BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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DEFINITION: The meaning of meme stocks is sort of self-explanatory: hyped stocks that perform well. But from a fundamental perspective, they shouldn’t do well at all.
For example, Reddit forums and social media hype drive meme stocks. Speculators on Twitter and Reddit united together to trade their favorite companies in hopes of driving them “to the moon.”
It may not be fair to call them speculators. These hype beasts want to buy and hold stocks of companies that might not have a great long-term outlook.
Brokerages like Robinhood helped level the playing field with apps and ‘easier’ access. That’s giving retail traders more opportunity. Robinhood traders can buy with just a few clicks on their smartphones and use partial positions to buy chunks of stocks.
Posted on October 19, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
YOU DECIDE AND OPINE
By Dr. David E. Marcinko MBA
The Plot Thickens
Autumn is here, and leaves aren’t the only thing falling.
After seven months of higher monthly closes, plus one record-setting high early in the month, the benchmark S&P 500® Index wobbled its way to a 5% pullback in September. The causes were many—uncertainty emanating from Washington, inflation, supply chain problems, and softer earnings growth forecasts—and now the horizon is looking foggy as we gaze ahead toward the final months of 2021.
Shipping bottlenecks and a near-record number of job openings are raising costs and putting upward pressure on wages, which may start to hurt profit margins, and the twin specters of inflation and higher interest rates are making investors wonder when the Federal Reserve might step in to raise interest rates.
But, if there’s a potential bright spot, we have to look across the sea to the Eurozone, where the signs point toward an era of increased government spending that could be positive for global economic growth.
If you’ve ever listened to an early morning financial news broadcast, you’ve heard a reference to “futures” and how they affect the stock market before it opens. Physicians Investors follow the futures because it provides an indication of where stocks are headed at the opening bell. One of the most widely followed futures is the Dow Futures, whose underlying value is based on the Dow Jones Industrial Average, an index of 30 major U.S. companies.
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DEFINITION: After the markets close at 4 pm New York time, implied open prices of the Dow Jones Industrial Average, S&P 500 Index, and NASDAQ, which fluctuate from minute to minute, can be calculated.
Considering the DJIA as an example, the basis of calculating implied open is the price of a “DJX index option futures contract “.
How much will it cost you to start a dental practice – with Business Plan?
There are many costs to consider to set up a successful dental practice. Note that the following values are not the exact amount but an average of setting up a dental practice:
Purchase price – this includes valuation fees of between $1,000-4,500, solicitor fees of between $4,000 – 17,000, accountancy and bank fees of around $3,000, and bank solicitors, which can be up to $3,500. Many of these can be reduced or obliterated.
Materials – $40,000
Lab fees – $36,000
Staff costs – $82,000
Other costs (associates fees) – [$245,000 – $295,000]
Other Factors
“Big” Tech – Many startup doctors want to include CBCT or CAD/CAM or 3D printing in their startup, any of which can add $25,000-$175,000. In other situations, waiting is the best option.
Cabinetry Preferences – Costs for cabinetry can range from $5,000 to $175,000.
Practice Management Software (PMS) – Pricing will range from a few thousand dollars to $25,000; OR none at all.
Mechanical Delivery – Typically referred to as chairs, lights, and units, this category of dental equipment costs will range between $5,000 and $100,000 based on your startup plans.
Vision – Ignore the so-called “experts” who will try to create a cookie-cutter model for your equipment costs. That is the thinking of corporate dentistry. You want a customized private practice vision that allows you to create a model matching your standards. Prioritize your vision, so your values and philosophy will lead your dental equipment budget and purchasing decisions. Your equipment budget will be—and should be—customized.
A cap on how much the US government can borrow to finance its operations.
It was introduced during World War I so that Congress wouldn’t have to approve every bond issuance by the Treasury Department as it had done previously—freeing up more time for name-calling.
The debt ceiling has been suspended dozens of times over the years, including 3x during the Trump administration.
Without suspending the debt ceiling, the US wouldn’t be able to borrow money to pay its bills—and things would get ugly if that happened. The federal government would have to slash spending for programs like Medicaid, local governments would find it harder to borrow, and financial markets could go haywire.
In short, a failure to act would “produce widespread economic catastrophe,” Treasury Secretary Janet Yellen wrote in the Wall Street Journal.
Important note: The debt ceiling doesn’t account for new spending, like the $3.5 trillion proposal the Democrats have on the table. Instead, it’s about spending Congress has already authorized, such as paying out Social Security. Over the years, the debt ceiling has become a “political weapon,” according to the AP, as each party tries to blame the other for their spending habits and for heaping more debt on the US.
If you’re a physician looking to get ahead on planning for retirement, you’re likely familiar with individual retirement accounts, or IRAs. An IRA is a tax-advantaged vehicle that helps you grow your retirement savings. Roth IRAs are particularly attractive, because you don’t pay taxes on withdrawals in retirement.
There’s one problem: you can’t contribute to a Roth IRA directly if you make above a certain income. A backdoor IRA, though, can solve your problem by allowing you to convert a traditional IRA into a Roth.
Here’s how it works:
First, place your contribution in a traditional IRA—which has no income limits.
Then, move the money into a Roth IRA using a Roth conversion.
But make sure you understand the tax consequences before using this strategy.
The mega backdoor Roth allows you to put up to $38,500 in a Roth IRA or Roth 401(k) in 2021, on top of the regular contribution limits for those accounts. If you have a Roth 401(k) at work (and the plan allows for the mega option as described below), generally you can choose whether the final destination of your mega contributions is the Roth 401(k) or a Roth IRA. If your employer offers only a traditional 401(k), then your mega contributions would end up in a Roth IRA.
Here’s a quick summary of what you need to have in place for the ideal mega backdoor Roth strategy:
A 401(k) plan that allows “after-tax contributions.” After-tax contributions are a separate bucket of money from your traditional and Roth 401(k) contributions. About 43% of 401(k) plans allow after-tax contributions, according to a 2017 survey of large and midsize employers by consulting firm Willis Towers Watson.
Your employer offers either in-service distributions to a Roth IRA — that is, you can take money out of the 401(k) plan while you’re still working at the company — or lets you move money from the after-tax portion of your plan into the Roth 401(k) part of the plan. If you’re not sure, ask your human resources department or plan administrator.
You’ve got money left over to save, even after maxing out your regular 401(k) and Roth IRA contributions.
Do your children have income-generating assets in a custodial account?
If so, be sure you understand the so-called kiddie tax.
This law was passed to discourage wealthier individuals from transferring assets to their children to take advantage of their lower tax rates. The kiddie tax has seen many iterations but current rules tax a minor child’s unearned income—including capital gains distributions, dividends, and interest income—at the parents’ tax rate if it exceeds the annual limit ($2,200 in 2021).
The tax applies to dependent children under the age of 18 at the end of the tax year (or full-time students younger than 24) and works like this:
The first $1,100 of unearned income is covered by the kiddie tax’s standard deduction, so it isn’t taxed.
The next $1,100 is taxed at the child’s marginal tax rate.
Anything above $2,200 is taxed at the parents’ marginal tax rate.
So – If your child also has earned income, say from a summer job or legitimate work in your medical office or practice, the rules become more complicated.
Markets: While yesterday was somewhat of a snoozefest on Wall Street, today should be more interesting. In a quarterly event known as “quadruple witching,” stock options, index options, stock futures, and index futures all expire on the same day, which can produce fireworks.
The phrase quadruple witching brings to mind stories that begin, “It was a dark and stormy night…” or folkloric visions of witches flying chaotically on broomsticks across the brightness of a moon.
In the context of investing, quadruple witching also refers to possible chaos but chaos in the financial markets. Such chaos can erupt due to four different types of contracts on financial assets expiring on the same day. The quadruple witching hour is the last hour of the trading session on that day. The question is whether investors can make abnormally robust profits on quadruple witching days due to market fluctuations.
What Is Quadruple Witching?
Quadruple witching refers to four days during the calendar year when the contracts on four different kinds of financial assets expire. The days are the third Friday of March, June, September and December. The assets on which the contracts expire on that day are stock options, single stock futures, stock index futures and stock index options. Options contracts also expire monthly. Futures contracts expire quarterly.
Because all four types of contracts expire on the same day, the quadruple witching day usually sees a heavier volume of trading. This is why the reference to chaos is made about this witching day. Market volume is increased partly due to offsetting trades that are made automatically. Volume on quadruple witching days has increased roughly two-thirds of the time since 2005.
Recent Quadruple Witching Expiration Day
On June 18, 2021, a quadruple witching day, a near-record volume of single-stock equity options was set to expire at the end of the day in the amount of $818 billion. As a result, a near-record of single stock open interest of about $3 trillion stood on June 18, 2021. Open interest refers to how many contracts are open during any given point during the day. It is an important metric for traders to watch since a large amount of open interest can move the value of the underlying stock.
Taking a distribution from a tax qualified retirement plan, such as a 401(k), prior to age 59 1/2 is generally subject to a 10 percent early withdrawal tax penalty.
However, the IRS rule of 55 may allow you to receive a distribution after attaining age 55 (and before age 59 1/2 ) without triggering the early penalty if your plan provides for such distributions.
The distribution would still be subject to an income tax withholding rate of 20 percent, however. (If it turns out that 20 percent is more than you owe based on your total taxable income, you will get a refund after filing your yearly tax return.)
There’s an aspect to retirement that many physicians do not plan for … the transition from work and practice to retirement. Your work has been an important part of your life. That’s why the emotional adjustments of retirement may be some of the most difficult ones.
For example, what would you like to do in retirement? Your retirement vision will be unique to you. You are retiring to something not from something that you envisioned. When you have more time, you would like to do more traveling, play golf or visit more often, family and friends. Would you relocate closer to your kids? Learn a new art or take a new class? Fund your grandchildren’s education? Do you have philanthropic goals? Perhaps you would like to help your church, school or favorite charity? If your net worth is above certain limits, it would be wise to take a serious look at these goals. With proper planning, there might be some tax benefits too. Then you have to figure how much each goal is going to cost you.
If have a list of retirement goals, you need to prioritize which goal is most important. You can rate them on a scale of 1 to 10; 10 being the most important. Then, you can differentiate between wants and needs. Needs are things that are absolutely necessary for you to retire; while wants are things that still allow retirement but would just be nice to have.
Recent studies indicate there are three phases in retirement, each with a different spending pattern [Richard Greenberg CFP®, Gardena CA, personal communication]. The three phases are:
The Early Retirement Years. There is a pent-up demand to take advantage of all the free time retirement affords. You can travel to exotic places, buy an RV and explore forty-nine states, go on month-long sailing vacations. It’s possible during these years that after-tax expenses increase during these initial years, especially if the mortgage hasn’t been paid off yet. Usually the early years last about ten years until most retirees are in their 70’s.
Middle Years. People decide to slow down on the exploration. This is when people start simplifying their life. They may sell their house and downsize to a condo or townhouse. They may relocate to an area they discovered during their travels, or to an area close to family and friends, to an area with a warm climate or to an area with low or no state taxes. People also do their most important estate planning during these years. They are concerned about leaving a legacy, taking care of their children and grandchildren and fulfilling charitable intent. This a time when people spend more time in the local area. They may start taking extension or college classes. They spend more time volunteering at various non-profits and helping out older and less healthy retirees. People often spend less during these years. This period starts when a retiree is in his or her mid to late 70’s and can last up to 20 years, usually to mid to late-80’s.
Late Years. This is when you may need assistance in our daily activities. You may receive care at home, in a nursing home or an assisted care facility. Most of the care options are very expensive. It’s possible that these years might be more expensive than your pre-retirement expenses. This is especially true if both spouses need some sort of assisted care. This period usually starts when the retiree is their 80’s; however they can sometimes start in the mid to late 70’s.
If early retirement is a major objective, start thinking about activities that will fill up your time during retirement. Maintaining your health is more critical, since your health habits at this time will often dictate how healthy you will be in retirement.
Planning Issues – Mid Career
If early retirement is a major objective, start thinking about activities that will fill up your time during retirement. Maintaining your health is more critical, since your health habits at this time will often dictate how healthy you will be in retirement
Planning Issues – Late Career
Three to five years before you retire, start making the transition from work to retirement.
Try out different hobbies;
Find activities that will give you a purpose in retirement;
Establish friendships outside of the office or hospital;
Discuss retirement plans with your spouse.
If you plan to relocate to a new place, it is important to rent a place in that area and stay for few months and see if you like it. Making a drastic change like relocating and then finding you don’t like the new town or state might be very costly mistake. The key is to gradually make the transition.
An IRA in which distributions continue after the primary beneficiary’s death.
For an IRA to be inherited, the primary beneficiary must have already been receiving the required minimum distribution; the distributions either continue or are re-calculated based upon the secondary beneficiary’s life expectancy.
If the secondary beneficiary is the widow(er) of the primary beneficiary, she/he may roll over the inherited IRA into her/his own IRA without penalty.
Posted on September 13, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
ABOUT NOSE SWAB KITS
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BY. DR. DAVID EDWARD MARCINKO MBA
What is an at-home Covid test?
There are two types of tests for COVID-19. Viral tests tell you if you have a current infection, and antibody tests tell you if you’ve been previously infected.
If you’re experiencing symptoms or think you’ve been exposed to COVID-19, contact your health care provider or your state or local public health department to find out where you can get tested. Tests are available at many health centers and some pharmacies. Call in advance to see if an appointment is required. The testing process and timeline for results vary by location.
But – Rather than having a doctor or health professional get all up in your nostrils, you can swab yourself and get the results in less than an hour. At-home rapid tests (known as “antigen” tests) are less reliable than the lab-based PCR [polymerase chain reaction] test, but experts say they can be an extremely useful tool for allowing life to proceed semi-normally.
NOTE: PCR means polymerase chain reaction. It’s a test to detect genetic material from a specific organism, such as a virus. The test detects the presence of a virus if you have the virus at the time of the test. The test could also detect fragments of the virus even after you are no longer infected.
Problem is, in the US over-the-counter rapid tests are expensive and scarce.
Abbott Laboratories sells a two-pack for $24, and Quidel’s QuickVue sells a test for $15. But even if you are willing to shell out for one, good luck finding a rapid test on pharmacy store shelves or on e-commerce websites, where they’re often sold out.
The saver’s credit is a tax credit that’s intended to promote retirement savings among low- and moderate-income workers. It can reduce an eligible taxpayer’s federal income taxes when they save in a qualified retirement plan. It may be especially useful to medical students, nurses, interns, residents and fellows.
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In 2021, the maximum credit is worth $1,000 for individuals and $2,000 for married couples filing jointly, although it phases out for higher earners. To qualify for the credit, individuals must have an adjusted gross income of $32,500 or less. The income threshold for married couples is $65,000.
Because the credit is non-refundable, eligible taxpayers are able to use it to effectively reduce their tax bill to zero – but it cannot provide them with a tax refund.
Current reimbursement structures involve the submission and payment of medical CPT® coded claims. But, some doctors feel they need to “up-code” to maximize revenue or “down-code” for fear of having a claim denied. Contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.
This hybrid reimbursement system might use a two-payment structure.
For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.
The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.
Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar.
Posted on September 8, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
QUICK DEFINITION – INVESTING BASICS
MUTUAL COMPANY: A company that has no capital stock or stockholders. Rather, it is owned by its policy-owners and managed by a board of directors chosen by the policy-owners.
Any earnings, in addition to those necessary for the operation of the company and contingency reserves, are returned to the policy-owners in the form of policy dividends.
STOCK COMPANY: A joint-stock company is a business entity in which shares of the company’s stock can be bought and sold by shareholders.
Each shareholder owns company stock in proportion, evidenced by their shares (certificates of ownership). Shareholders are able to transfer their shares to others without any effects to the continued existence of the company.
Posted on September 6, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
DOCTORS MUST KNOW THE DIFFERENCE
Dr. David Marcinko MBA CMP®
J. Christopher Miller; JD
HISTORY
Do you remember when Andy DuFresne confronts the chief guard of his prison in The Shawshank Redemption and tells him to divert an inherited sum of money into his wife’s name? Even sixty-five years after the 1949 setting of that conversation, a common means of protecting assets from the reach of creditors is to transfer property into a spouse’s name. Assuming that the spouse is not also at substantial risk of being the target of lawsuits because of the spouse’s profession or lifestyle, it is an effective means of accomplishing that goal. Creditors with valid judgments against an individual may only attach and seize those assets owned by that individual. Anything worth doing is worth doing right, however, and there are several pointers to structuring asset ownership in a way that maximizes its protective value.
STATES
A small number of states, such as Hawaii, Pennsylvania, and Florida, have statutes that automatically protect property jointly owned by spouses from creditors of either spouse, but often not from creditors of both spouses together. Property that benefits from this characterization is held in as a “tenancy by the entirety,” and prevents only one spouse from transferring away property that the married couple obtained together. Again, variation in state law determines just how beneficial the formation of a “tenancy by the entirety” can be from an asset protection standpoint. This protection comes from a public interest in the preservation of marital assets, such that one spouse’s indiscretion may not harm the position of the other spouse.
The most significant limits to the advantage provided by the tenancies of the entirety are first, that the creditors with claims against both spouses may seize such jointly held property, and second, that upon the first death between the spouses, the property flows directly to the surviving spouse alone, who then no longer has the benefit of the creditor protection. Moreover, in April of 2002, the U.S. Supreme Court sharply curtailed the benefit provided by tenancies by the entirety by ruling that it does not shield an asset from the federal authorities, even if the tax liability was incurred only by one spouse.[1]
Some states in the South and West are community property states, which is similar to, but not the same as, tenancy by the entirety. Under the community property theory, all property acquired by either spouse during the residency in that state (or in some states, prior to or during the residency), will be considered jointly owned property even if titled to an individual spouse. Merely by moving to one of these community property states, a person can automatically shift assets, thus reducing the quantity of assets subject to the creditors of the wealthier spouse.
PROPERTY
Community property and land owned as tenants-by-the-entirety is different from a third type of ownership called Joint Tenancy with Rights of Survivorship, sometimes abbreviated as “JTWROS”. Joint tenancy with rights of survivorship may ease some burdens associated with probating a decedent’s estate, but this form of ownership is not ideal when viewed through the asset protection prism.
An alternative is to hold assets in the name of one spouse or the other, or as “tenants-in-common.” Tenancy-in-common is best described as a situation in which each spouse owns a one-half undivided share in the property, but does not have the automatic right to full ownership at the death of the other spouse.
Three advantages flow from this form of ownership:
Neither spouse owns the property exclusively.
A creditor seizing the interest of one spouse would not have a valuable asset because it could not evict the remaining spouse, so creditors will attack these assets only as a last resort to satisfy their claims. However, a lien recorded against either fractional interest would have to be satisfied upon its sale, so that the net proceeds would be reduced by the amount of the lien. For this reason, tenancy-in-common is only a temporary means of protecting an asset from an adverse judgment, and not quite the same as fully separate ownership. This flaw is one reason why many estate planners recommend the funding of property into the name of a spouse or family member less vulnerable to adverse judgments.
If either spouse were to die, only half of the property would be subject to estate tax.
Ownership of property as tenants-in-common helps in the estate planning arena by facilitating the process of equalizing the assets held by each spouse. Changes made during 2010 and 2013 to the estate tax laws have pushed the federal estate tax exemption above $5 million, so fewer individuals (less than ½ of 1% of the general public by some estimates) will realize an actual tax savings from such planning. Even more appealing is that surviving spouses can now claim the unused exemption left behind by a deceased spouse. Estate tax concerns are now playing a much smaller role in recommending how spouses own their property.
A dying spouse has the ability to control how his or her interest is distributed.
In many simple Wills, all property of a spouse is given by bequest to the surviving spouse. Such a bequest could include partial ownership interests in real estate. If the surviving spouse is concerned about asset protection, this additional property would not be beneficial because it would easily be sacrificed to the survivor’s creditors. One way of avoiding this result is to build an estate plan in which each spouse bequests the partial interest owned by that spouse to a trust. At the first death between two spouses, the trust will hold the partial ownership interest for the benefit of the surviving spouse. The trust holding the partial residence interest preserves the deterrent faced by creditors of the surviving spouse because seizure of the surviving spouse’s interest would not terminate the spouse’s right to use the land provided for in the trust.
A different set of rules applies to property held jointly by medical professionals who are not married to each other. If property is owned jointly among siblings or business associates instead of a business entity, the owners should make sure that the deed names them as tenants-in-common. Otherwise, each successive death among the owners will shift the ownership to the survivors, and leave the family of the deceased owner with no lasting value from the owner’s investment into the property and its improvements.
LONG TERM
Assets should be held in a way that protects them from creditors for the long term. The form of asset holdings should thus be a significant part of the discussions held with professional advisors, so that the protection lasts beyond your death or that of your spouse. Structure the protected assets so that they do not flow back to you if your spouse should pass away. In this manner, integrated asset protection, estate planning, and financial planning unite to protect the family’s interests by extending the benefits of creditor protection for the long term.
ASSESSMENT: Your comments are appreciated.
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[1] See United States v. Craft, 535 U.S. 274 (Apr. 17, 2002).
Use National Financial Awareness Day to your Advantage
Aug. 14th is National Financial Awareness Day. Financial awareness is about more than just understanding the basics on how money works. It’s also about evaluating your own budget, savings and investments to make sure your finances are working for your needs.
So if it’s been a while since your last financial “check up,” National Financial Awareness Day can be the extra push you’ve needed to finally take a look under the hood.
Posted on August 11, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Review
This is a handy, word-packed reference book with health information technology terminology of the past, present, and future. The paperback book is small and compact in size but amazingly full of words, abbreviations, and even names of leaders in the health information technology industry. While any book like this will require updating on a periodic basis, many of the terms will remain relevant for a good period of time. I found the dictionary very useful and recommend it as a good addition to the reference shelf in the office or library.
—Doody’s Book Review
From the Back Cover
Over10,000 Detailed Entries!
“”There is a myth that all stakeholders in the healthcare space understand the meaning of basic information technology jargon. In truth, the vernacular of contemporary medical information systems is unique, and often misused or misunderstood? Moreover, an emerging national Heath Information Technology (HIT) architecture; in the guise of terms, definitions, acronyms, abbreviations and standards; often puts the non-expert medical, nursing, public policy administrator or paraprofessional in a position of maximum uncertainty and minimum productivity ?The Dictionary of Health Information Technology and Security will therefore help define, clarify and explain…You will refer to it daily.””
–– Richard J. Mata, MD, MS, MS-CIS, Certified Medical Planner? (Hon), Chief Medical Information Officer [CMIO], Ricktelmed Information Systems, Assistant Professor Texas State University, San Marcos
Posted on August 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
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TEXTBOOKREVIEW
Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today’s increasingly competitive health care market.
Offering practical experience and applied operating vision, the authors integrate Lean managerial applications, and regulatory perspectives with real-world case studies, models, reports, charts, tables, diagrams, and sample contracts. The result is an integration of post PP-ACA market competition insight with Lean management and operational strategies vital to all health care administrators, comptrollers, and physician executives. The text is divided into three sections:
Managerial Fundamentals
Policy and Procedures
Strategies and Execution
Using an engaging style, the book is filled with authoritative guidance, practical health care–centered discussions, templates, checklists, and clinical examples to provide you with the tools to build a clinically efficient system. Its wide-ranging coverage includes hard-to-find topics such as hospital inventory management, capital formation, and revenue cycle enhancement. Health care leadership, governance, and compliance practices like OSHA, HIPAA, Sarbanes–Oxley, and emerging ACO model policies are included. Health 2.0 information technologies, EMRs, CPOEs, and social media collaboration are also covered, as are 5S, Six Sigma, and other logistical enhancing flow-through principles. The result is a must-have, “how-to” book for all industry participants.
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint. ―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers. Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.
In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.
Posted on July 22, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BOOK REVIEW
“The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion therefore is to ‘read it, refer to it, recommend it, and reap’.”
—Michael J. Stahl, PhD, Physician Executive MBA Program [William B. Stokely Distinguished Professor of Business]
The University of Tennessee, College of Business Administration
Posted on July 21, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
TEXTBOOK RELEASE AND REVIEW
Reviews
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint. ―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
The U.S. individual tax return is based around the concepts of Adjusted Gross Income (AGI) and Taxable Income (TI). AGI is the amount that shows up at the bottom of page one of Form 1040, individual income tax return. It is the sum of all of the taxpayer’s income less certain allowed adjustments (like alimony, one-half of self-employment taxes, a percentage of self-employed health insurance, retirement plan contributions and IRAs, moving expenses, early withdrawal penalties and interest on student loans). This amount is important because it is used to calculate various limitations within the area of itemized deductions (e.g., medical deductions: 10 percent of AGI; miscellaneous itemized deductions: 2 percent of AGI).
When a healthcare professional taxpayer hears the phrase “an above the line deduction”, the line being referenced is the AGI line on the tax return. Generally, it is better for a deduction to be an above the line deduction, because that number helps a taxpayer in two ways. First, it reduces AGI, and second, since it reduces AGI, it is also reducing the amounts of limitations placed on other deductions as noted above.
Obviously, if there is an above the line there is also a “below the line” deduction. These below the line deductions are itemized deductions (or the standard deduction if itemizing is not used) plus any personal exemptions allowed. AGI less these deductions provides the taxable income on which income tax is actually calculated. All of that being said, it is better for a deduction to be an above the line deduction. Although this is a bit dry, it helps to understand the concepts in order to know where items provide the most benefit to the medical professional taxpayer.
PERSONAL TAXATION CALCULATIONS
Gross Income (all income, from whatever source derived, including illegal activities, cash, indirect for the benefit of, debt forgiveness, barter, dividends, interest, rents, royalties, annuities, trusts, and alimony payments-no more)
Less non-taxable exclusions (municipal bonds, scholarships, inheritance, insurance
proceeds, social security and unemployment income [full or
partial exclusion], etc.).
Total Income
Less Deductions for AGI (alimony, IRA contributions, capital gains, 1/2 SE tax,
moving, personal, business and investment expenses, and
penalties, etc.).
Adjusted Gross Income (bottom Form 1040)
Less Itemized Deductions from AGI, (medical, charitable giving, casualty,
involuntary conversions, theft, job and miscellaneous expenses, etc.), or
Less Standard Deduction (based on filing status)
Less Personal Exemptions (per dependents, subject to phase outs)
Taxable Income
Calculate Regular Tax
Plus Additional Taxes (AMT, etc.)
Minus Credits (child care, foreign tax credit, earned income housing, etc.)
Recruitment has become a refined art in recent years as practices and physicians themselves grow increasingly savvy about the finer points of marketing positions and securing employment. It’s more competitive than ever, too. Many organizations are going after the same physicians. Add to that a shortage of doctors in key specialties and certain geographical areas and the pressure becomes that much more intense. Moreover, the aging of the physician workforce, their increased dissatisfaction with managed care, and changes in doctors’ work expectations (they want more free time) have affected the demand and supply.
Additionally, both practicing physicians and residents fresh out of training have become more discerning and skillful in managing the search process. Candidates have learned to be selective based on how they’re treated on the phone, how they’re treated in person during site visits, or how smoothly the negotiations go. One small bump in the road and they could choose to go elsewhere. In truth, they look to rule organizations out, not in.
Even the smallest of practices must have an effective recruitment plan because they compete directly with the big guys — larger practices and hospitals that have polished their efforts and perfected their processes.
Facts about Physician Recruiters and Executive Search Firms
1) If you are job hunting, you should send your resume to recruiters
Different recruiters know about different positions. They do not usually know about the same ones. This is particularly true with retained firms. By sending your resume out widely, you will be placed in many different confidential databases and be alerted of many different positions. If you send your resume to only a few, it may be that none you send to will be working with positions which are suited for you. Throw your net widely.
If you change jobs, it is also wise to send follow-up letters to the recruiters and alert them of your new career move. Many search firms follow people throughout their careers and enjoy being kept up-to-date. It is a good idea to have your resume formatted in plain text so you can copy and paste it into email messages when requested to do so. Then, follow up with a nicely formatted copy on paper by postal mail.
Some estimate that only 1% to 3% of all resumes sent will result in actual job interviews. So, if you only send 50 resumes, you may only have less than 2 interviews, if that many. Send your resume to as many recruiters as you can. It is worth the postage or email time. Generally, recruiters will not share your resume with any employer or give your name to anyone else without obtaining your specific permission to do so. The recruiter will call first, talk to you about a particular position and then ask your permission to share your resume with that employer.
2) Your resume will be kept strictly confidential by the executive search firm.
It is safe to submit your resume to a search firm and not worry that the search firm will let it leak out that you are job hunting. Recruiters will call you each and every time they wish to present you to an employer in order to gain your permission. Only after they have gained your permission will they submit your name or resume to the identified employer. The wonderful aspect of working with search firms is that you can manage your career and your job search in confidence and privacy.
3) Fees are always paid by the employer, not the job candidate.
Recruiters and search firms work for the employer or hiring entity. The employer pays them a fee for locating the right physician for the job opening. This is important to remember, in that when you interact with executive recruiters, you are essentially interacting with an agent or representative of the employer. Recruiters are more loyal to employers than they are to job candidates because they work for the employer. This should not present a problem, but, should cause you to develop your relationship with the recruiter with the same integrity and professionalism that you would with the employer.
Recruiters are paid fees in one of two ways – retainer fees or contingency fees. This is an important distinction and will affect your process with both the employer and the recruiter. Some employers prefer working with contingency firms and some with retained firms. Both are respected by employers and useful in your job search, but, the two types of firms will not be handling the same positions with the same employers simultaneously.
A “retained” recruiter has entered an exclusive contract with an employer to fill a particular position. The retained recruiter, then, is likely to advertise a position, sharing the specifics of the position, location and employer openly. The retained firm feels a great obligation to fulfill the contract by finding the best person for the job.
A “contingency recruiter” on the other hand, usually does not have an exclusive relationship with the employer, and is only paid a fee if the job search is successful. Often, if the employer uses contingency firms, there will be more than one contingency firm competing to fill a certain position. As a job hunter, if you are sent to an interview by a contingency firm, you may find that you are competing with a larger number of applicants for a position. Generally, retained firms only send in from 3 to 5 candidates for a position.
Recruiters will be paid fees equal to about 25% to 35% of the resulting salary of the successful candidate plus expenses. This does not come out of the job candidate’s salary. This is paid to the recruiter through a separate relationship between the employer and the search firm. This may seem like a large fee, but, keep in mind that recruiters incur a great many expenses when searching for successful job candidates. They spend enormous amounts of money on computer systems, long distance calls, mail-outs, travel and interviews. Recruiters work very hard for these fees. Employers recognize the value of using recruiters and are more than willing to pay recruiters the fees. All you have to do is contact the recruiter to get the process moving.
4) Not all medical recruiters work only with physicians.
Some search firms work exclusively with physicians or in healthcare, while others may work in several fields at once. Some of the larger generalist firms will have one or more search consultants that specialize in healthcare. It is important for you, as a job hunter, to assess the recruiters’ knowledge of your field. If you use industry or medical specialty buzz words in describing your skills, experience or career aspirations, you may or may not be talking a language the recruiter understands fully. It is wise to explore fully with the recruiter his understanding of your field and area of specialization.
5) Recruiters and search consultants move around.
Recruiters, like many professionals, move to new firms during their careers. Often you will find that recruiters will work at several firms during their careers. Since it is much more effective to address your letters to a person rather than “to whom it may concern”, it is smart for job hunters to have accurate and up-to-date information about who is who and where, since this can change frequently. Search firms also move their offices, sometimes to another suite, street or state. If you have a list of recruiters that is over one year old, you will certainly waste some postage in mailing your resumes and cover letters. Many of your mail-outs will be returned to you stamped “non-deliverable”, unless you obtain an up-to-date list. A resource, like the Directory of Healthcare Recruiters is updated very frequently, usually monthly [www.pohly.com/dir3.html].
6) Most search firms work with positions all over the country.
If you are from a particular state, and want to remain in that state, don’t make the mistake of only sending your resume to recruiters in your state. Often the recruiters in your state are working on positions in other states, and recruiters in other states are working on positions in your state. This is usually the case. Very few recruiters work only in their local area, most work all around the US and some internationally. Regardless of your geographic preference, you should still send your resume to all the healthcare recruiters. If you really only want to remain in your area, you can specify that preference in your cover letter.
7) Recruiters primarily work with hard to fill positions or executive positions.
Some recruiters specialize in clinical positions for physicians, managed care executive positions, healthcare financial positions or health administration positions. Others may specialize in finding doctors, nurses or physical therapists. Generally, an employer does not engage a recruiter’s assistance in filling a position unless it is hard to fill. Sometimes employers will engage search firms to save them the valuable time of advertising or combing through dozens of resumes.
Contingency recruiters tend to work with more mid-level management and professional positions, but, this is not always the case. Retained firms generally work with the higher level clinical or administrative positions.
One thing you will be assured of is that if a recruiter is working on a position that means that the employer is willing to pay a fee. That usually means that the position is a valued position and one worth closer inspection on your part. Even in healthcare, with certain exceptions, our economy is an “employer’s market”. This means that employers receive a deluge of resumes for their open positions. Increasingly, employers are using recruitment firms to handle their openings and schedule the interviews because employers simply do not have the manpower or time to handle the many resumes they receive. Therefore, if a job hunter is submitted by a recruiter, that job hunter has a great advantage over all other applicants.
Posted on July 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
HSA Update 2021
By Michael Thompson
High-deductible health plans have been popular, but it’s becoming clear they are not right for all employees, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.
Posted on July 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
MANAGEMENT STRATEGIES, OPERATIONAL TECHNIQUES, TOOLS, TEMPLATES AND CASE STUDIES
TEXTBOOKREVIEWS:
Hospitals and Health Care Organizationsis a must-read for any physician and other health care provider to understand the multiple, and increasingly complex, interlocking components of the U.S. health care delivery system, whether they are employed by a hospital system, or manage their own private practices.
The operational principles, methods, and examples in this book provide a framework applicable on both the large organizational and smaller private practice levels and will result in better patient care. Physicians today know they need to better understand business principles and this book by Dr. David E. Marcinko and Professor Hope Rachel Hetico provides an excellent framework and foundation to learn important principles all doctors need to know. ―Richard Berning, MD, Pediatric Cardiology
… Dr. David Edward Marcinko and Professor Hope Rachel Hetico bring their vast health care experience along with additional national experts to provide a health care model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are, and, by applying the well-illustrated principles, improve the efficiency of the system without sacrificing quality patient care. … The health care delivery system is not an assembly line, but with persistence and time following the guidelines offered in this book, quality patient care can be delivered efficiently and affordably while maintaining the financial viability of institutions and practices. ―James Winston Phillips, MD, MBA, JD, LLM
Depression is Highest Among 18-25 Year Olds at 11%.
19% of US Adults Have Anxiety and 56% of Those with Anxiety Are Impaired By Their Condition.
12% of People with Diabetes Have Associated Depression… Resulting in Missed Appointments, Poorer Diet, Decreased Medication Adherence and Increased Complications.
To Address This Problem, The Intermountain Health System Incorporated a Mental Health Provider in Their Primary Care Clinics.
Results: Improved in Diabetes Care, Decreased Hospitalizations and Decreased ER Utilization.
Treating Mental Health Not Only Improves Mental Wellbeing, But Also Lowers Overall Healthcare Costs as Well.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
NOTE: If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline at 1800-273-TALK (8255), text “help” to the Crisis Text Line at 741-741 or go to suicidepreventionlifeline.org.
Posted on July 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Dr. David Edward Marcinko is Speaking Up
Dr. David Edward Marcinko MBA CMP® enjoys personal coaching and public speaking and gives as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.
These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.
His talks tend to be engaging, iconoclastic, and humorous. His most popular presentations include a diverse variety of topics and typically include those in all iMBA, Inc’s textbooks, handbooks, white-papers and most topics covered on this blog.
Posted on July 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
It’s official, Dr. David Marcinko, your advocacy is making a big impact!
Just Nominated
Congratulations on your 10th annual WEGO Health Awards nomination. Whether you’re a patient advocate, influencer or collaborator, we’re honored to recognize your contributions to the online health community.
We created the WEGO Health Awards as a way to celebrate and thank the patients and caregivers who support, educate, and inspire others. It’s now our 10th season and the patient leader community is stronger than ever. We could not be more proud to include you as a nominee.
You can expect to hear from us each week with updates and important announcements.
I recently learned from Bloomberg editor David Shipley that the American citizenship test wasn’t standardized until the 1950s, and before that aspiring citizens were quizzed on their understanding of American history by a judge. It was … pretty hard.
Here are several questions you might’ve been asked to become an American citizen in 1944. How would you do? Answers at the bottom of this post.
Which of the following states seceded during the Civil War? Florida, Maryland, Delaware, Kentucky*
Which of these cities has not been a capital of the US? NYC, Boston, Princeton, Philadelphia
Where must all bills intended to raise revenue originate? Popular referendum, the House, the Senate, the president
Which was not one of the original 13 colonies? South Carolina, Massachusetts, Georgia, Maine.
HAVE A GREAT MONDAY OFF
And, thank you if working today.
Citizenship test: 1) Florida seceded 2) Boston wasn’t a capital 3) Bills to raise revenue must originate in the House 4) Maine wasn’t an original colony
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