Why Practicing Medicine is More than just a Paycheck

Your Healthcare Career Evaluation

By Eugene Schmuckler PhD, MBA

By Dr. David E. Marcinko MBA

www.MedicalBusinessAdvisors.com

Studs Turkel, in his outstanding book Working, makes the comment that work is the mechanism by which many of us get our daily bread and our daily purpose. If this is to be the case then the workplace needs to offer us something more than a paycheck. The Wilson Learning Corporation surveyed 1500 people asking “If you had enough money to live comfortably for the rest of your life, would you continue to work? Seventy percent said that they would continue to work, but 60 percent of those said they would change jobs and seek “more satisfying” work.

Auto Career Advisor

Each of us has in fact been put in charge of our own careers. Our personal career management is a lifelong process. Our task is to be able to discover our place in the world where we will be able to enjoy a high level of wellness. This requires us to now assess our career, not from the eyes of the sixteen year old who initially chose the career. The career you are now pursuing needs to be compatible with your own unique skills, knowledge, personality and interests. It is important to keep in mind that no one is married to his or her job. When it comes to the workplace most of us are in dating relationships.

A Medical Career Worth Examined

As part of your examining your current medical career, answer the following questions: Why do you work? What does work mean to you? What do you want from work?

Research shows that most people work for three major reasons. The first of these is money. Not only is this necessary for our most basic needs it also serves as a means of determining our self-image. A second reason is to be with other people. Being at work enables us to belong, to be part of something beyond ourselves. We become part of a team. Some offices consider co-workers to be part of an extended family. The work setting affords us the opportunity for receiving feedback, recognition and support. The third most often given reason is that work validates us as people if we consider what we do as having meaning. “I chose the medical profession so as to make a difference.” Individuals with career success have a sense of purpose, a feeling that their work has meaning and contributes to a worthwhile cause. This is not a trick question. How well does what you do in your office every day meet your needs for money, affiliation and meaning?

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Job Purpose

Without a sense of purpose on the job the chances are that your performance while adequate will not place you in the excellent category. Therefore, it is necessary for each and every one of us to be able to succinctly answer the question, “What is the purpose of your job?” That is a tough question to answer.

As a medical professional you may have seen what you considered to be the purpose of your job radically changed due to changes in the way services are now delivered. While we cannot bring back the past we can work around the present. Think about this for a moment, “If you want something to happen make a space for it.”4 What this means that whether you remain in your current profession or move elsewhere there is a need for you to establish long-range, medium-range, short-range, mini, and micro goals.

Long Term

Long-range goals are those concerned with the overall style of life that you wish to live. Regardless of your current age these goals are necessary. Long-range goals don’t need to be too detailed, because like the federal budget surplus, changes will come along. Just as the government is making projections into the future you too need to be making projections including but not limited to retirement.

Medium Term

Medium-range goals are goals covering the next five years or so. These are the goals that include the next step in your career. These are goals over which we have control and we are able to monitor them and see whether we are on track to accomplishing them and modify our efforts accordingly.

Short Term

Short-range goals generally cover a period of time about one month to one year from now. These are goals that can be set quite realistically and we are able to see fairly quickly whether or not we are on track to reaching them. We don’t want to set these goals at impossible levels but we do want to stretch ourselves. After all, that is the reason you are probably reading this chapter.

Mini-Goals

Mini-goals are those goals covering from about one day to one month. Obviously we have much greater control over these goals than you do over those of a longer-term. By thinking in small blocks of time there is much more control over each individual unit.

Micro-Goals

Micro-goals are goals covering the next 15 minutes to an hour. These are the only goals over which you have direct control. Because of this direct control, micro-goals, even though modest in impact, are extraordinarily important, for it is only through these micro-goals that you can attain your larger goals. If you don’t take steps toward your long-range goals in the next 15 minutes, when will you? The following 15 minutes? The 15 minutes after that? Sooner or later, you have to pick 15 minutes and get going. At some point procrastination has to be put aside.5

Personal Assets Evaluation

In thinking of your goals it now becomes necessary to evaluate your personal assets. Conducting this personal inventory requires you to identify your assets as well as your shortcomings. First, look at a time in your life when you were performing at your best. What were your thoughts and feelings? How did you behave? What were you doing? Now look at the reverse when you were doing poorly. What were your thoughts and feelings at that time? How did you behave? What were you doing?

If you are like others when you were at your best you described yourself as being confident, enthusiastic, organized, relaxed, focused, in control, friendly and decisive. The flip side, when at your worst you were fearful, apathetic, messy, anxious, lacking direction, out of control, argumentative and frustrated.

As you can see the emotions when we are at our best are all positive. This leads to the conclusion that it is to our advantage to be at our best as much as possible. Being at our best derives from working in those areas where we contribute our talents to something we believe in.  As we continue our own personal inventory we need to look at our special abilities. That is, what are you good at and find easy to do. Think of the following questions. It’s not necessary to write down you answers just think about them.

  1. How would you like to be remembered?
  2. What have you always dreamed of contributing to the world?
  3. Looking back on your life, what are some of your major contributions?
  4. When people think of you, what might they say are your most outstanding characteristics?
  5. What do you really want from your life and your work?
  6. In what way may you still feel limited by the past? If so, by what?
  7. What will it take to let go of what has happened, no matter how good or bad? Are you willing to let go?
  8. How might the rut of conformity or comfort be limiting you? Why?
  9. How different do you really want life to be? Why.
  10. Have you ever stated what it is you truly desire? If no, why not?
  11. How good could stand life to be?

doctors

Career Changers

Thinking about remaining in your present career or moving into another one is not easy. You are at the edge of a cliff and need to decide if you are going to turn back or to trust in yourself to successfully make it down to the bottom. People who are afraid of the dark lose their fear with just the slightest of a light in the room. As you have been going through this chapter you have been shining a light, however dim it may appear to you. You can see all of the items around you. The obstacles are there but with your advance knowledge you can anticipate ways to avoid them.

Personal Analysis

Having looked at and possibly re-evaluated your plans you can now do a thorough analysis of your assets. The assets requiring the most scrutiny are the following:

  1. Your talents and skills
  2. Your intelligence
  3. Your motivation
  4. Your friends
  5. Your education
  6. Your family

Your talents and skills are more than likely what has gotten you to the point you are at in your present career. For purposes of definition talents are innate, skills are acquired. Some have talent in interpersonal relations and some in artistic pursuits. Skills may be selected to complement the already present talents. It is skills that are necessary for expanding your options. As you seek out new skill areas ask yourself these questions. Do the skills provide occupational relevance? Might you be able to get others to pay you to teach them the skill? Will the skill be useful throughout life? Will the skill help you conquer new environments and gain new experiences? And, of course, Is it something you like to do?

Intelligence

Intelligence is considered to be the ability of the individual to cope with the world. Originally, intelligence focused primarily in the area of cognitive skills. Recently attention has been directed to what is called emotional intelligence, a concept that directs attention to social skills. Whether you were able to breeze through your courses in college or you truly had to work hard, earning your degrees demonstrates a better than average amount of cognitive intellectual ability. In order to maximize your brainpower, challenge yourself regularly.

Motivation

Motivation looks at how hard you are willing to work, your level of persistence, and the degree to which you want to do well. Different things motivate each of us and our personal motivators can vary from day to day. How many times have you had people say that they could not do your job? What are the activities that are attractive to you? More than likely an important motivator for you is to do something worthwhile. It has also been found that we tend to perform at about the same level as those people who are close to us. What this means is that those people with whom you work are going to have s substantial impact on your motivation.

Friends

Friends of course are invaluable assets. We use our friends as models for our own behavior. Those persons we consider friends share many of our attitudes, actions and opinions. With time we will change to be like our friends and they will change to become like us. Associating with those like us tends to temper our behavior. We try not to associate with the “wrong crowd” lest we become like them.

Education

Education needs to be ongoing. Recently, it was reported “all careers and businesses will be transformed by new technologies in often unpredictable ways. The era of the entrepreneur will make ‘boutique’ businesses more competitive with the behemoths, as mid-sized institutions get squeezed out. And medical break-throughs and the ongoing health movement will enhance-and extend-people’s lives.”[1] The implication of these changes is that new technologies often require a higher level of education and training to use them effectively and new biotechnology jobs will open up. The authors state that all the technological knowledge we work with today will represent only 1 percent of the knowledge that will be available in 2050. The half-life of an engineer’s knowledge today is only five years; in ten years, 90 percent of what an engineer knows will be available on the computer. In electronics, fully half of what a student learns as a freshman is obsolete by his or her senior year. The implication here is that all of us must get used to the idea of lifelong learning.

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Assessment

Finally, family influences who and what we are and do. They can be a support group or they can be a deterrent to your goals. It is incumbent on every individual reading this chapter to consult with immediate family members at all stages of your career planning process.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What career stage are you in currently; and are you satisfied-why or why not? Is practicing medicine more than a paycheck?

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

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Note Dr. Gene Schmuckler is director of behavior economics for www.CertifiedMedicalPlanner.com, as well as www.MedicalBusinessAdvisors.com. He is an expert on physician career re-engineering, and a retired Professor of Organizational Behavior who taught Dr. Marcinko [our Publisher-in-Chief] in business school, almost two decades ago. He contributed the chapter on physician leadership and personal branding in the third edition of the upcoming book: www.BusinessofMedicalPractice.com to be released in the autumn of 2010.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko and Dr. Schmuckler, are available for seminar or speaking engagements.

Contact: MarcinkoAdvisors@msn.com

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4 Campbell, D. If You Don’t Know Where You are Going You’ll Probably End Up Somewhere Else, Niles, IL: Argus Communications, 1974.

5 Campbell, D. op. cit.

[1] The Futurist, March–April 2001.

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Understanding the Medical Career Choice!

Regrets and Recriminations – or Joy and Bliss?

By Eugene Schmuckler PhD, MBA

http://www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

www.MedicalBusinessAdvisors.com

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Jimmy’s mother called out to him at seven in the morning, “Jimmy, get up. It’s time for school.” There was no answer. She called again, this time more loudly, “Jimmy, get up! It’s time for school!” Once more there was no more answer. Exasperated, she went to his room and shook him saying, “Jimmy, it’s time to get ready for school.”

He answered, “Mother, I’m not going to school. There are fifteen hundred kids at that school and every one of them hates me. I’m not going to school.”

“Get to school!” she replied sharply.

“But, Mother, all the teachers hate me, too. I saw three of them talking the other day and one of them was pointing his finger at me. I know they all hate me so I’m not going to school,” Jimmy answered.

“Get to school!” his mother demanded again.

“But mother, I don’t understand it. Why would you want to put me through all of that torture and suffering?” he protested.

“Jimmy, for two good reasons,” she fired back. “First, you’re forty-two years old. Secondly, you’re the principal.”

Similar Physician Sentiments

Many of us have had conversations with medical colleagues at which time sentiments of those expressed by Jimmy have been voiced. The career choice that was made many years ago is now, for some reason, no longer as exciting, interesting and enjoyable, as it was when we first began in the field. The career that was undertaken with great anticipation is now something to dread.

The reason for this is occurrence is not that difficult to understand. Two of the most important decisions individuals are asked to make are ones for which the least amount of training is offered: choice of spouse and choice of career. How many college students receive a degree in the field they identified when they first enrolled at the college or university? In fact, how many entering freshmen list their choice of major as undecided? It is only during the sophomore year when a major must be declared is the choice actually made. So, career choices made at the age of 19 might be due to having taken a course that was interesting or easy, appeared to have many entry level jobs, did not require additional educational or professional training requirements, or was a form of the “family business.” Now as an adult, the individual is functioning in a career field that was selected for him or her by an eighteen-year-old.

Judging Career Success

How do we judge career success? A career represents more than just the job or sequence of jobs we hold in a lifetime. The typical standard for a successful career is by judging how high the individual goes in the organization, how much money is earned, or one’s standing attained in the medical profession.

Yet, career success actually needs to be judged on several dimensions. Career adaptability refers to the willingness and capacity to change occupations and/or the work setting to maintain a standard of career progress.  Many of you did not anticipate the managed care, Health 2.0, or political changes in your chosen medical profession, or specialty, when you began your training.

A second factor is career attitudes. These are your own attitudes about the work itself, our place of work, your level of achievement, and the relationship between work and other parts of your life.

Medical Career Identity

Career identity is that part of your life related to occupational and organizational activities. This is the unique way in which we believe that we fit into the world. Our career is only one part of our being. We play many roles in life each of which combine to make up or totality. At any point in time one role may be more important than another [life saving physicians versus retail sales clerk]. The importance of the roles will generally change over time. Thus at some point you may choose to identify more with your career, and at other times, with your family.

inheritance

Career Performance

A final factor is career performance, a function of both the level of objective career success and the level of psychological success.  How much you earn and your reputation factor into, and reflect, objective career success. To be recognized as a “leader” in a medical field and asked to submit chapters for inclusion in text-books, medical journals or new-wave blogs such as this may be a more important indicator of career success than money.

Psychological success is the second measure of career performance. It is achieved when your self-esteem, the value you place on yourself, increases. As you can see, there is a direct relationship between psychological success and objective success. It may increase as you advance in pay and status at work or decrease with job disappointment and failure. Self-esteem may also increase as one begins to sense personal worth in other ways such as family involvement or developing confidence and competence in a particular field, such as consistently shooting par on the golf course. At that point, objective career success may be secondary in your life. This is why many people choose to become active in their church or in politics. Even though one may have slowed down on the job, or in their professional career they can be extremely content with their life.

Case Model Scenario

Consider the following situation.

You are traveling on business. Although you are on a direct flight, you have a one-hour layover before the second leg of the flight and your final destination. Leaving the plane, after having placed the “occupied” card on your seat you walk down the concourse. On the way, you encounter a friend that you knew in high school. The two of you sit to have a cup of coffee and then you realize that your departure time is rapidly approaching. In fact, you will be cutting it quite close. Running down the concourse you return to the gate only to find that the door has been closed, the jetway is being retracted and the plane is being backed away from the gate. You stare out the window watching the plane go to the end of the runway and then begin its takeoff. Something goes horrible wrong and the plane crashes on takeoff, bursting into flames. It is apparent that there will be no survivors.

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Assessment

To the world you are on that plane (remember the occupied card). Traveling on business your generous insurance policy will be activated. In anticipation of being in a location where they may not have ATM machines you have a good deal of cash, sufficient for at least a month.

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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McNally, D. Even Eagles Need A Push, New York, NY: Delacorte Press, 1991.

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About the Covestor Mutual Fund Portfolio Sharing Service

Certified Medical Planner

What it is – How it works

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Covestor, with offices in New York and London, is a web platform started by entrepreneurs Perry Blancher, Richard Tachta and Simon Veingard http://www.covestor.com. Their belief was that salaried mutual fund managers have no monopoly on investment talent and shouldn’t have a lock on the rewards that come with investment success. As financial services, and online netizens, they also believed in democratizing the investment management industry and helping proven self-investors compete with the large institutions. This is known as the power of “crowd-sourcing.” All core philosophies seem to be shared by this ME-P.

What it is

According to their website, Covestor is both a portfolio sharing service for proven self-investors and for those wishing to track them; where data is private, secure and anonymous. With Covestor, one can coat-tail successful investors and follow their real trade activity. Or, have their moves auto-traded for you by Covestor Investment Management. Members can also keep track of their investments andBuild a free track record comparable to professional mutual funds. Members earn fees for their hard work, and Manage a model that their clients can mirror thru shared management fees.

Profit Sharing Investors

Covestor investors sharing portfolios include professionals, full time amateurs and industry specialists. They are a serious bunch with an average reported portfolio size of over $200,000 (excluding cash). Positions are typically held in over 5,000 different equities; are based in 50 countries and span the full range of ages, backgrounds and styles.

Issues

As a doctor-investor, health economist and former certified financial planner, there are at least three issues needed to be raised about this firm.

The first is SEC/NASD/FINRA rules and applicable SRO and state regulations for brokers, RIAs, FAs and related others? The status of suitability versus fiduciary accountability for ERISA regulated plans is also questioned. The third [and least important] is the potential negative impact on traditional financial services “professionals.”

In other words, is this another example of how technology will flatten the “intermediary curve” and reduce the profit of middle sales-men and sales-women? Oh! What about medical specificity for our target audience?

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Assessment

I am sure there are other issues as well. Your thoughts and comments on this ME-Pare appreciated; especially from financial services “professionals”, lawyers and FAs, etc, Give em’ a click and tell us what you think http://www.covestor.com?

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.

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On Disruptive Healthcare Innovators and Financial Industry Change Agents

Calling all Young Doctors, FAs and Medical Executives with “FLY”

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

In my real-job travels as a medical management consultant, speaker and physician focused financial advisor, my clients and their healthcare practices / financial services business models run the gamut from the sublime to the ridiculous; from pegboards to eMRs and clinical groupware; from cash/bond holders to hedge fund devotees and IPO junkies.

And, from broker-sharks and commissioned sales agents, to fee-only financial advisors and fiduciary RIAs. Fortunately, we see much more of what’s in-between than the latter [www.MedicalBusinessAdvisors.com and www.CertifiedMedicalPlanner.org

Business Analogy

Nevertheless, I am always struck by the fact that change and disruptive innovation [both positive and negative] seems to be within the realm of the young, rather than the more “mature” [sic].

Why? Younger folks just don’t seem to have the mental baggage and fear of failure that older counterparts seem to harbor. THINK: Janis Joplin: Freedom is just another word for nothing left to loose.

For example, Microsoft, Dell, Google, Yahoo, Facebook, Apple and Twitter, etc. No one told these young founders that “it can’t be done” – or – “we don’t do it that way around here.” Or, they did not listen to such talk. Unfortunately, this hubris [confidence or elan] is often just lost with age in the guise of political correctness.

Nevertheless, although started by folks in their youth, the professional management that most successful companies in the public domain ultimately require is from “older” folks.

Healthcare / Financial Services Analogy

Still, it is not surprising to learn that even some hospitals that house the most accomplished authorities in the fields of IT and quality care do not always follow their own advice when it comes to making improvements in the delivery of healthcare, or in their operational and delivery activities. THINK: Robert Wachter, MD.

And, it is not unusual for industries like the financial services and banking sectors, facing deep structural change, to be slow moving. THINK: Harry Markopolis.

Also, consider the auto industry – public education and labor unions – before the fall. Why – because the leaders of such sectors are typically promoted within, and because of past success, and not any ability to change the current environment?

IOW: They were hired for their ability to maintain the status quo, rather than for their ability to make constructive changes.

Assessment

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Do we call this need for young blood, the “theory of business evolution?” The dinosaur is dead … long live the dinosaur!

Moral: We can’t help getting physiologically old – but we can help getting cognitively old to the extent possible. Be disruptive – champion change – don’t settle and raise a little hell in the dual industries we love and serve!

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Get fly! Review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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On Employer Based Health Insurance Premium Costs

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One Client’s Comparative Expense Analysis Experience

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

Hospital Costs

A colleague posted an interesting essay recently on his blog The Incidental Economist. Austin Frakt PhD is a health economist with an educational background in physics and engineering. After receiving a PhD in statistical and applied mathematics, he spent four years at a research and consulting firm conducting policy evaluations for various federal health agencies. Here is the post.

Link: http://theincidentaleconomist.com/index.php?s=Kaiser%2FHRET+

The Survey

In his essay, Austin reported these figures from a cited survey:

“The 2009 Kaiser/HRET employer health benefits survey found that employees pay 17% of the $4,824 annual premium for single coverage and 27% of the $13,375 annual premium for family coverage (all average figures)”.

Case Report Model

So, if the survey is correct, it got me thinking about how much a long-time client paid as a doctor-employer, when she last practiced in a certain medical group back in 2000. And, especially about how much she would be paying today if still in business with the same group. This brief case-report with comparative expense analysis [CEA} is the up-shot.

My Client’s Story

Her health insurance premium costs including doctor-partners, was about $13,500 annually, per employee. This was a sunk cost, but an above the AGI line deductible business expense to the practice and entirely employer paid as a fringe benefit [all valid corporate expenses are deductible as there is no AGI line on a business tax return]. She and her three partners were both very magnanimous to their employees, and naïve. They became virtually insolvent a few years later and were bought out by a larger medical group for a pittance. Today, they are grunt employee doctors in a 25 plus physician group practice.

My Numbers

Now, if I crunched the numbers correctly as an citizen economist, on my HP12-C calculator, using health insurance inflation rates of 3%, 5% and 7% respectively for a decade [low], she would be now be paying somewhere between $18,143 and $21,990 and $26,556 in 2010 [dangerously assuming linear economics]. Each of her 15-18 employees at the time was a female, head of household, with 1-4 dependents of their own; no singles. Her own family unit included a professional husband and young daughter in private elementary school. They were the most health conscious of the bunch.

Her Situation

So, she left the group in 2000, and we transitioned her to solo private practice with a HD-HCP indemnity-styled [better] plan that pays 100% after her $5,000, and later $10,000, deductible. She has 100% prescription drug coverage, no OB coverage and no networks, second opinions or pre-certification requirements. Today, she has more than $50-K in the savings portion [cash account earning 3.5%, tax deferred].

Her Reaction

As she just turned age 55, there as was significant jump in her family coverage premiums from about $1,350/quarter to $1,650/quarter! Of course, her carrier offered a ten percent discount to $1,485 quarter, when she pitched a fit, and completed a health and wellness survey which “they” verified.

My Intervention

So, I used my “insider” knowledge as a doctor, financial advisor and insurance agent and went back to the open market place for coverage. Her new direct halth insurance coverage [she used a non-fiduciary insurance agent intermediary previously] is better, and her premium is only $1,248/quarter or about $5,000 annually to age 58. Bye, bye insurance agent. Link:  www.CertifiedMedicalPlanner.com

Now, if we use the non-inflated [a conservative unlikely scenario] 27% employee premium contribution for the present value projections of $18,143 and $21,990 and $26,556 today – each employee would be responsible for about $4,898, $5,937 and $7,170 respectively [please again recall both our conservative nature and the repeat danger of linear economic assumptions].

Where Did the Money Go?

So, under the 3-5% health insurance inflation scenario, my client would have been contributing about $5,417 for her heath insurance. This is very close to what she is annually paying now! So, where did the much larger employer’s contribution portion of the money go? Probably to overhead costs, marketing, advertising, sales and commissions, HR, high-risk pool premiums, ie … down the drain?

What did my client do with the monetary difference? Well, she paid all family doctor and drug bills that were under the high-deductible threshold; some went to her annual family health club membership dues, covered extras and various “wants and nice-to-haves”, and the remainder of course, went into her savings account portion. In other words … not down the drain.

There is an additional $1.000 “catch up” savings provision for those over age 55. She paid it – to herself.

The Road Ahead – More Expensive

I informed my colleague-client that there likely will be another big premium jump when she turns 58, 60 and age 62 respectively. We will report back to ME-P readers on market competition and related health insurance pricing at that time, ceteris paribus.

Assessment

Does the competitive open marketplace find a way to reduce HI costs– sooner or later? High Deductible HealthCare Plans were launched as a temporary pilot project in 1997 and initially sold poorly. In the past few years however, there has been a boom in HD-HCPs and the pilot project was made permanent. What other HI innovations may be in the future?

Of course, President Obama was against them in his original healthcare reform plan. But, now in his weakened political position, they seem acceptable to him. So, go figure. Utility depends on political winds, not economic efficacy, I suppose. 

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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Congratulations Harry Markopolos

A Future SEC Chairman?

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.com

Harry Markopolos is finally taking his victory lap. He is out hustling a new book about his nearly decade-long pursuit of Bernie Madoff, and rightful criticism of the Securities Exchange Commission [SEC].

And, he’s been on a whirlwind media and PR tour of sorts: CNBC, MSNBC, “The Daily Show with Jon Stewart”, etc. Still, we’ve written about him before on this ME-P

No Schadenfreude

According to one trade magazine essay, Markopolos finally seems relaxed and at peace. Bernie Madoff is in jail. The Feds are closing in on his accomplices. Markopolos clearly is having some fun. After being ignored for so long, he’s finally the center of attention – on his terms.

But to be sure, schadenfreude was not a philosophy taught to Harry and I, while students back-in-the-day, at Loyola University Maryland.

http://www.fa-mag.com/fa-news/5322-harry-markopolos-sec-chairman.html

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. In my opinion, Harry would be a much better SEC chairman than Mary L. Schapiro, the 29th SEC Chairman [January 2009] -or- Christopher Cox, the 28th Chairman [June 2005].

Dare I say it … I’m just wild about Harry.

So, FAs, investors and doctor colleagues; what do you think about Harry? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Access Management in the Hospital Check-In and Admissions Setting

The Role of Operational Activity Based Cost Management

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

www.HealthcareFinancials.com

In order to be paid and maintain cash flow, hospitals and clinics set up levels of specialization. The result is usually more handoffs, delays, eroding financial positions, and a frustrated set of patients and physicians. Much seems out of control. When you factor in the maze of Health Insurance Portability and Accountability Act (HIPAA) technologies, it becomes overwhelming. Now, consider these operational inefficiencies in light of Obama Care?

Access Management

At the hub of the patient hospital or clinic experience is admitting or registration. This department collects information for clinicians treating the patient, meets Joint Commission standards and other requirements, facilitates medical record documentation, patient flow, revenue capture, billing and collections, and ultimately begins to settle accounts. The access management area has numerous customers in addition to the doctor, patient, or family member sitting across from them.

Increasing HR Complexity

Without the benefit of relevant information, managers attempt to staff access management departments based on past history — namely, if patient and physician complaints are not too high, there is probably enough staff. However, staffing in access management has not kept up with the increased demands and complexity of the process, and other hospital areas often suffer. Clinicians and medical records personnel must often deal with incomplete or incorrect information, and take up the slack.

Beware Un-Happy Stakeholders

All of these deficits make for an unhappy set of customers (physicians and patients) as they continually live with the repercussions of inaccurate and incomplete information. This does not go unnoticed by patients and physicians, as these situations erode confidence in the hospital’s ability to get things done correctly.

Emotional Touch Points

Access Management is the clinic or hospital’s first chance to create an “emotional contract” with the customer. It is here that the tone is set for the patient on the issues with respect to his or her hospitalization. And it is here that the provider has the chance to begin working on the patient’s behalf so that clinical outcomes are appropriate. All of this must happen in an environment that minimizes the likelihood of an unfavorable occurrence, and outside the realm of the complex legal requirements established by state and federal officials.

Tips from the Manufacturing Sector

So why are there unresolved issues in the access management area? In a manufacturing environment, if there are problems on the front-end design, huge problems ripple downstream in terms of recalls, warranty-related expenses, lawsuits, and customers that abandon the company’s products. world -class manufacturers dealt with these issues with their ISO-9000, Total Quality Management (TQM), and Six Sigma programs during the ’80s and ’90s. Hospitals, however, have allowed issues in their access management process to fester and create huge and costly problems in the downstream process. 

Assessment

In an effort to help solve access management issues, every provider must take a proactive role in dealing with the trend. The first step in this journey is healthcare administrator and physician-executive assessment.

This assessment is not a management engineering set of time studies aimed at micro-costing every second of work. The critical path information needed for this plan is reasonable and collected in a few days by talking to the people performing the work. Estimates are gathered based on workers’ views about how they spend their time. This information is combined with available workload measures and general ledger cost information, and activity-based reports are produced.

Conclusion

Going forward, ABCM it is an exercise in operational planning. Activity-based information is used to look at areas where work can be restructured so errors and rework can be eliminated. New technologies that target problematic activities are selected and implemented. Outside companies that can perform complex activities more economically can be used (e.g., www.ICMS.net).

Join Our Mailing List

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Healthcare Organizations [A Journal on CD-ROM]

Journal of Financial Management Strategies

By Ann Miller; RN, MHA

[Executive-Director]

ADVERTISEMENT

www.HealthcareFinancials.com

All hospitals, healthcare systems and organizations use a variety of teaching, educational and didactic techniques to bring value to patients, payers, providers, governments and third-party intermediaries. This Intellectual Capital is the sum total of all knowledge and expertise used to serve society and stakeholders. Leaders, CXOs and employees provide almost all of this Intellectual Capital.

Our Beliefs 

We believe that Healthcare Organizations: [Journal of Financial Management Strategies] adds to this Intellectual Capital by guiding you, empowering your organization, and creating value for your patients, employees, investors and clients by bridging the intersection of medical mission and profit margin.

Our Vision

To be the pre-eminent interpretive guide for financial management strategies, and the enduring business analytics guide for all healthcare organizations; and to promote related enterprise-wide health economics initiatives.

Our Mission

Healthcare Organizations: [Journal of Financial Management Strategies] promotes and integrates academic and applied research, and serves as a multi-disciplined forum for the dissemination of economic, financial, business, management, IT and administration information to all healthcare organizations; both emerging and mature.

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Assessment

Our goal is: “Bridging the Intersection of Medical Mission and Profit Margin”

Conclusion                                               

So, feel free to give em’ a click and be sure 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.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Understanding Hospital Community Essentiality

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Views Differ on this Important Concept

[By Calvin W. Wiese; CPA, CMA, MBA]

An important component of hospital financial analysis is essentiality. Hospitals are unusual businesses that many times possess some form of essentiality to their communities. Healthcare is important to the economic vitality of every community. Many hospitals have served their communities for many years; it is not uncommon to find hospitals that have been continuously operating for more than 100 years in the same community.

Many Hospital Types

As we have discussed here and elsewhere, most hospitals are not-for-profit. In not-for-profit hospitals, no private party actually “owns” the hospital; control is vested in various boards, but no one explicitly “owns” a not-for-profit hospital. In a broad sense, communities own not-for-profit hospitals. They are considered “charities” with a “charitable purpose.” Though a not-for profit hospital may not have owners, it has many” stakeholders,” parties that have vested interests in the continuing success of the hospital.

Many Diverse Stakeholders

Many hospitals have broad and vast webs of stakeholders. Stakeholders are why hospitals rarely close or are shut down. Too many stakeholders have interests in the continuing successful operation of hospitals.

Hospital stakeholder relationships need to be considered in the analysis of essentiality. How strong are these relations? How many are there? How important is the continuing success of this hospital to these stakeholders?

Health Services Analysis

Another dimension of the essentiality is medical service analysis. For examples, how significant are the hospital’s services? If the hospital shuts down, what population segments would suffer? How significant is the population that would suffer? How much would they suffer?

Assessment

Analysis of hospital’s stakeholders and services should provide a credible view of the degree of essentiality associated with a hospital. Higher degrees of essentiality suggest higher likelihoods that hospitals, one way or another, will meet their commitments, particularly their payment commitments.

Conclusion

So, tell us what you think about your hospital’s essentiality? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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ME-P Advertising and Sales Opportunities

Sponsor the Medical Executive-PostME-P Sponsorship Networks

Now, you can reach out and impress more than 100,000 physicians and nurse-executives, financial advisors, CEOs and medical management consultants in the Health 2.0 space. Sponsor the ME-P. Increase your sales.

Our premium institutional e-journal: www.HealthcareFinancials.com and complimentary companion newsletter blog: www.HealthcareFinancials.wordpress.com has limited sponsorship and advertising opportunities available. So, be sure to act now!

Advertise with Us!

Reserve your space today. https://healthcarefinancials.wordpress.com/2007/11/11/advertise/

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Our Newest ME-P Milestone

Growing and Thriving – Thanks to You!

By Ann Miller; RN, MHA

[Executive Director]Congratulations

This month we passed the 145,000 reader mark. As you know, the ME-P was launched in 2007 and initially reached about a thousand Internet pioneers. It has grown exponentially, from our initial list-serve, to more than one hundred thousand readers and subscribers today.

A Thriving Community

The ME-P is now a thriving online and onground community that connects physicians with financial advisors and management consultants.

Our goal in the modern Health 2.0 era is to: “bridge the gap between medical mission and profit margin.”

Since inception, we have become one of the most popular and influential electronic networks in the healthcare administration, economics and financial planning space. 

Assessment

ME-P would like to thank all of our devoted readers, zealot subscribers, authors and participants as well as our advertisers for making this publication possible:

Channel Surfing

Join Our Mailing List

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First Annual iMBA, Inc Educational Cruise

Meet, Greet, Lunch and Learn from the Experts

By Ann Miller; RN, MHA

[Executive-Director]

CruiseSome time ago, a CPA, CFP® and fellow Certified Medical Planner™ suggested that we hold annual meetings, or education seminars, for all our colleagues. As a nascent organization at the time, this was considered a “pipe dream.” But, it may now become a reality depending on your response. All interested stakeholders are invited. 

 

The Cruise

Currently, we are soliciting interest in a – Princess – Caribbean cruise [Southern] for 2010. This would afford us the opportunity to meet  you on both a formal or informal basis. Educational and other activities would then be scheduled,  as-needed or requested. Departure from Ft. Lauderdale, Florida. All info subject to change without notice, at this time.

www.CertifiedMedicalPlanner.comcmp-logo

For example, activities could be arranged for CMP™ program credits in health economics and medical management; or simply on an ad-hoc [audit] informational basis. We will also attempt to individualize and accommodate personal situations and professional needs. 

Seeking Interest and Input

And so, your thoughts, ideas and comments on this Medical Executive-Post cruise idea and opportunity are appreciated. Please email me your ideas; or contact us for more information with details. Serious inquiries only:

MarcinkoAdvisors@msn.com

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Seeking Sponsors

Ship Solstice

We are also seeking sponsors for this cruise, and other iMBA corporate engagements.

https://healthcarefinancials.wordpress.com/2007/12/11/support-the-executive-post

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

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Health Insurance Prospective Payment System [HIPPS] Grouper Software and Documentation Codes

Enter the CMPs

Understanding Home Health Prospective Payment System (HH PPS) Case-Mix Refinement Changes

[By Staff Reporters]

AdvocacyA few operational changes were made to the V-Code Table in the updated version of the ICD-9-CM Official Guidelines for Coding and Reporting, including:

  • HH PPS grouper software and documentation (effective October 1, 2006): Contains Version 1.06 of the home health PPS case mix grouper software codes, which accommodates changes in OASIS reporting requirements effective 10/1/2006.  Also includes the grouper coding logic (pseudo-code), test records, and demonstration programs.
  • HH Consolidated Billing Master Code List: An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS.  A master list worksheet shows the dates each code included and excluded from consolidated billing editing on claims, with associated CMS transmittal references.  The master list also associates each code with any related predecessor and successor codes.  Supplemental worksheets show the list of included codes for each CMS transmittal to date.

Example:

The national unadjusted (wage index) per-visit rate payments paid per code were: [a] home health aide $44.37; [b] medical social service $153.55; [c] occupational therapy $105.44; [d] skilled nursing care $95.79 and [e] speech pathology $113.81.

Assessment

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Link: http://www.cms.hhs.gov/homehealthpps/downloads/transitionepisodesqa.pdf

Link: http://www.cms.hhs.gov/HomeHealthPPS/downloads/GuidanceforHHAs_Posting_12-18-2007.pdf

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.

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Launching the ME-P Tutoring Service

Seeking Academic Assistance in Health Economics, Finance and Administration

By Ann Miller; RN, MHA

[Executive-Director]ME-P Consulting

Enhanced knowledge and a better understanding of medical economics – healthcare finance and medical management – is at present central to more effective policy – making for better health services. We can provide a basic understanding of the key issues in health economics. You can either go online for tutoring or get your homework augmented/reviewed/completed through our assignment help service.

Email Based Homework or Employment Assignment Help in Health Economics

We may be the best resource to get answers to all your doubts regarding health economics, approaches to healthcare finance, medical practice management and other healthcare policy and administration specializations. You can submit your work, homework or assignments to us and we will make sure that you get the answers you need which are timely and also cost effective. Our tutors are available round the clock to help you out in any way with health economics and related topics. 

Live Online Tutor Help for Health Economics

We have a vast panel of experienced economics tutors who specialize in health economics and can explain the different theories to you effectively. You can also interact directly with our tutors for a one-to-one session and get answers to all your problems in other specializations in healthcare finance and medical management. Our tutors will make sure that you achieve the highest grades for your economics assignments. 

Assessment

Ideal for undergraduate and graduate students, practice managers, healthcare administrators, nurses, physician executives and employed laymen. Please contact us for competitive rates and premium prices for this personalize educational service: MarcinkoAdvisors@msn.com

Link: https://healthcarefinancials.wordpress.com/schedule-a-consultation/

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Health Administration Terms: www.HealthDictionarySeries.com

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Get the New ME-P Widget

Spreading ME-P Content and Informaton with our Gift to You

By Ann Miller; RN, MHA

[Executive Director]Our Gift

As someone who reads far too many medical, healthcare finance, political and health economics blogs on a daily basis, I decided to compile our ME-P blog RSS feeds into a nice, clean widget which you can quickly cut and paste into your own blog, wike or website.

Why Would you Want this Widget?

  • Easily keep up with latest ME-P posts and comments on more than 50 topical channels.
  • Spread goodwill throughout the blogo-sphere when you send visitors to other blogs.

Assessment

If you’re not tech savvy, we’ve done the hard work – just cut and paste and you’re done. Please e-mail me if you have any questions.

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Channel Surfing

Get more from www.BlogSurfer.US  Be sure to visit our other topic channels too! Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. 

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Why Most Financial Advisors Won’t be Fiduciaries

Industry Groups Differ On Fiduciary Standard

By Staff ReportersBenjamin Bills

The House Financial Services Committee recently heard two takes on the fiduciary standard – investment advisors who want it applied to broker dealers – and broker-dealers who want to apply a universal standard of care to all advisors, including investment advisors.

Assessment

And so, we encourage all ME-P subscribers to read industry trade magazines [aka ”trade rags”] to learn how some financial advisors fleece physicians and other investors by not being fiduciaries; with sincere apologies to all honest and hard working fiduciary advisors.Become a CMP IOW: Follow the money.

Link: http://www.financialadvisormagazine.com/fa-news/4532-industry-groups-differ-on-fiduciary-standard-.html

www.CertifiedMedicalPlanner.com

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. 

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Product Details  Product Details

 

Take the Hospital Endowment Fund Management Challenge!

Calling all Financial Advisors – Are You CMP™ Worthy?

By Staff ReportersBecome a CMP

After conducting a comprehensive fundraising program, the Hoowa Medical Center received initial gifts of $50 million to establish an endowment. Its status as the community’s only trauma center and neonatal intensive care unit causes it to provide substantial amounts of unreimbursed care every year. This phenomenon, together with the declining reimbursements and an estimated 6% increase in operating costs, leaves the Center with a budgeted cash shortfall of $4 million next fiscal year. Although the new endowment’s funds are available to cover such operating shortfalls, the donors also expect their gifts to provide perpetual support for a leading-edge medical institution.

The Treasurer

Bill, the Center’s treasurer, has been appointed to supervise the day-to-day operations of the endowment. One of his initial successes was convincing his investment committee to retain a consultant who specializes in managing endowment investments. The consultant has recommended a portfolio that is expected to generate long-term investment returns of approximately 10%. The allocation reflects the consultant’s belief that endowments should generally have long-term investment horizons. This belief results in an allocation that has a significant equity bias. Achieving the anticipated long-term rate of returns would allow the endowment to transfer sufficient funds to the operating accounts to cover the next year’s anticipated deficit. However, this portfolio allocation carries risk of principal loss as well as risk that the returns will be positive but somewhat less than anticipated. In fact, Bill’s analysis suggests that the allocation could easily generate a return ranging from a 5% loss to a 25% gain over the following year.

The Committee

Although the committee authorized Bill to hire the consultant, he knows that he will have some difficulty selling the allocation recommendation to his committee members. In particular, he has two polarizing committee members around whom other committee members tend to organize into factions. John, a wealthy benefactor whose substantial inheritances allow him to support pet causes such as the Center, believes that a more conservative allocation that allows the endowment to preserve principal is the wisest course. Although such a portfolio would likely generate a lower long-term return, John believes that this approach more closely represents the donors’ goal that the endowment provide a reliable and lasting source of support to the Center. For this committee faction, Bill hopes to use MVO to illustrate the ability of diversification to minimize overall portfolio risk while simultaneously increasing returns. He also plans to share the results of the MCS stress testing he performed suggesting that the alternative allocation desired by these “conservative” members of his committee would likely cause the endowment to run out of money within 20 to 25 years.

The Polarizer

Another polarizing figure on Bill’s committee is Marcie, an entrepreneur who took enormous risks but succeeded in taking her software company public in a transaction that netted her millions. She and other like-minded committee members enthusiastically subscribe to the “long-term” mantra and believe that the endowment can afford the 8% payout ratio necessary to fund next year’s projected deficit. Marcie believes that the excess of the anticipated long-term rate of return over the next year’s operating deficit still provides some cushion against temporary market declines. Bill is certain that Marcie will focus on the upside performance potential. Marcie will also argue that, in any event, additional alternative investments could be used as necessary to increase the portfolio’s long-term rate of return. Bill has prepared a comparative analysis of payout policies illustrating the potential impact of portfolio fluctuations on the sustainability of future payout levels. Bill is also concerned that Marcie and her supporters may not fully understand some of the trade-offs inherent in certain of the alternative investment vehicles to which they desire to increase the allocated funds.

Key Issues:

1. Given the factors described in the case study (anticipated long-term investment return, anticipated inflation rate, and operating deficit) how should Bill recommend compromise with respect to maximum sustainable payout rates?

2. How should Bill incorporate the following items into his risk management strategy?

a. educating the committee regarding types of risk affecting individual investments, classes, and the entire portfolio;

b. measuring risk and volatility;

c. provisions for periodic portfolio rebalancing;

d. using tactical asset allocation; and,

e. developing and implementing a contingency plan.

3) What additional steps should Bill take to form a group consensus regarding the appropriate level of endowment investment risk?

4) What additional elements should Bill add to his presentation to target the concerns of the “conservative” and “aggressive” committee members, respectively?

Assessment

And so, financial advisors, planners and wealth managers; are you up to answering this challenge? We dare you to respond! Visit: www.CertifiedMedicalPlanner.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Off-Road Touring with Dr. Marcinko [Final Part 2009]

Hello Everyone and Thank You!

By Ann Miller; RN, MHAOff Road Touring '09

To all of you who made it to one of our venues for an Off Road Tour segment with our Publisher Dr. David E. Marcinko, or to those who just read his posts, we wanted to thank you for your support and for supporting each other!

Our mission – is to bridge the gap between financial planning and medical practice management, and to serve as a networking resource for medical, managerial and financial advisory colleagues who possess the ethics and intellect to serve in a fiduciary capacity.

The Next Step

Ready for the next step? Just visit www.HealthcareFinancials.com and subscribe to the Journal of Financial Management Strategies, to create a roadmap to success for your healthcare organization.

Thanks with a Shout-Out

Finally; we give a hearty shout-out to www.MedicalBusinessAdvisors.com who made the book “signing and opining” tour possible. We are so proud of our partnership with an institute whose team learning approach creates such rich success for students, both in the virtual and real-world classroom and in their personal and professional lives www.CertifiedMedicalPlanner.com

Online Certified Medical Planner Program

Interested in becoming a Certified Medical Planner ™ or to learn about how your broker-dealer, advisory firm or company can build an educational partnership with us? Call me at 770.448.0769 (9am – 5pm EST).

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. 

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Assessment

Thanks so much for your interest in our Summer 2009 tour, and the ME-P. We hope it, and all our books, texts, dictionaries, products and educational formats serve you well!

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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ReThinking Medical Professional Autonomy in the Era of Obama Care

Eying Contemporary Medical Ethics in Healthcare Reform

By Render S. Davis; MSA, CHE

And, Staff Reportersbiz-book

Not so long ago, a physician’s clinical judgment was virtually unquestioned. Now with the advent of clinical pathways and case management protocols, many aspects of treatment are outlined in algorithm-based plans that allied health professionals may follow with only minimal direct input from a physician. Much about this change has been good. Physicians have been freed from much tedious routine and are better able to watch more closely for unexpected responses to treatments or unusual outcomes and then utilize their knowledge to chart an appropriate response.  

Restrictive Protocols

What is of special concern, though, is the restrictive nature of protocols in some managed care plans that may unduly limit a physician’s clinical prerogatives to address a patient’s specific needs. Such managed care plans may prove to be the ultimate bad examples of “cook book” medicine. While some may find health care and the practice of medicine an increasingly stressful and unrewarding field, others are continuing to search for ways to assure that caring, compassionate, and ethically rewarding medicine remain at the heart of our health care system.

Assessment

Link: For another opinion: http://healthcareorganizationalethics.blogspot.com/2009/09/obamas-speech-good-ethics-and-good.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How does the specter of HR 3200-3400 in the healthcare reform debate impact the concept of medical autonomy and professional ethics? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

ME-P Thought-Leader [MD] in the News

Brian J. Knabe MD of Savant Capital Management

By Max Alexander

Dow Jones Newswires; 212-416-2245 Brian J. Knabe MD

Lots of doctors get burnt out dealing with the business end of medicine. But Brian Knabe, a family practice physician in Rockford, Ill., had such a passion for crunching numbers that he became a financial planner.

Knabe, 42 years old, still sees patient’s two half-days a week. He also teaches residents for another half-day at the University of Illinois – College of Medicine.

Most of the week, he’s a certified financial planner with Savant Capital Management.

“I hear all the jokes,” says Knabe, “the most popular being some version of, ‘Hey I guess my portfolio’s doing so badly, they had to bring in the doctor.'”

When the laughter dies down – it doesn’t take long – people often ask what motivated him to transition from medicine into finance.

His short answer is what you’d expect from a wealth adviser: “I wanted to diversify my career.”

The long answer includes a lifelong passion for math that runs in the family. Knabe’s father and brother are both engineers, and the doctor himself majored in bioengineering at Marquette University. “In college, I loved calculus, statistics and differential equations,” he says.

Growing up in Rockford, his best friend was Brent Brodeski, a partner at Savant, and Knabe had been a client of the firm since 1995. “For years, I joked with Brian, ‘If you ever get bored with medicine, you can join us,'” says Brodeski. “Three years ago he called and said, ‘I’ll take you up on that.’ I was floored.”

Knabe wasn’t bored with medicine. “I love taking care of patients, and the intellectual stimulation of the field,” he says. “So I told the partners at Savant that I would only do this if they allowed me to continue practicing medicine part-time.” Meanwhile, he went back to Marquette and got his CFP credentials.

About half of Knabe’s financial clients are doctors, who appreciate his insider’s knowledge of their work and financial issues. Both fields involve privacy and trust, he notes, and both involve planning for the future. They also involve an element of uncertainty.

Sometimes his advice is specifically health-related.

“One client I was working with was a couple where the husband had a terminal illness,” recalls Knabe. “I worked closely with the family in planning living will issues and durable power of attorney for health care. I’ve helped other clients wade through health insurance and disability issues.”

Yes, financial clients do sometimes ask him for medical advice, but he stops them before they can unbutton their shirt.

“If they have a problem and need a diagnosis, I’ll tell them where to go to get a second opinion,” he says.

Link: http://online.wsj.com/article_email/BT-CO-20090914-711325-kIyVDAtMEM5TzEtNDIxMDQwWj.html 

Managing Editor’s Note:Become a CMP

Dr. Knabe is also enrolled in the www.CertifiedMedicalPlanner.com program in health economics and medical practice management for financial advisors and healthcare consultants.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Take the Lost Managed Care Contract Challenge!

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporterscmp-logo

The Hope Outreach Medical Clinic (HOMC) is a private, for-profit, single specialty medical clinic in a south-eastern state. It submitted its bi-annual Request for Proposal (RFP) to continue its current managed care fixed-rate contract. Upon review of the RFP, however, Sunshine Indemnity Insurance Company, the managed care organization (MCO), denied the contract request for the upcoming year.

Seeing Economic Estimates

In shock, the clinic’s CEO asked the clinic’s administrator to work with its legal team to develop a defensible estimate of economic damages that would occur as a result of the lost contract. The clinic intended to bring suit against the MCO for breach-of-contract. However, the administrator is not an attorney and is loathe to-enter the fray. After consideration however, he decided to assist in filing the Statement of Claim (SOC) because he realized that changes in patient services (unit) volume would be a valid economic surrogate. He then requested the following information from his controller, in order to develop a change in economic profit [damages] estimate.

Change in patient visits (unit) volume

  1. Fees (price) per patient (unit)
  2. Marginal (incremental) cost per patient (unit)
  3. Change in current fees (prices)
  4. Patient volume (units) affected

Key Issues:

  1. Fee (price) per patient (units) may be obtained from the fee schedule used by the MCO to pay HOMC.
  2. Marginal (incremental) costs per patient (unit) are approximated using variable costs.
  3. Higher cost payors exist because lower patient volumes raise the average cost per patient (unit) due to existing fixed costs.

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond!

Visit: www.CertifiedMedicalPlanner.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Do Financial Advisors Add Value to Retail Portfolios?

Some Consultants Emphatically Say … No!

By Staff Reportersfp-book1

Nope! So says Andre’ Cappon, Guy Manual, Stephan Mignot and Seth Varnhagen of the CBM Group, Inc; a consulting firm in Manhattan, New York. In fact, while writing in Registered Rep – a trade magazine for FAs in September 2009 – they estimate that long-term real (adjusted for inflation), actual (after taxes, fees and market timing) returns for the average retail investor, to be around 0 percent. That’s right; not the 8-12 percent usually attributed to long term investing trends.

Or; do you simply have the wrong type of Financial Advisor [FA]?

Visit: www.CertifiedMedicalPlanner.com Do you need a fiduciary advisor? Who really knows for sure?

About the CBM Group

Founded in 1992, the CBM Group is a general management consulting firm specialized in the financial services industry. Their goal is to help leading financial institutions, and their financial advisors, create and sustain the competitive advantages necessary to thrive in the global marketplace.

Link: www.theCBMGroup.com

Assessment

Despite the math, and numerics like Ibbotson charts showing impressive long-term gains, on average retail investors — like doctors, medical professionals and ME-P readers — have made very little actual return on their savings; according to CMB.

Link: http://registeredrep.com/advisorland/marketing_selling/0901-small-investment-return/index.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does your FA add value to his/her fees of 1-3%; or are they a drag on your portfolio’s performance. Ever consider “doing it yourself”  like some medical institutions www.HealthcareFinancials.com 

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Product Details  Product Details

Take the DME Inventory Switching Challenge!

Join Our Mailing List

 Calling all Administrators and Management Consultants – Are You CMP™ Worthy?

 [By Staff Reporters]ME-P Logo.2

The new administrator for the ABC Medical Clinic understood that all inventory costing methods were acceptable to use in his Durable Medical Equipment [DME] department. LIFO, FIFO, specific identification, and the average cost method are all attractive methods under different circumstances in the business cycle, and companies may use the method that best fits their circumstances.

Reducing Taxes

For example, if ABC wished to reduce corporate income taxes in a period of inflation and rising prices, it would use LIFO. If matching DME sales revenue with the current cost of DME goods sold was desired, LIFO would also be used. Unfortunately, LIFO may charge against DME revenue the cost of DME not actually sold, and LIFO may allow the ABC Medical Clinic to manipulate net income by varying the time-periods it makes additional DME purchases. On the other hand, FIFO and specific identification method allows a more precise matching of ABC revenue with historic DME costs. However, FIFO too, can promote “paperless-phantom profits,” while specific identification can promote possible income manipulation.  It is only under FIFO that net income manipulation is not possible.

CEO – 2 – CFO [Case Model]

“Let’s go with FIFO,” the new administrator said to his Chief Financial Officer, Bert. “The profits will make us look good to the home office and we can always switch back to LIFO if inflation starts back-up again, right Bert?” He mused, but he was not amused because freedom of choice does not include changing DME inventory methods every few years, especially if only to report higher income. “The switching of methods violates the basic tenet of consistency, which requires the use of the same inventory cost and accounting methods in preparing financial reports and statements,” Bert emphatically stated.

Key Issues

1) Is this sort of inventory costing and maneuvering permissible?

2) What is its justification?

3) How is it notated in financial reports?

4) Is this sort of thing ethical?

Assessment

“The switching of methods violates the basic tenet of consistency, which requires the use of the same inventory cost and accounting methods in preparing financial reports and statements,” Bert emphatically stated.

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

Product Details 

Take the Hospital eHR Implementation Challenge!

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporters Washington DC

The fictitional Washington Hospital is embroiled in the healthcare reform debate and interested in implementing an electronic health record (EHR) for its major clinic areas. The flagship hospital currently utilizes a legacy-based system and several of the clinics have independently purchased software programs to provide a more inclusive electronic data base particular to that clinic.

Scenario

In addition, each of the software programs purchased in specific clinics has been modified to serve their own needs. The other satellite hospitals and clinics are not linked to the flagship hospital and have independent systems, applications and software in place. The hospital is interested in obtaining one EHR system that can be used in a standardized and uniform methodology and process throughout all of its hospitals and clinics.

Key Issues

Should the Washington Hospital?

1) Abandon the clinic’s software programs in lieu of a more centralized EHR?

2) Assess various EHR systems for healthcare providers available in the marketplace, comparing a series of hospital and clinic developed requirements against vendor capabilities?

3) Obtain an EHR product that provides interface to the existing clinic software products?

4) Assess whether the EHR vendors totally comply with HIPAA and privacy regulations as well as update their systems automatically with HIPAA changes?

5) Have the vendors assess the existing system/applications/software programs currently in use at each of the hospitals and clinics and determine the best application configuration?

6) Utilize the internal Information Technology staff to develop an interface solution?

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond! Visit: www.CertifiedMedicalPlanner.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

HALLOWEEN: Nathaniel Potter MD & Touring with Dr. Marcinko [Part VI]

About Nathaniel Potter, MD

By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Dateline: Baltimore MarylandNathaniel Potter MD

While in Washington DC on the second portion of our recent ME-P book “signing and opining” tour, I had the good fortune to visit the gravesite of the noted physician Nathaniel Potter, MD. Dr. Potter was born in Carolina county Maryland in 1770 and died in Baltimore on 2 January, 1843. He graduated from the University of Pennsylvania in 1796, and settled in Baltimore, where he practiced medicine until his death. In 1807, he associated with Dr. John B. Davidge in founding the University of Maryland, School of Medicine where he ultimately served as professor and dean. He died penniless.

THINK Potter’s field!

About Green Mount Cemetery

Green Mount Cemetery is located in Baltimore, MD. Established in 1839, it is noted for the large number of historical figures that have been interred in its grounds as well as a large number of prominent Baltimore-area families. It retained the name Green Mount when the land was purchased from the heirs of Baltimore merchant Robert Oliver. Green Mount is also a treasury of precious works of art, including striking works by major sculptors like William Rinehart and Hans Schuler. The cemetery was listed in the National Register of Historic Places in 1980.

Assessment

In as much as Dr. Potter was a well know figure to me, I was most pleased at the impromptu visit to his grave. You see, although I attended Temple University because of my future specialty, my first medical school choice would have been at University of Maryland if post-graduate education opportunities had been different at the time. And, I passed the medical school, and the imposing Greek themed Davidge Hall Dome, daily for four years as I rode the number 8 public transportation bus to my undergraduate studies at nearby Loyola University, in Townson Maryland. Of course, the fact that Potter was educated at the University of Pennsylvania School of Medicine, the first in the nation, did not elude me when I worked in its ER as a young medical student in Philadelphia, back in-the-day. University of Maryland was the fifth such medical school in the country.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my summer promotional tour. Attendance at several formal and informal engagements increased since the early summer. The previously noted sales spike for our texts, handbooks and dictionaries; as well as interest in our online www.CertifiedMedicalPlanner.org  program.

Part V: https://healthcarefinancials.wordpress.com/2009/08/21/off-road-touring-with-dr-marcinko-part-v/

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:

Product DetailsProduct Details

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***

Medical Inventory Management Methodologies

Understanding Traditional Costing Methods

By David J. Piasecki, with
Hope Rachel Hetico; RN MHA, CMP™cmp-logo1

A good inventory management system offers opportunities for improved efficiency in any healthcare organization. The following traditional methods of inventory cost accounting and management are useful when one is calculating the cost of supplies (as opposed to medical items for resale and DME).

a. LIFO

The last-in first-out (LIFO) inventory costing method means the last items purchased are the first to be used (at least for cost calculations if the inventory consists of identical units). In times of rising prices, a lower total cost inventory is produced with a higher cost of goods sold. The last items purchased are most often the most expensive, and used first for the calculation. This happens because LIFO increases an expense (cost of goods sold) and decreases taxable income. Given the same revenue, higher expenses mean less profit. Deflation has the opposite effect.

b. FIFO

The first-in first-out (FIFO) inventory costing method means the first items purchased are the first to be used (at least for cost calculations if the inventory consists of identical units). In times of rising prices, a higher total cost inventory is produced with a lower cost of goods sold. This happens because FIFO decreases an expense (cost of goods sold) and increases taxable income. Deflation has the opposite effect.

Note: Any switch from FIFO to LIFO does not change reality, and although a decrease in reported incomes occurs, it does not increase cash outflows. However, for a taxable healthcare entity, after-tax net cash flow does increase.

c. Specific Identification

Specific identification is used for larger pieces of equipment, as it traces actual costs to an identifiable unit of product and is usually applied with an identification tag, serial plate, or radio frequency identification device (RFID) scanner. It does not involve flow-of-cost analysis. It does, however, permit the manipulation of income because healthcare entities state their cost of goods sold, and ending inventory, at the actual cost of specific units sold.

d. Average Cost

Average costing calculates ending inventory using a weighted average unit cost. When prices are rising, cost of good sold is less than under LIFO, but more than that under FIFO, and hence income manipulation is also possible.

e. Just-in-time Management

Although technically not a costing technique, JIT inventory management means that inventory supplies like DME are delivered as soon as needed by the healthcare organization, the prescribing doctor, or the patient. In JIT, inventory is “pulled” through the flow process. This is contrasted to the “push” approach used by conventional IM. In the push system, DME is already on-site, with little regard to when it is actually needed. In the JIT “pull” system, the overriding concern is to keep a minimum cost inventory, so that means having a system in which inventory is obtained on an as-needed basis.

The key elements of JIT consist of six parts:

1. a few dependable vendors or suppliers willing to ship with little advance notice;

2. total sharing of demand information throughout the supply chain;

3. more frequent orders;

4. smaller size of individual orders;

5. improved physical plant (hospital or clinic) layout to reduce travel flow distance; and

6. use of a total quality control system to reduce flawed medical products.

Using the JIT method, inventory is delivered when needed, rather than in advance, saving handling and storage costs. The healthcare entity never needs to stockpile inventory, and cash flow is enhanced. JIT is further characterized as follows:

  • little or no work orders;
  • little or no tracing of materials;
  • fewer inventory accounts or accounts payables;
  • reduction or elimination of work-in-progress or handling activities; and
  • no tracing of overhead and direct labor costs

JIT requires a dependable working relationship with suppliers and the precise calculation of inventory needs, especially for the following:

  • sterile surgical packs;
  • gastro-intestinal and gastro-urinary instrumentation;
  • orthopedic and OB-GYN inventory;
  • invasive heart and lung equipment;
  • radio isotopes and trace radiographic materials; and
  • equipment for almost all pre-schedule medical interventions and procedures.

Assessment

This means that, when JIT inventory monitoring is used, healthcare managers are better prepared with the proper inputs to control and reduce inventory, including when dramatic bursts or declines occur. This means a more rapid and higher cash flow balance, rather than inventory balance. Each of these traditional methods of inventory cost accounting is adequate for most healthcare facilities, but as inventory orders and costs continue to increase, economic order quantity [EOQ] costing may be the most effective means of accounting for inventory in DME-intensive organizations.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Can you think of any other inventory management technologies?  Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Meet Brian J. Knabe MD CFP™ CMP™

A New ME-P Thought-Leader

By Ann Miller; RN, MHA

[Executive Director]Brian J. Knabe MD

Brian J Knabe MD is a financial advisor with Savant Capital Management www.SavantCapital.com. He uses his experience from the medical field in his work with clients, portfolio managers, physicians and other financial advisors to develop comprehensive planning, investment, and tax strategies for professionals.

Medical and Financial Background

Brian is a magna cum laude graduate of Marquette University with an honors degree in biomedical engineering. He earned his medical degree from the University Illinois College of Medicine. Brian also attended the University of Illinois for his family practice residency, where he served as chief resident. Brian is currently pursuing his Certified Financial Planner (CFP®) designation, and he recently passed the exam.

Certified Medical Planner™

Dr. Knabe is also matriculating in the online www.CertifiedMedicalPlanner.org [CMP™] charter-designation program for financial advisors and medical management consultants, from the Institute of Medical Business Advisors, Inc.

Personal Background

As if the above were not enough to keep him busy, Brian is also a clinical assistant professor in the Department of Family Medicine with the University of Illinois. He is a member of several professional organizations, including the American Academy of Family Physicians, the American Medical Association [AMA], and the Catholic Medical Association. Brian has also served as the vice president of membership for the Blackhawk Area Council of the Boy Scouts of America.

Our Congratulations

And so, we trust all ME-P readers will give a congratulatory “shout-out” to Brian J. Knabe MD, our newest “thought-leader.” Read his position paper here:

Evidence Based Investing [A Scientific Framework for the Art of Investing]

Link: Evidence Based Investing[1][1]

We trust we will hear much more from him in the future.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think about the credentials of Dr. Knabe. Is this extreme education a new-wave of fiduciary focus for all financial advisors and planners in the healthcare space? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Concierge Medicine and the “Zombie” Medical Practices

Continued Growth of Boutique Medical Practices Today

[By Dr. David Edward Marcinko; MBA CMP™]dem2

The boutique, or direct reimbursement, or cash based medicine, or concierge medical practice business model requires an annual fee for personalized treatment that includes amenities far beyond those offered in the typical practice, or suggested by physician medical unions. Patients pay annual out-of-pocket fees for top tier service, but also use traditional health insurance to cover allowable expenses, such as inpatient hospital stays, outpatient diagnostics and care, and basic tests and physician exams. Typical annual fees can range from $1,500 to $ 5,000 per patient, to family fees that top $25,000 a year, or more. The concept, initially developed for busy corporate executives, has now made its way to others desiring such service.

A Higher Level of Care

Medical providers get to provide a much higher level of care and get to know their patients as they enjoy the incentive to spend appropriate time with them, and over time, get to know them within their unique social/cultural context as well (hence the house calls become important). Patients enjoy the access, the attentiveness, and are willing to spend cash to have the type of unhurried, contemplative time with physicians that is required to develop a trusted relationship and deliver high quality care. The financial remuneration potential is compelling as well.

Now, let us compare and contrast various parameters of traditional medical practice [third party reimbursement] with the same parameters of  so-called “new-wave” concierge medicine. Then, let the next-generation of doctors decide.

Current Traditional Model

  • patients seen at 15-20 min increments
  • 2,000 – 3,000 patients
  • Paperwork, administrative burdens, frustrations, and lack coordinated care
  • Impersonal experience (long waits, un-intelligible interactions with health care system)
  • Average Salary = $150,000-250,000

Concierge Practice Model Potential

  • direct relationship with patients
  • 300-500 patients
  • $1,500 – $3,000 access/retainer fee
  • Reduced overhead, positive interactions, care coordination and increased quality
  • Personalized experience (reduced headaches and paperwork with transparent pricing)
  • 24/7 access, same day appointments with multiple other amenities
  • Average Salary = $100,000 – $500,000

Enter the Franchisors

Concierge medical practices can be developed organically, or use a franchise business model [personal communication, Suzanne R. Dewey, Forté Partners, LLC, Williamstown, MA]. Examples of franchisors include:

Opponents and Pessimists

There have been plenty of opponents, within medicine and outside, to the idea of concierge practices almost from the first day.  For example,

The state of Washington’s insurance commissioner attacked the concept of practices offering all the primary care patients needed for a prepaid fee or retainer, arguing that such practices amounted to the business of underwriting health insurance. He said that the practices would have to meet all the regulatory requirements for such an insurance business, including establishing capital reserves and maintaining loss reserves for the payment of claims. It didn’t work, and besides, few concierge practices offer free traditional medical care once retainers are paid–most concierge physician’s bill insurance plans for all the services covered under their patients’ coverage.  The Medicare folks chimed in and managed to drive one physician out of business, arguing that he had tried to charge Medicare patients an extra $600 a year for services already covered by Medicare, hence he was guilty of illegal “balance billing.” Rather than fight Medicare over the issue, the doctor gave up and closed his practice. [C. Davis, “Big Problems for Medicare and Concierge Medicine,” Sierra Sacramento Valley Medicine, 55:3, May/June, 2004 (www.ssvms.org)]” 

Attacking ME?

Objections to concierge medicine focus on both its causes and its effects, and some critics have even attack me, personally. For example, just look what “they” said in the online journal: “Health Care Strategic Management.”

Many critics argue that concierge medicine merely reflects physician greed and unconcern over the needs of the community. Indeed, a recent book by David Marcinko, Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors], includes a chapter on “The Case for Concierge Medicine” (Ch. 24) as one of the ways ‘savvy’ physicians can maximize their profit, as if that is what medicine is all about. While the image of physicians may retain some Marcus Welby elements of their rushing to the hospital or a patient’s home in the middle of the night, most physicians would rather stay home and leave the job to someone else, it is argued”.

Nicht Schadenfreude

Just think! My mother always feared I’d be a no-body. Good publicity – bad publicity – just spell the name correctly. Schadenfreude may be defined as a “largely unanticipated delight in the suffering of another which is cognized as trivial “ and I take no delight in the slow collapse of traditional medical practice models; or the economic, professional or personal pain of colleagues. But, I also often tell my critics – and clients – that although it’s awfully nice to be altruistic; I am always mindful of the competitive business adage: “no margin-no mission.” And, in as much as this attack was written in July 2005, I can only wonder if I was prescient, or just lucky? With all due respect, I believe it was the former, rather than the later. Why so? Well, just consider how fast www.ChoiceMed.com is growing. This stuff is not rocket-science.

www.MedicalBusinessAdvisors.combiz-book1

About Concierge Choice Physicians

Concierge Choice Physicians: http://choice.md  is a national organization offering a hybrid business model. Physicians divide their practice between a traditional practice and a retainer practice. The retainer practice is limited to approximately 150 patients. A typical concierge practitioner may have 300-500 patients, while the norm for a traditionalist is about 2,000-3,000 patients.

Assessment – Whither the “Zombies”

I, also ruefully wonder how many “zombie” medical practices [practitioners] are out there? You know the kind – a medical practice with neither a good/bad balance sheet. One with only subsistence level operating performance; a practice that is not growing organically or thru merger activity. It is just barely existing as the doctor-in-charge slowly, agonizingly, milks it to death; or retires, whichever comes first.

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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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Understanding the Need for Onsite Practice Management Visits

Interview Information also Important

By Dr. David E. Marcinko and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

According to Robert James Cimasi MHA, ASA, AVA, CMP™ of Health Capital Consultants, LLC, in St. Louis, MO, the following types of information specific to medical practices should be gathered by the financial executive, financial advisor or healthcare consultant when performing a practice enhancement engagement, or especially, an economic valuation and appraisal. This information may be obtained through an interview, questionnaire, or preferably a site visit:

  • Background Information: Include such information as the number of years the entity has operated at its current location and in the community, as well as the office hours.
  • Building Description: Include the location (urban/suburban), proximity to hospitals and other medical facilities, and its size, construction, electrical and computer wiring, age, access to parking, and so on.
  • Office Description: Approximate acquisition details and price, as well as ownership or lease details should be included.  The square footage and number of rooms, and a description of different office areas should be outlined, including, where applicable: medical equipment, including all diagnostic imaging and major medical equipment; pharmacy, laboratory, examination rooms, waiting rooms, and other areas.
  • Management Information Systems: Document types of hardware and software and the cost, age, and suitability of all components, including their management functions, reporting capabilities, and integration between programs.
  • History of the Entity: Give the date founded and by whom, the number of full-time equivalent (FTE) physicians in practice by year, the physicians who have joined and left the entity, the dates they practiced at the entity, and their relationship and practice arrangement with the entity.
  • Staff Description: Include the number and types of non-physician positions as well as the tenure and salary of all current employees.
  • Competitive Analysis: Include details of hospital programs impacting practice, growth or decline in the volume of business and the reasons, association with other physicians, competitive strengths and threats, the number and volume of procedures performed, any change in the number and volume, and the corresponding fees.
  • Patient Base Information: Encompass income distribution and percentages from different payors, the number of new patients and total patients seen per week, the age mix of patients, the number of hours spent in patient care per week, and the number of surgeries performed.
  • Managed Care Environment: Details the terms and conditions of all managed care contracts including discounts and withholds, the impact on referral patterns and revenues, willingness to participate in risk sharing contracts and capitation, and the entity’s managed care reporting capabilities.
  • Hospital Privileges and Facilities: List all hospital privileges held by physician members of the medical practice and the requirements for acquiring privileges at the different local hospitals.
  • Credit Policy and Collections: Include practice policies for billing and payment, use of collection agencies, acceptance of assignments, other sources of revenues, and an aged breakdown of accounts receivable.
  • Financial Management: Include cash management procedures and protections, credit lines and interest, controls to improve payment of accounts payable, late payment frequency, formal or informal financial planning methods, and budgeting processes.
  • Operational Assessment: Include governance structure for the entity, detailing responsibilities and procedures for performance, conflicts, recruitment, outcomes measures, case management, reimbursement; income, continuing medical education (CME), credentialing, and utilization review.

Assessment

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The financial advisor must also allow for discussion of overall relationships with physicians in the community, practice concerns, and needs.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever had such an onsite visit? Was it by a fiduciary financial advisor or medical management consultant; or other? What was the outcome? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Discount Brokerages versus On-Line Brokerages

Physicians Must Appreciate the Differences

By Daniel B. Moisand; CFP® and the ME-P StaffME-P Blogger

Here are a few questions for all physician-investors to consider in 2009:

1. True or False? 

The key to investment success is to pay as little for a trade as possible.

2. True or False? 

The higher the number of trades in an investment account, the better the investment results.

3. True or False? 

The majority of revenue of a discount or on-line brokerage comes from trades. 

A: The answers should be crystal clear! False, False and True. It is almost entirely that simple.

Cost Control

Much like a medical practice, keeping costs down is an important objective of personal finance but, it is certainly not the key to success.  There are many studies that show that active trading garners inferior results compared to a longer term buy and hold type of strategy. One of the most publicized recently was conducted by a UC-Davis team led by Dr. Terrance Odean. The study examined the actual tracing activity of thousands of self-directed accounts at a major discount brokerage over a six-year period. The results were clear. Regardless of trading level, most of the accounts underperformed the market and showed that the higher the number of trades, the worse the result.

Of Bulls and Bears

While the U.S. markets were on a dramatic upswing a decade ago, the general interest level in them increased as well.  More households owned financial assets than ever before. Demographics drive much of this surge. The older edge of the baby boom generation is finding that as the children leave home, they have more income than ever before and saving for retirement becomes a higher priority. The proliferation of defined contribution [401-k, 403-b] retirement plans has also forced more people to take responsibility for their long-term security. When, the US stock market was on a tear; one would have be wise to remember an old Wall Street saying – “Don’t confuse brains with a bull market.” Unfortunately today, far too many self-directed investors did not heed the warnings. The media is full of stories about investors whose portfolios were decimated by the recent bear market. While this loss of wealth is somewhat tragic, in almost all cases the losses were made possible by poor planning and/or poor execution that a mediocre advisor would have avoided.

The Business of Advice

One also cannot conclude that everyone is acting as his or her own investment advisor. The advice business continues to thrive. Sales of load mutual funds have continued to grow, as has commission revenue at full-service firms. No-load funds have continued to grow as well and gain market share from the load funds. However, it would be inaccurate to tie that growth to do-it-yourselfers. Much of the growth of no-load funds can be attributed to the advice of various types of advisors who are recommending the funds. In addition, several traditionally no-load fund families have begun to offer funds through brokers for a load.

The Discounters

For physicians and all clients, the primary attraction to a discounter is cost. Everyone loves a bargain. Once it is determined that it is a good idea to buy say 100 shares of IBM, the trade needs to get executed. When the trade settles one owns 100 shares of IBM, regardless of what was paid for the trade. There is no harm in saving a few bucks. However, the decision to buy the IBM shares and when to sell those shares will have a far greater impact on the investment results than the cost of the trade as long as the level of trading is kept at a prudent level. The fact is that most good advisors use discount firms for custodial and transaction services. The leading providers to advisors are Schwab, Fidelity, and Waterhouse.fp-book1

Ego Driven

In addition to cost savings, discounters appeal to one’s ego for business. Everyone wants to feel like a smart investor; especially doctors. Often, marketing materials will cite the IBM example and portray the cost difference as an example of how the investor is either stupid or being ripped off. There is also a strong appeal to one’s sense of control. An investor is made to feel like they are the masters of their own destiny.  All of this is a worthy goal. One should feel confident, in control, and smart about financial issues. Hiring a professional should not result in losing any of these feelings, rather solidify them. Getting one’s affairs in order is smart. The advisor works for the client so a client should maintain control by only delegating tasks to the extent one is comfortable. Knowing that the particular circumstances are being addressed effectively should yield enhanced confidence.

Sales Pressure Release

The final reason people turn to discount and on-line brokerages is to avoid sales pressure. Unlike the stereotypical stockbroker, no one calls to push a particular stock. Instead, sales pressure is created within the mind of the investor. By maintaining a steady flow of information about stocks and the markets to the account holders, brokerages keep these issues in the forefront of the investor’s minds. This increases the probability that the investor will act on the information and execute a trade. Add some impressive graphics and interfaces and the brokerage can keep an investor glued to the screen. The Internet has made this flow easier and cheaper for the brokerages, lowering costs and increasing the focus on trade volume to achieve profitability.

Assessment

The pressurized information flow however, does little to protect investors during a bear market. Ironically, this focus on trading is one of the very conflicts investors are trying to avoid by fleeing a traditional full service broker.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What are your feelings on discount and internet brokers? Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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About Certified Medical Planner™

 

 

 

SPONSOR NOTICE

 

Top 10 Reasons to Become a

Certified Medical Planner™

 

1. Expertise: Provide health economics, business and financial advice to physicians.

2. Credibility: Gain health industry recognition and fiduciary clout.

3. Opportunity: Focus on the lucrative and expanding physician advisory niche.

4. Recognition: Join a select group of advisory experts.

5. Distinction: Become quality; rather than product driven.

6. Achievement: 500 hours of financial, health economics and management education.

7. Evidence: Validate deep healthcare industry knowledge.

8. Resource: CMP™ text and hand books, dictionaries, and institutional print journal.

9. Distinction: Set yourself apart with our chartered logo and trade-mark identity.

10. Commitment: Become the “go-to” financial advisor for all medical professionals.

 

www.CertifiedMedicalPlanner.com

 

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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I Jealously “Shake my Fist” at Somnath Basu PhD

On CFP® Mis [Trust] – One Doctor’s Painful Personal Experience

[“So Sorry to Say it … but I Told You So”]

By: Dr David Edward Marcinko; FACFAS, MBA, CMP™

[Publisher-in-Chief]dem21

According to Somnath Basu, writing on April 6, 2009 in Financial Advisor a trade magazine, the painful truth is that many financial practitioners are merely sales people masquerading, as financial planners [FPs] and/or financial advisors [FAs] in an industry whose ethical practices have a shameful track record. Well, I agree, and completely. This includes some who hold the Certified Financial Planner® designation, as well as the more than 98 other lesser related organizations, logo marks and credentialing agencies [none of which demand ERISA-like fiduciary responsibility]. For more on this topic, the ME-P went right to the source last month, in an exclusive interview with Ben Aiken; AIF® of Fi360.com  

fp-book4

The CFP® Credential – What Credential?

Basu further writes that stockbrokers and insurance agents who earn commissions from buying and selling stocks, insurance and other financial products realize that a Certified Financial Planner® credential will help grow the volume of their business or branch them into other related and lucrative products and services. After all, there are more than 55,000 of these “credentialed” folks. And, this marketing designation seems to have won the cultural wars in the hearts and minds of an unsuspecting – i.e., duped public; probably because of sheer numbers. Didn’t a CFP Board CEO state that its’ primary goal was growth, a few years ago? Can you say “masses of asses”, as the oft quoted Bill Gates of Microsoft used to say when only 2,000 micro-softies defeated 400,000 IBMers during the PC operating system wars of the early 1980’s. Quantity, and marketing money, can trump quality in the public-relations business; ya’ know … if you repeat the lie often enough … yada … yada … yada! Yet, as the so-called leading industry designation, the CFP® entry-barrier standard is woefully low. Moreover, the SEC’s [FINRA] Series #7 general securities licensure sales examination is not worth much more than a weekend’s study attention, even to the uninitiated.

insurance-book2

Easy In – Worth Less Out

In our experience, we agree with Basu and others who suggest that scores of lightly educated, and sometimes wholly in-articulate and impatient individuals are zipping through the CFP® Board of Standards approved curriculum in three to six months of online, on-ground, or “self-study”. But, that some can do so without a bachelor’s degree when they join wire-houses and financial institutions, which cannot be trusted to adequately train them, is an abomination. And, even more sadly, some of these CFP™ mark-holders, and other folks, believe they have actually received an “education” from same. Of course, their writing skills are often non-existent and I have cringed when told that, in their opinion, advertiser-driven trade magazines constitute “peer-reviewed” and academic publications. Incidentally, have you noticed how thin these trade-rags are getting lately? Much like the print newspaper industry, are they becoming dinosaurs? One agent even told me, point-blank, that his CLU designation was the equivalent of an “academic PhD in insurance.” This was at an industry seminar, where he thought I was a lay insurance prospect.

THINK: No critical thinking skills.

biz-book4

Education

There is another sentiment that may be applied in many of these cases; “hubris.” I mean, these CFP® people … just don’t know – how much they don’t know.”  The very real difference between training versus education is unknown to many wire-houses and FAs, isn’t it? And, please don’t get me started on the differences in pedagogy, heutagogy and androgogy. Moreover, it’s sad when we see truly educated youngsters become goaded by wire-houses into thinking that these practices are de-rigor for the industry. One such applicant to our Certified Medical Planner™ program, for example, had both an undergraduate degree in finance and a graduate degree in economics from the prestigious Johns Hopkins University – in my home town of Baltimore, MD [name available upon request]. He was told, in his Smith Barney wire-house training program, to eschew CMP™ accountability and RIA fiduciary responsibility, when working with potential physician and lay clients; but to get his CFP® designation to gather more clients. To mimic my now 12 year-old daughter; it seems that: SEC Suitability Rules – and – Fiduciary Accountability Drools. And, to quote Hollywood’s “Mr. T”; I pity the fools, er-a, I mean clients. But, T was an actor, and this is serious business.

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Of CEU Credits and Ethics

Beside trade-marks and logos, we are all aware that continuing education, and a code of ethics, is another important marketing and advertising component of state insurance agents and CFP licensees. It’s that old “be” – or “pretend to be” – a trusted advisor clap-trap. Well, I say horse-feathers for two reasons. First, both my insurance and CFP® Continuing Educational Unit [CEU] requirements were completed by my daughter [while age 7-10], by filling in the sequentially identical and bubble-coded, multiple-choice, answer-blanks each year. Second, this included the mandatory “ethics” portions of each test. When I complained to my CEU vendor, and state insurance department, I was told to “enjoy-the-break.”  My daughter even got fatigued after the third of fourth time she took the “home-based tests” for me.  After I opened my big mouth, the exact order of questions was changed to increase acuity, but remained essentially the same, nevertheless. My daughter got bored, and quit taking the tests for me, shortly thereafter. She always “passed.”dhimc-book3

Thus, like Basu, I also find that far too many financial advisors are unwilling to devote the time necessary to achieve a sound education that will help attain their goals, and would rather sell variable or whole life products than simple term life, even when the suitability argument overwhelmingly suggests so, for a higher payday. We not only have met sale folks without undergraduate degrees, but also too many of those with only a HS diploma, or GED. Perhaps this is why a popular business truism suggests that the quickest way for the uneducated/under educated class to make big bucks, is in sales. Just note the many classified ads for financial advisors placed in the newspaper job-section, under the heading “sales.” Or, in more youthful cultural terms, “fake it – until you make it.”

Of the iMBA, Inc Experience

According to Executive Director Ann Miller RN MHA, and my experience at the Institute of Medical Business Advisors, Inc:

“Far too many financial advisors who contact us about matriculation in our online Certified Medical Planner™ program – in health economics and management for medical professionals – don’t even know what a Curriculum Vitae [CV] is? Instead, they send in Million Dollar Roundtable awards, Million Dollar Producer awards, or similar sales accomplishments as resume’ boosters. It is also not unusual for them to list some sort of college participation on their resumes, and websites, but no school affiliation or dates of graduation, etc. And, they become furious to learn that we require a college degree for our fiduciary focused CMP™ program, and not from an online institution, either. The onslaught of follow-up nasty phone-calls; faxes and emails are laughable [frightening] too.”  

www.MedicalBusinessAdvisors.com

Assessment

More often than not, it is the financial institutions that FAs and CFP™ certificants’ work for that reward sales behavior with higher commissions, rather than salaries; which encourage such behavior and create the vicious cycles that are now the norm.

THINK: ML, AIG, Citi, WAMU, Wachovia, Hartford, Prudential, etc.

Note: Original author of Restoring Trust in the CFP Mark, Somnath Basu PhD, is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. We have asked him to respond further.

My Story: I am a retired surgeon and former Certified Financial Planner® who resigned my “marketing trademark” over the long-standing fiduciary flap. I watched this chicanery for more than a decade after protesting to magazines like Investment Advisor, Financial Advisor, Registered Rep, Financial Planner, the FPA, etc; up to, and even including the CFP® Board of Standards; to no avail. Feel free to contact me for a copy of a 43 page fax, and other supportive documentation from the CFP® Board of Standards – and their outsourced intellectual property attorneys – over a Federal trademark infringement lawsuit they tried to institute against me for innocent website errors placed by a visually impaired intern. Obviously, they disliked the launch of our CMP™ program. As a health economist and devotee of Ken Arrow PhD, I polity resigned my license, as holding no utility for me, to the shocked CFP Board. They later offered to consider re-instatement for a mere $600 fee with letter of explanation, to which I politely declined. Of course, my first thought after living in the streets of South Philadelphia while in medical school, during the pre-Rocky era, was to say f*** off – but I didn’t. Nevertheless, I still seem to be on their mailing list, years later. No doubt, the list is sold, and re-sold, to various advertisers for much geld. And, why shouldn’t they; an extra bachelor, master and medical degree holder on their PR roster looks pretty good. I distrust the CFP® Board almost as much as I distrust the AMA, and its parsed and disastrous big-pharma funding policies. Right is right – wrong is wrong – and you can’t fool all of the people, all of the time, especially in this age of internet transparency.

Shaking my Fist at Somnath … in Envy

And so, why do I shake my fist at Somnath Basu? It’s admittedly with congratulations, and a bit of schadenfreude, because he wrote an article more eloquently than I ever could, and will likely receive much more publicity [good or slings-arrows] for doing so. You know, it’s very true that one is never a prophet in his own tribe. Oh well, Mazel Tov anyway for stating the obvious, Somnath. The financial services industry – and more specifically – the CFP® emperor have no clothes! Duh!

ho-journal5

Good Guys and White Hats

Now that Basu’s article has appeared in Financial Advisor News e-magazine, the other industry trade magazines are sure to follow the CFP® certification denigration reportage, in copy-cat fashion. And, the fiduciary flap is just getting started. This is indeed unfortunate, because I do know many fine CFP® certificants, and non-CFP® certified financial advisors, who are well-educated, honest and work very diligently on behalf of their clients. It’s just a shame the public has no way of knowing about them – there is no white hat imprimatur or designation for same – most of whom are Registered Investment Advisors [RIAs] or RIA reps. For example, we know great folks like Douglas B. Sherlock MBA, CFA; Robert James Cimasi MHA, AVA, CMP™; J. Wayne Firebaugh, Jr CPA, CFP®, CMP™; Lawrence E. Howes MBA, CFP®; Pati Trites PhD; Gary A. Cook MSFS, CFP®, CLU; Tom Muldowney MSFS, CLU, CFP®, CMP™;  Jeffrey S. Coons PhD, CFP®; Alex Kimura MBA, CFP®; Ken Shubin-Stein MD, CFA; and Hope Hetico RN, MHA, CMP™; etc. And, to use a medical term, there are TNTC [too many, to count] more … thankfully!

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Apply to our Financial Advisor Consultant Listing Service

We’re collecting information on financial advisors, financial planners, accountants, attorneys and/or related folks in the Health 2.0 space who have a particular affinity or expertise advising doctors, nurses, medical professionals, and related others. And, we have been for some time, now.

New Channel Development for Medically Focused Financial Advisors and Management Consultants*

Beta-in-Progress

By Ann Miller; RN, MHA

[Executive Director]solo-consultant3     

A New Approach

Unfortunately, this usually means that some really interesting and smart folks, who purchase our books, dictionaries, print-journal, blog or email us; may get lost in the confusion. The result is that too many great medically focused consultants that we’d love to hear about are getting lost in the shuffle. And so, we’re trying something else instead.

Tell us about your Practice

Tell us about your financial advisory practice, and you may end up being mentioned in dispatches, or featured on a separate channel that we are developing. Selection and inclusion criteria include but are not limited to the following credentials:

  • Undergraduate or Graduate degree
  • Industry acknowledged certification or designation
  • Clean CRD record
  • Clean criminal record
  • Insurance agents need not apply
  • Stock brokers need not apply
  • Fiduciaries are encouraged
  • RIAs and independent advisors are encouraged
  • Published authors or educators are encouraged
  • Mission statement on physician niche focus required.

Assessment

So, if you want our readers to pay attention to your financial advisory practice or firm, this will get it into a systematic review process starring our crack staff.  Otherwise you may face the peril of lost notoriety to other non-specific niches; or referral sources.

Publisher’s Note: The inclusion or rejection decision is final; but not set in stone and our terms and conditions may change without notice; the beta project may also be cancelled at any time. We reserve the right to reject anyone, at any time, for any reason or no reason at all. This is a beta project-in-development. The advisors listed are not affiliated or endorsed by iMBA Inc., in any way. This is an advertisement opportunity only.

*NOTE: There is a $120 annual fee for this listing service. It is waived for subscribers of our two volume companion print journal, upon request. www.HealthcareFinancials.com

List Link: https://healthcarefinancials.wordpress.com/schedule-a-consultation/financial-advisor-listings/list-of-advisor-consultants/?preview=true&preview_id=8633&preview_nonce=a3203ab9f9

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What do you think about this idea to develop a new promotional channel for truly physician focused financial advisors?

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Integrating Financial and Medical Practice Succession Planning

Some Steps to Consider

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko8

Medical practice succession planning is a dynamic process requiring current physician ownership and management to plan for the future and implement the resulting plan. Many doctors approach succession planning initially through retirement planning. Once they understand the issues and realities of the tax laws, they are much more amenable to working out a viable succession plan. At the Institute of Medical Business Advisors Inc, we find that some physician-clients have not clearly articulated their goals, but have many pieces of the plan that need to be organized and analyzed to meet their objectives; including both personal and financial issues.

Link: www.MedicalBusinessAdvisors.com

A Step Wise Process

The steps necessary for successful succession planning are as follows: 

  • Gathering and analyzing data and personal information
  • Contacting the doctor’s other advisors
  • Valuing the practice according to USPAP and IRS guidelines
  • Indentifying the right qualified physician purchaser
  • Projecting estate and transfer taxes
  • Presenting liquidity needs
  • Gathering additional corporate information
  • Identifying dispositive and financial goals
  • Analyzing the needs and desires of non-key employees

An Integrated Approach 

Succession planning can help address financial and nonfinancial issues in a timely manner. Proper planning can also help the doctor accomplish goals with effective, appropriate strategies that satisfy family needs as well as tax issues. Here is a triad approach:

1. First: Address financial and nonfinancial issues in a timely manner

As with other estate planning engagements, there is no due date for succession planning. The owner of a medical practice is busy growing and managing the office. S/he is often not focused on the desirable outcomes in an orderly practice succession. For example, if family members are involved in the practice, there is a good chance that personal issues will need to be addressed. These nonfinancial issues can be just as important as financial concerns when building a comprehensive, workable succession plan.

2. Next: Focus on taxes

Taxes are important because the medical practice probably represents the largest concentration of wealth in the doctor’s estate. When planning for estates with large amounts of wealth, doctors frequently ignore personal issues. It’s important not to make the critical error of maximizing tax savings but destroying the practice through a poor succession plan.

3. Finally: Identify and reach goals

When the physician-owner has addressed succession planning issues in a timely manner, s/he has the opportunity to develop the most effective objectives to accomplish goals. Given enough time, the doctor can even modify goals to reflect changes in the economic environments, as well changes in his or her personal life.

Assessment 

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Medical practices exhibit particular strengths and weaknesses not typically found in publicly owned companies or non-professional family businesses. For example, many times the doctor doesn’t realize the type and amount of planning that needs to be done to transfer the business to a new doctor for maximum value. That is why doctors often need the advice of professionals to define goals and formulate medical practice succession strategies.

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
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PRACTICES: www.BusinessofMedicalPractice.com
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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Meet Dr. Gary L. Bode CPA MSA CMP™ [Hon]

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Introducing our Newest Thought-Leader

Dr. Gary Bode; CPA, MSA, CMP

[By Ann Miller RN MHA]

The Medical Executive-Post is proud to introduce Dr. Gary L. Bode as our newest thought-leader for healthcare financial modernity. Dr. Bode was the Chief Financial Officer [CFO] for a private mental healthcare facility, and previously the Chief Executive Officer [CEO] of Comprehensive Practice Accounting, Inc, in Wilmington, NC. The firm specialized in providing tax solution to medical professionals. Dr. Bode was a board certified practitioner and managing partner of a multi-office medical group practice for a decade before earning his Master’s of Science degree in Accounting [MSA] from the University of North Carolina. He is a nationally known forensic health accountant, financial author, educator and speaker.

A Multi-Faceted Healthcare Financial Expert

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. Currently, Dr. Bode is Chief Accounting and Valuation Officer (CAVO) for the Institute of Medical Business Advisors, Inc. He is also a Certified Medical Planner™ http://www.CertifiedMedicalPlanner.org  He provides litigation support in his areas of expertise and has been previously accepted as a legal expert witness www.MedicalBusinessAdvisors.com

Assessment

Gary has promised to publish his most exciting ideas and innovative work on our blog. He is also available for private consulting engagements and related professional work on an ad-hoc, or interim basis. So, let’s give a warm ME-P “shout-out” to Dr. Gary L Bode; our newest thought-leader.   

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Launching our ME-P Advertising Initiative

Learning and Growing with your Help

By Medical Executive-Post Staff stk321042rkn

This complimentary and companion blog forum for the 2-volume, 1,200 pages, quarterly print-journal at www.HealthcareFinancials.com provides the very latest news, information, insider reports, rated commentary, white-papers, professional posts and ranked subject matter information on the health care industrial complex. We see it as a “between-the-issues” communications forum, with in-vivo knowledge repository integrated with a ranking utility and professional social network for modernity.

Linking Stakeholders

In other words, we link movers-shakers and promote those in the profession with financial advisors, medical management consultants and health economists. All stakeholders of the healthcare industrial complex are invited to read, vote, submit posts and become involved with us.

Complimentary Resources

In order to make these high-level resources available to you at no cost, we promote our in-house textbooks, dictionaries, white papers, handbooks and print journal; online. www.MedicalBusinessAdvisors.com We also promote our consulting services, seminars, speaking engagements and online education program in heath economics and management for consultants www.CertifiedMedicalPlanner.com  

Soon, we intend to sparsely sell ads to sponsors interested in reaching out to our informed audience.

Privacy Assured

Of course, our sponsors will require some anonymous, aggregate data for reporting purposes

www.HealthDictionarySeries.com But, at no time will personal information or e-mail address be shared with vendors, sponsors or other sites. Please feel free to review our privacy policy.

Assessment

Don’t forget to send in your informed posts, and comments, too! Deep subject matter content is our lifeblood.

Read, rant, rate, rank and rave!

Please be sure to subscribe here for increased functionality.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Will subscribers object to some focused and target-specific advertisements on this blog-site? Or, shall we remain purists? Why or why not?

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

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About National Compliance Services, Inc.

Want, Need or Risk Reduction Mechanism?
Staff Reporters

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As readers and subscribers to the Medical Executive Post, and our related print periodicals, dictionaries and books are aware, choosing the right financial consulting firm, or consultant, is always a challenging task www.HealthCareFinancials.com Today, this is true more than ever, given the financial meltdown and the all too obvious shenanigans of Wall Street www.HealthDictionarySeries.com Lay and physician investors alike are affected; along with related financial advisors of all stripes, degrees and designations [spurious or more credible] www.MedicalBusinessAdvisors.com

National Compliance Services

According to the National Compliance Services, Inc. [NCS] website, an experienced team of customer-oriented professionals is in place that strives to meet personal and corporate compliance needs so that clients can focus on areas of expertise www.NCSonline.com

A Protean Focus

NCS operates in the financial compliance and regulatory services industry. Its strength may be in providing efficient, and reasonably priced products and services for many different sub-arenas, such as: investment and financial advisors, hedge and mutual funds, stock-brokers and broker-dealers. Their customized services are designed to structure a compliance program that is appropriate for any individual, or firm’s unique regulatory needs. NCS works to ensure compliance with applicable federal and/or state rules and regulations.

Range of Products and Services

NCS has offered its personalized services to more than 6,000 clients, both domestically and internationally. Their consultants include former regulatory examiners, accountants, attorneys, and other individuals with extensive hands-on industry experience.

Verification Services

NCS also offers a standard or customized line of verification services to Mutual Funds, Hedge Funds, Custodians, Broker-Dealers, Investment Advisers, and Third-Party Vendors. Verification services can be customized to include any or all of the following:

  • Firm Registration/Notice Filing with the Proper Jurisdiction(s)
  • Adviser Representative Registration(s)
  • Adviser Representative Degree(s) or Professional Designation(s)
  • Firm Reported Disciplinary History
  • Adviser Representative Reported Disciplinary History
  • Proper Registration of Solicitors
  • Proper Registration of Wholesalers and Third-Party Vendors
  • Bank Background and Activity Reports, and
  • OFAC Checks, etc.

Assessment

Moreover, claims of verification for over 15,000 Registered Investment Advisers, and Investment Adviser Representatives, seem plausible. For example, NCS recently contacted www.CertifiMedicalPlanner.com to verify the good-standing of a member and charter-holder.

Contact Info:

For further information, please contact:

Alex Aghyarian
National Compliance Services, Inc
Verification Technician
Phone: 561.330.7645 ext 302 and Fax: 561.330.7044
aaghyarian@ncsonline.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Verification in most any space is worthwhile of course; but is membership in a vague or nebulous organization helpful or harmful to the uninitiated?

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

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Health Industry Analysis Services

From iMBA Inc.

Staff Writersho-journal3          

Who we are?

The Institute of Medical Business Advisors, Inc is a consulting and industry analyst firm that conducts research which bridges “healthcare mission and profit”; with a particular focus on organizational management, personal finance and health economics for physicians and their advisors www.MedicalBusinessAdvisors.com

What we do?

The results of our research and development activities may be compiled into reports. Reports come in two forms, those sponsored by a specific client (custom research) or those sponsored by iMBA Inc; and typically released in the form of Award Winning white papers, books, chapters, dictionaries, portfolios and periodicals, etc www.HealthcareFinancials.com

All reports – regardless of sponsorship – use proven methodologies of both primary and secondary references systems and individual and group thought leader citations www.HealthDictionarySeries.com

Educational Activities

Our educational activities are wide and deep, as well, offering both online and on-ground initiatives for individuals and corporations www.CertifiedMedicalPlanner.com

Assessment

Contact Ann for additional details.

MarcinkoAdvisors@msn.com

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

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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ETF Portfolio Diversification and Cost Reductions

A Multi-Dimensional Investment Product

By JD Steinhilber

 Certified Medical Planner  

Most physicians and their financial advisors and/or Certified Medical Planners™ [CMP™] believe that effective diversification is most readily achieved by combining poorly correlated asset classes within an investment portfolio.

And, when combined with low costs, a winning combination may be achieved for most any physician-investor’s wealth achievement and management goals.

Diversification Impact

One of the most basic examples of proper diversification is two poorly correlated assets like stocks and bonds. Over time, the returns of these two asset classes have a very low level of correlation. Over shorter time periods, the degree of correlation between stocks and bonds can vary widely.

From January 1999 to November 2002, for example, stocks and bonds had a negative, or inverse, correlation. Real Estate Investment Trusts [REITS] and international stocks are examples of other asset classes that tend to be poorly correlated with US stocks. And, volatility is expected to increase beyond 2008.

Because exchange-traded funds replicate the performance of entire asset classes, which themselves are diversified among numerous securities, it is possible to construct well-diversified, high-performing portfolios with only 5-10 ETFs. Accordingly, ETFs provide a highly efficient means of diversification.

Reduction of “Style Drift

Mutual funds also facilitate diversification, but actively managed mutual funds are susceptible to “style drift” and their portfolio holdings at any particular time are unknown. This presents a challenge to diversification efforts.

In contrast, ETFs offer asset class purity, meaning their holdings are totally transparent, disclosed daily and not subject to style drift. Actively managed mutual funds are also more expensive and less tax-efficient than ETFs.

Cost Impact

Exchange-traded funds have some of the lowest expense ratios of any registered investment product. In fact, ETFs have a cost advantage, on average, in excess of 100 basis points relative to actively managed mutual funds. This can have a significant impact on a portfolio’s performance over time.

For example, assume that investor A and investor B each invest $10,000 and earn the same gross annualized return over a 20 year time frame. After expenses, assume that investor A earns a net return of 10% and investor B earns a net return of 9%. After 20 years, investor A would have $67,275, while investor B would have $56,044, representing a difference of $11,231.

Trading Cautions

It is important to point out that physician-investors have to pay commissions when they buy or sell ETFs.As a result, the cost advantages of ETFs relative to mutual funds diminish the more actively an ETF portfolio is traded. ETFs are therefore not appropriate vehicles for active traders; they are more suitable for investors.

Of course, physicians and all investors tend to be more conscious of investment costs when portfolio returns are low or negative.Given that costs are among the few controllable variables in a portfolio’s returns, investors and advisors should always be evaluating portfolio costs relative to the benefits received.

Assessment: 

Exchange-traded funds may provide an opportunity to enhance net returns by reducing investment expenses and increasing returns through improved diversification.

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
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

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Annuity Insurance Products

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A Brief Overview of Annuities for Physicians

[By Gary A. Cook, MSFS, CFP®, CLU, ChFC, RHU, LUTCF, CMP™ (Hon)]

[By Kathy D. Belteau, CFP®, CLU, ChFC, FLMI]

[By Philip E. Taylor, CLU, ChFC, FLMI]fp-book1

 Introduction

Annuities were reportedly first used by Babylonian landowners to set aside income from a specific piece of farmland to reward soldiers or loyal assistants for the rest of their lives.

Today’s annuities substitute cash for farmland; however the concept is the same. In 1770, the first annuities were sold in the United States and were issued by church corporations for the benefit of ministers and their families. Annuities have grown on a tax-deferred basis since enactment of the Federal Income Tax Code in 1913.  They began to gain widespread acceptance in the early 1980s when interest rates credited exceeded 10%.  During the last two decades, annuities have been the fastest growing sector of premiums for life insurance companies.

Nevertheless, are they actually “needed” by contemporary physicians – – or merely “sold” to them? 

An annuity is a legal contract between an insurance company and the owner of the contract. The insurance company makes specific guarantees in consideration of money being deposited with the company.

Annuities are generally classified as fixed or variable – deferred or immediate.  As their names indicate, deferred annuities are designed as saving funds to accumulate for future use.They are growth-oriented products where the tax on the interest earned is deferred until the money is withdrawn.  An immediate annuity is used for systematically withdrawing money without concern for the money lasting until the end.  The insurance company assumes this risk.

Deferred Annuities

The deferred annuity contract, like a permanent life insurance policy, has been found by some to be a convenient method of accumulating wealth.  Funds can be placed in deferred annuities in a lump sum, called Single Premium Deferred Annuities, or periodically over time, called Flexible Premium Deferred Annuities.  Either way, the funds placed in a deferred annuity grow without current taxation (tax-deferred).  .

Fixed Deferred Annuity

Fixed deferred annuities provide a guaranteed minimum return of return (usually around 3 percent per year) and typically credit a higher, competitive rate based on the current economic conditions.

Fixed annuities are usually considered conservative investments as the principal (premium) is guaranteed not to vary in value. Insurance companies are required by state insurance laws to maintain a reserve fund equal to the total value of fixed annuities.  Fixed annuities are also protected by State Guaranty Fund Laws. 

Example: 

Dr. Park, a retired physician, desires a safe financial vehicle for $100,000 of her excess savings.  She doesn’t need the earnings of this investment for current income and also wants to reduce her income tax liability.  She decides to purchase a fixed deferred annuity with her $100,000.  The annuity guarantees a 3 percent annual return and the current rate is 6 percent. 

After the first year, $6,000 of interest is credited to the annuity and Dr. Park has no current income taxes as a result.  If the 6 percent interest rate does not change, after 3 years, the annuity will have $119,102 of value.

Variable Deferred Annuity

Recently, variable deferred annuities have become very popular.  Like fixed annuities, variable deferred annuities offer tax-deferred growth, but this is where the similarities end.  Variable annuities are not guaranteed.  The appreciation or depreciation in value is totally dependent on market conditions.

Variable deferred annuities assets are maintained in separate accounts (similar to mutual funds) that provide different investment opportunities.  Most of the separate accounts have stock market exposure, and therefore, variable annuities do not offer a guaranteed rate of return.

But, the upside potential is typically much greater than that of a fixed annuity. The value of a variable deferred annuity will fluctuate with the values of the investments within the chosen separate accounts.  Although similar to mutual funds, there are some key differences.  These include:

·  A variable annuity provides tax deferral whereas a regular mutual fund does not

·  If a variable annuity loses money because of poor separate account performance, and the owner dies, most annuities guarantee at least a return of principal to the heirs.  This guarantee of principal only applies if the annuity owner dies.  If the annuity value decreases below the amount paid in, and the annuity is surrendered while the owner is alive, the actual cash value is all that is available.

·  When money is eventually withdrawn from a deferred annuity, it is taxable at ordinary income tax rates.  With taxable mutual funds, they can be liquidated and taxed at lower, capital gains rates.

·  There is also a 10 percent penalty if the annuity owner is under 59½ when money is withdrawn.  There is no such charge for withdrawals from a mutual fund.

· The fees charged inside of a variable annuity (called mortality and expense charges) are typically more than the fees charged by a regular mutual fund. 

Assessment

Variable deferred annuities are sensible for physicians who want stock market exposure while minimizing taxes.  Most financial advisors and Certified Medical Planners™ [CMP™] recommend regular mutual funds when the investment time horizon is under 10 years.  But if the time horizon is more than 10 years, variable annuities may occasionally become more attractive because of the additional earnings from tax-deferral. 

Both types of deferred annuities are subject to surrender charges.  Surrender charges are applied if the annuity owner surrenders the policy during the surrender period, which typically run for 5 to 10 years from the purchase date.  The charge usually decreases each year until it reaches zero.  The purpose of the charge is to discourage early surrender of the annuity. 

Equity Index Annuity 

The equity index annuity combines the basic elements of both the variable and the fixed annuity. The credited interest earnings are generally linked to a percent of increase in an index, such as the Standard & Poor’s 500 Composite Stock Price Index (S&P 500). This percentage is called the Participation Rate and may be guaranteed for a specified period of up to 10 years or adjusted annually. Thus, the physician annuity owner is able to participate in a portion of market gains while limiting the risk of loss. 

Typically, the indexed annuity has a fixed principal, with the insurance company and contract owner sharing the investment risk.  If the S&P 500 Index goes up, so do interest earnings.  If it declines, the insurance company guarantees the principal.   

So, the physician contract owner accepts the risk of an unknown interest yield based on the growth or decline of the S&P 500.  Medical professionals and healthcare practitioners should pay particular attention to surrender penalties, asset management fees and any monthly caps on appreciation. 

Immediate Annuities

Immediate annuities provide a guaranteed income stream.  An immediate annuity can be purchased with a single deposit of funds, possibly from savings or a pension distribution, or it can be the end result of the deferred annuity, commonly referred to as annuitization.  Just like deferred annuities, immediate annuities can also be fixed or variable.  

Immediate annuities can be set up to provide periodic payments to the policy owner annually, semiannually, quarterly or monthly.  The annuity payments can be paid over life or for a finite number of years.  They can also be paid over the life of a single individual or over two lives. 

Insurance Agent Commissions

Immediate Fixed Annuity

Immediate fixed annuities typically pay a specified amount of money for as long as the annuitant lives.They may also be arranged to only pay for a specified period of time, i.e., 20 years.  They often contain a guaranteed payout period, such that, if the annuitant lives less than the guaranteed number of years, the heirs will receive the remainder of the guaranteed payments. 

A note of caution here, as the selection of an immediate annuity is an irrevocable decision! 

Example: 

Dr. Jones is 70 years old and retired.  He is only of average wealth, but is concerned that if he lives too long, he could deplete his savings.  He decides to use $100,000 and purchase a lifetime immediate annuity with 20 years certain.  The insurance company promises to pay him $7,000 per year as long as he lives. If Dr. Jones dies four years after purchase, he would only have received $28,000 out of a $100,000 investment.  However, his heirs will receive $7,000 for the next 16 years.  If Dr. Jones survives to the age of 98, he would have received $196,000 (or 28 years of $7,000).

Immediate Variable Annuity

Immediate variable annuities provide income payments to the annuitant that fluctuates with the returns of the separate accounts chosen.  The theory is that since the stock market has historically risen over time, the annuity payments will rise over time and keep pace with inflation.   If this is indeed what happens, it is a good purchase, but it cannot be guaranteed. 

Some companies will, at a minimum, provide a guarantee of a low minimum monthly payment no matter how poorly the separate accounts perform.

Split annuities

A popular method of adding income and yet still accumulating savings is through the use of two separate annuity policies.  Part of the funds is placed in an immediate annuity to provide monthly income.  The balance is placed in a deferred annuity grows to the total value of the premium paid for both annuities.  

The income that is received from the Immediate Annuity includes a portion of the initial premium, as well as the taxable interest earned.   Only the portion of income that is interest is taxable. The ratio between the annuity principal and interest being paid out is called an Exclusion Ratio. 

Example:

Dr. Jeanne Jones has put $100,000 into a 5-year non-tax deferred vehicle at 5%. The earnings to supplement Jeanne’s retirement is $25,000.  With a combined federal and state tax of 33%, the net after tax income would be $16,750. Jeanne takes the same $100,000 using the split annuity concept she would receive $24,444 over the 5 years.  Based on an exclusion ration of 89%, her total taxable amount is $2,797.  This would yield $923 in taxes at the same 33% tax rate.  Jeanne would have $23,521 of spendable income with the split annuity compared to the $16,750.

Qualified Annuities

The term qualified refers to those annuities which permit tax-deductible contributions under one of the Internal Revenue Code (IRC) sections, i.e., § 408 Individual Retirement Accounts (IRA), § 403(b) Tax Sheltered Annuities, § 401(k) Voluntary Profit Savings Plans.  Qualified annuities can also result from a rollover from such a plan.  

Assessment

Currently, there is much lively debate in the industry as to whether an annuity, which is tax-deferred by nature, should be used as a funding vehicle within a tax-qualified plan, i.e., a tax-shelter within a tax-shelter.  Since the investment options within the annuity are also generally available to the plan participant without the additional management expenses of the annuity policy, it is felt this could be a breach of fiduciary responsibility. And, most insurance agents are not fiduciaries. 

Both the National Association of Securities Dealers (NASD) and the Securities and Exchange Commission (SEC) have gone on record as criticizing these sales.  

However, there are numerous examples of deferred annuities that have outperformed similar investment-category mutual funds, even after taking the annuity expenses into account. 

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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Here is the answer taken directly from the www.CertifiedMedicalPlanner.org website.

The CERTIFIED MEDICAL PLANNER™ charter designation program is a live, instructor-led, online asynchronous educational exercise designed to increase your health industry knowledge, affinity for physician-clients and financial advisory practice revenues in an honest and ethical fashion; regardless of compensation model. Fiduciary capacity is implicit.

We provide 500 hours of health economics and medical practice management education, during a 12 month period, that comprises four quarter-mesters. Adult learners should plan on spending 5-10 hours per week on study activities. The program may be crashed under special situations and/or delivered traditionally and onground upon request.

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