and payors continue to seek to control costs and markets. Legal and regulatory issues also affect change as providers adapt to new opportunities and restrictions.
In particular, there are a wide variety of cost, operational, and regulatory pressures impacting the specialty and surgical hospital industry.
Of course, these pressures are offset by the stable and increasing demand for hospital services, particularly for those hospitals already in operation.
Assessment
Bob feels that hospitals that are operationally efficient will continue to be successful within this environment; others will not. How about you?
More: Arkansas Medical News Interviews Dr. Marcinko
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Health Dictionary Series: http://www.springerpub.com/Search/marcinko
Practice Management: http://www.springerpub.com/product/9780826105752
Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Hospitals: http://www.crcpress.com/product/isbn/9781439879900
Physician Advisors: www.CertifiedMedicalPlanner.org
Filed under: Book Reviews, CMP Program, Health Economics | Tagged: A Hospital Industry Outlook, ACA, Blue Cross and Blue Shield Association, david marcinko, GDP, national health expenditures, National Hospital Week, NHE, Robert Cimasi | Leave a comment »
Related chapters: Chapter 27: Salary Compensation and Chapter 29: Concierge Medicine and Chapter 30: Practice Value-Worth
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PERSONAL PREAMBLE
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Physician compensation is a contentious issue and often much fodder for public scrutiny. Throw modern pay for performance [P4P], and related metrics, into the mix and few situations produce the same level of emotion as doctors fighting over wages, salary and other forms of reimbursement.
This situation often springs from a failure of both sides to understand mutual compensation terms-of-art when the remuneration deal was first negotiated. This physician salary and compensation information is thus offered as a reference point for further investigations.
Introduction
More than a decade ago, Fortune magazine carried the headline “When Six Figured Incomes Aren’t Enough. Now Doctors Want a Union.” To the man in the street, it was just a matter of the rich getting richer. The sentiment was quantified in the March 31, 2005 issue of Physician’s Money Digest when Greg Kelly and I reported that a 47-y.o. doctor with 184,000 dollars in annual income would need about 5.5 million dollars for retirement at age.
Of course, physicians were not complaining back then under the traditional fee-for-service system; the imbroglio only began when managed care adversely impacted income and the stock market crashed in 2008.
Today, the situation is vastly different as medical professionals struggle to maintain adequate income levels. Rightly or wrongly, the public has little sympathy for affluent doctors following healthcare reform. While a few specialties flourish, others, such as primary care, barely move.
In the words of colleague Atul Gawande, MD, a surgeon and author from Brigham and Women’s Hospital in Boston, “Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of practice.” And so, it is critical to understand contemporary thoughts on physician compensation and related trends.
Compensation Trend Data Sources
A growing number of surveys measure physician compensation, encompassing a varying depth of analysis. Physician compensation data, divided by specialty and subspecialty, is central to a range of consulting activities including practice assessments and valuations of medical entities. It may be used as a benchmarking tool, allowing the physician executive or consultant to compare a practitioner’s earnings with national and local averages.
The Medical Group Management Association’s (MGMA’s) annual Physician Compensation and Production Correlations Survey is a particularly well-known source of this data in the valuation community. Other information sources include Merritt Hawkins and Associates; and the annual the Health Care Group’s, [www.theHealthCareGroup.com] Goodwill Registry.
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www.CertifiedMedicalPlanner.org
Assessment
However, all sources are fluid and should be taken with a grain of statistical skepticism, and users are urged to seek out as much data as possible and assess all available information in order to determine a compensation amount that may be reasonably expected for a comparable specialty situation. And, realize that net income is defined as salary after practice expenses but before payment of personal income taxes.
Conclusion
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FINANCE: Financial Planning for Physicians and Advisors
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Filed under: Book Reviews, Career Development, CMP Program, Practice Management, Practice Worth | Tagged: Atul Gawande, concierge medicine, david marcinko, doctor salary, Goodwill Registry, Greg Kelly, Health Care Group’s, Medical Group Management Associations, MGMA, More on the Doctor Salary Conundrum, P4P, physician income, physician's money digest, private pay medicine, www.BusinessofMedicalPractice.com, www.CertifiedMedicalPlanner.org | 18 Comments »
There is No Investing Crystal Ball
By Lon Jefferies, MBA CFP CMP™
As the Dow has risen greatly since March 9, 2009, some physicians and investors worry that the market is overheated and due for a severe pullback; as recently experienced very minor events have illustrated.
But, an opposing view is that the current price of the S&P 500 is comparable to its value in 1999, despite the fact that its earnings and dividends have doubled since that time, and suggesting the market has additional room to grow.
The Future is UnKnown
There is no crystal ball. What the stock market will do in the near future is anyone’s guess. As uncertainty is always a factor when investing, developing a portfolio that represents your risk tolerance and investment time horizon is critical.
Many physicians and investors realize they need to scale back the assertiveness of their portfolio as they approach retirement, but why is this important? The mechanics of an investment portfolio are very different for a portfolio in the distribution phase than for a portfolio still accumulating assets. If an investor is taking withdrawals from their account, it is much more difficult to recover from losses because distributions only serve to exacerbate the market decline.
Dr. Israelsen Speaks
As Craig Israelsen PhD points out in the February 2013 issue of Financial Planning Magazine with the following illustration, a portfolio enduring annual 5% withdrawals faces a much steeper climb back to break even after a loss than does an accumulation portfolio:
Clearly, the conclusion is if you are taking distributions from your account, or intend to do so soon, it is vitally important to avoid large losses. As it may be realistic for investors still accumulating assets to recover from a -20% loss by obtaining an average annualized return of 7.7% for three years, it is unlikely that a retiree taking distributions from his account will get the 16.5% annual return required for three years in order to recover from a similar loss.
Diversify
Protect yourself from unsustainable losses by maintaining adequate diversification within your portfolio. Bonds serve as a buffer against volatility and will likely decrease your loss during stock market corrections.
Additionally, ensure your portfolio has sufficient exposure to various asset classes: large cap, mid cap, and small cap stocks; US, international, and emerging market stocks; government, corporate, international, and emerging market bonds. Investing in multiple asset categories will protect your portfolio from a catastrophic loss next time a bubble in a market sector pops.
Assessment
Speak with a Certified Medical Planner™ or fiduciary and physician focused financial advisor to ensure your portfolio is assertive enough to meet your retirement goals while maintaining an acceptable level of risk. If you wait for the market to turn before taking action, it may be too late.
www.CertifiedMedicalPlanner.org
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: CMP Program, Investing | Tagged: certified medical planner, Craig Israelsen, DJIA, emerging market stocks, financial planning magazine, Investing, Lon Jefferies, NASDAQ, S&P 500, stock market crash | 4 Comments »
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