What is a ‘Healthy’ Automobile Battery?

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Ask a Battery Technician

By Dr. David Edward Marcinko MBA CMP™

By Nalley Lexus, Roswell, GA

Dr. Marcinko 1972 Vette

You know that sinking feeling when you turn your key in the ignition, and instead of the roar of the engine, all you hear is a sad, defeated gurgle?

That’s a dead car battery, and it’s enough to ruin anyone’s day.

I should know. I own a vintage 2000 XJL-V8 luxury Jaguar vintage touring sedan; electrical gremlins are the norm. So, routine battery maintenance and regular battery checks will significantly lower your risk for the battery blues.

How it works

As you probably already know, the car battery is the essential component that starts your vehicle’s engine. Within the battery, a chemical reaction creates an electrical charge, which subsequently starts the car’s motor. Battery power is also required for your car’s electrical components like cabin and headlights.

Healthy Battery

Your battery is in the clear if it is consistently working, and clean. Your battery and its cables should be cleaned on a monthly basis with a small, stiff brush like a toothbrush to clear out dirt and debris from the road. Never use any sort of cleanser when cleaning. Healthy batteries should also be clear of corrosion. Brush away the corrosion from battery terminals by dipping a toothbrush into flat dark soda, or a mixture of water and baking soda, before scrubbing. Apply petroleum jelly on the surface after cleaning to prevent future build-up.

Unhealthy Battery

If your battery is displaying any of these symptoms, it’s time for a check-up. So, I asked my dealer and received these tips:

  • Low water in the battery cell could be affecting battery performance. Check the indicator on the side of the battery for the water level. If it needs filling, stop by our service department for a special tool to fill it up.
  • Age is a huge factor in battery health. Batteries are designed to last about five years, but this lifespan could shorten based on use and maintenance habits. If your battery is five or older, consider getting it checked out.
  • Cracks in the battery’s plastic casing or other wear on the battery connections could mean damage and are worth a second look.
  • Loose tie straps need adjusting. Make sure your battery is tightly secured, because engine vibration could knock the battery around and cause damage.

Assessment

Of course, the biggest sign of an unhealthy battery is a dead one, but it’s much better to routinely maintain your battery than to be left in a lurch without power. Get peace of mind with a power-up at your service department; or DIY.

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My Jaguar's engine after a steam

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Assessment

The summer of 2014 is almost over – drive safely.

Conclusion

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What Vehicle Parts Are At Risk in the Summer Heat?

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Still susceptible to heat and summer sun

[By Dr. David Edward Marcinko MBA]

dem21America’s roads are always busy, but the summer months are particularly hectic; especially here in Atlanta, GA.

As millions of Americans head off for their annual summer vacation, you can expect long traffic jams and frustrated drivers.

Modern luxury cars – that many physicians love – may be mechanically advanced, but they are still susceptible to heat, and the summer sun can be particularly hazardous for certain parts of your car.

So, please allow me to equip you with some information pertinent to your warm weather journeys. Trust me – I’m a doctor!

Hoses and Belts

Though it may seem rather obvious, it is very important to keep the engine cool when driving in the summer heat. Hoses help pump coolant to and from the engine while belts enable the fan to run effectively and continually cool your car’s engine.

In extreme heat, however, hoses can crack and belts can snap. You can check the hoses and belts yourself by looking for visual signs of wear or damage. If you are unsure, schedule an appointment with our service department before you set out on a summer road trip.

Dave's Jaguar Sedan

Cooling system

Modern cars have very effective cooling systems, which can counter relatively high extremes of temperature, but they have their limits. Aside from problems with hoses and belts, low levels of coolant, a leak in the radiator or a missing radiator cap can spell disaster if you are driving in hot weather.

Tires

Your car’s tires are vulnerable throughout the year, however, under-inflated, over-inflated or worn tires can be particularly dangerous during the summer. Tire pressure changes as the temperature increases. If the tire is under-inflated, it can bulge outward and put pressure on the sidewalls of the tire. If this continues, the tire can eventually burst. If the tire is overinflated, you are also at greater risk of hydroplaning in the event of a rain shower.

Oil filter

The car you drive relies heavily on oil, as this substance allows car parts to run efficiently. Heavy driving during the summer puts additional pressure on the oil, and on the oil filters in your car. Aim to change your oil [natural or synthetic] filters as often as the owner’s manual recommends, and certainly get them checked before you head off on a summer expedition.

Jaguar Sedan

Assessment

Whether you are staying local this summer or driving hundreds of miles, I encourage your attention to the above to protect your car from the rigor of summer heat.

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Summer Tips for Physicians to Maintain their Vehicle

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Summer Tips for Physicians to Maintain their Vehicle

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Keeping your luxury vehicle running smoothly with these Hot-Weather “tips and pearls”

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Collision Center]

Dr. Marcinko

You and your car survived the harsh winter. Thanks to your preparation and careful driving, you stayed on the road and emerged from the thaw without incident. But, before breathing that sigh of relief and going on your way, make sure you know how to maintain your vehicle in the warmer temperatures with these tips and pearls.

Why? Warm weather can stress cars as much as the cold, so take steps now to prepare you and your car for the spring and summer by following these important tips.

Check the Climate Control System

Many doctors forget about their air conditioner while relying on the heater during the winter months. During that time, air conditioners can leak refrigerant and experience other mechanical failures without notice. Before getting caught without relief in the heat, take your car to your dealer for an AC checkup.

Inspect Windshield Wipers

During the winter, windshield wipers can stick to the windshield and tear before breaking free. Don’t let damaged wipers catch you off guard when the spring rains hit. Inspect your wipers and replace them if they look damaged or worn. If you need help with this, stop by your dealer for assessment, parts, and installation.

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Jag

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Inspect Tires

Your tires were fine before winter. Several months and possibly thousands of miles later, your tires may not be in such good shape now. Cold temperatures make the air inside tires shrink; that’s why you inflated your tires for winter driving. As the air warms, however, the air expands, often causing overinflated tires that can wear unevenly and prematurely. Check the tires on your car for proper air pressure and adjust them if necessary.

According to the National Highway Traffic Safety Administration, more than 3,000 deaths and 116,000 injuries between 2005 and 2009 resulted from tire-related problems. Don’t become part of those statistics.

Replace Air Filter

During the winter weather, salt and sand that are used to keep roads safe affect your car’s air filter. So, check it yourself or ask your dealer to check your air filter for signs of problems. By restoring free airflow into your engine, you can boost the fuel efficiency of your car by one-tenth or more. You will also improve acceleration, so take it easy on the gas.

Time for a Carwash

The melting snow, salt, and sand on winter roads covers your car and its undercarriage with a corrosive mixture, setting the stage for rust and marred paint. With winter weather past, take your car to the car wash for a thorough cleaning to prevent lasting damage from the winter. Better yet; wash it yourself. With some intentional care, you can keep your car looking great for a long time to come.

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Jag console

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General Inspection

The break between winter and summer is a great time to give your car a good once-over. Verify your registration and inspection stickers are up-to-date and that your insurance cards and all your paperwork are in order.

Also, check fluid levels for the oil, transmission, brakes, power steering, and windshield wash. If your car is due for scheduled maintenance, take it to your dealer now to have it done. Routine maintenance and prompt repairs will help your car beat the challenges of the heat.

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Does the Summer Sun Damage your Luxury Vehicle’s Paint Job?

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Protecting your vehicle from the effects of sunlight

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Lexus Roswell, GA]

Dr. DEMSunlight is dynamic. It keeps us warm, allows plants to grow, and can even be converted into electricity.

Unfortunately, sunlight has an equally harmful side on human skin. As a result, the ultraviolet rays in sunlight, also known as UV rays, can burn unprotected skin and blister it. This is well known by doctors, especially plastic surgeons, dermatologists, you and me.

UV Damage

But, did you know that UV rays can seriously damage the paint on your luxury car or truck, too? Yes – it’s true.

During the warm weather seasons, exposure to UV rays actually breaks down the molecules that give your vehicle’s paint its color and shine. Though modern automobile paint includes additives to resist these effects, the paint’s effectiveness only lasts for a limited time period. So, when a car spends much of its life entrenched in sunlight, its paint will gradually fade and become dull.

Temperature too!

While sunlight is harmful, temperature can be a problem, as well. When a car sits out in the fierce midday sun, it gets hot and its body panels expand. Such expansion causes the paint to contract at a microscopic level, which may ultimately crack your car’s paint or dry out and crack leather seats. Over time, the gradual effects of the sun’s heat diminish your car’s gleaming showroom finish. As the sun is ubiquitous, it may seem as though sun damage is inescapable.

However, it is possible to extend the life of your car’s paint job by following these tips.

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My Jaguar

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Tips and Pearls

Seek shade

Whenever possible, keep your ride out of sunlight. Park in a covered garage or use a car cover for an immediate solution. You may also park your car under the shade of a tree for a short period of time, but it is important to remember that tree sap and bird droppings can also damage your paint finish.

Wax

Modern vehicles are finished with a layer of “clear coat” over the actual paint color. This gives the paint its deep gloss and helps protect the pigment from UV rays, however it doesn’t last forever. Regular waxing provides additional protection for your car, filling in cracks that form as a result of sunlight exposure.

A simple way to see if your car needs waxing is by performing the water beading test. To perform this test, drip water onto your paint. If the water forms beads on the paint surface, your car is perfectly waxed. However, if the water spreads on the paint surface, your car is in need of a new wax job.

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My Jaguar XJ-V8

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Assessment

As a classic British Jaguar XJ-V8-L sedan aficionado; can you think of any more ways to protect my car, and your car, from the sun?

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A Word on Automobile Cabin Air Filter Maintenance

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Not Just for Physician-Allergists

[By Dr. David Edward Marcinko MBA CMP™]

DEM 2013Cabin air filtration is easily the most forgotten automobile maintenance item in passenger or luxury cars.

Since their introduction in roughly the early 1990s, more and more cars are equipped with cabin air filters – from a sub-compact to a full-sized luxury car, nearly all cars available in North America now come equipped with them and thus there’s a pretty good chance your car is equipped with one, and a fair to middling chance that it needs replacement.

Now is the time to Inspect

So now, following pollen, grass and hay-fever, season, is a great time to learn more about your cabin air filter. Cabin air filters tend to be buried deep within the dashboard of your vehicle, where the heating, air conditioning and ventilation system are located. They are usually about the size of a standard sized sheet of computer paper, and can vary in terms of material, most common being a cellulose mesh.

The cabin air filter is responsible for removing particulate from the air, which can include a whole litany of things you don’t want to be breathing; diesel exhaust, rubber particles, pollen, dust and general air pollution among other things.

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00t0t_3LK6BwGPBcB_600x450

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Since the air entering the car through the heating and air conditioning system has to pass through the cabin air filter, the filter can get clogged quite quickly depending on environmental conditions, and a clogged cabin air filter drastically reduces the overall effectiveness of your HVAC system as it struggles to get air flow that a clean cabin air filter would provide.

Other excellent reasons to change your cabin air filter, besides better circulation, include fresher smelling air and fewer allergens entering the cabin. Many cabin air filters accumulate leaves and other debris that your car winds up ingesting which can lead to musty or stale odors. Ultimately, switching out your cabin air filter is a small expense that keeps you from inadvertently sneezing months later.

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DEM's Jaguar

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As your cabin air filter is “out of sight, out of mind”, it’s definitely a good idea to get in the habit of having it inspected and replaced regularly. What are the right intervals for you? It all depends where (and how much) you drive. It’s a small and affordable maintenance item that will ensure you have many miles of driving comfort ahead.

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Assessment

I replace the cabin filter in my classic 2000 Jaguar XJ-V8-L touring sedan each Spring. What about you?

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filter

[Cabin Filter]

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Making Medical [Financial] Advice Memorable?

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Can Physician [Advisor] Body Language Assist Patient [Client] Adherence

[By Dr. David Edward Marcinko MBA CMP™]

DEM at Drexel

Recently, I was at Drexel University which is a private research university in Philadelphia. It was founded in 1891 by Anthony J. Drexel, a noted financier and philanthropist. Drexel offers over 70 full-time undergraduate programs and accelerated degrees. At the graduate level, the university offers over 100 masters, doctoral, and professional programs, many available part-time.

Now, I know DU well because as a student from Temple University back in the day, I visited frequently. It was there that I first learned of the work of H. Ebbinghaus on the nature of emotions and the human memory.

Two [2] Examples

As doctors, we usually want to make a memorable impression on our patients and encourage them to remember our medical advice or instructions.

OR, as financial advisors, we want our clients to follow our informed advice. But how?

One suggestion is to take advantage of the Serial Position Effect.

Definition

The Serial Position Effect is a term coined by German psychologist Hermann Ebbinghaus PhD.

Hermann Ebbinghaus (January 24, 1850 — February 26, 1909)

According to Wikipedia, Dr. Ebbinghaus was a German psychologist who pioneered the experimental study of memory, and is known for his discovery of the forgetting curve and the spacing effect. He was also the first person to describe the learning curve. He was the father of the eminent neo-Kantian philosopher Julius Ebbinghaus.

Through his studies, he found that people have a tendency to remember the first (primacy) and last (recency) things to occur, and scarcely the middle.

The graph below demonstrates the Serial Position Effect in recalling a list of words. However, this psychological effect can be applied to many things – from job interviews to television commercials to physician advice.

***Graph

 ***

So, during your next patient interaction or client-advisor relationship, instruct your target either at the beginning or end of the event; or patient encounter. They are much more likely to remember you, and recall the topic, conversation, medical advice or instructions.

Assessment

If you want to be remembered, don’t be in the middle! And, this will make your next patient interaction; or client meeting, much easier.

Conclusion

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How to Safely Clean an Auto Engine Bay

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Thoughtfully … with Some Care!

[By Dr. David Edward Marcinko MBA]

Dr David E Marcinko MBA

I’ve been washing the engine bay of my Jaguar XJ-V8-L for the past several years. How did I get started? Isn’t this really bad for my car? Why did / do I bother?

History

I worked with a neighbor who was seriously obsessed with keeping his 1986 Thunderbird clean – way more so than I ever was; or currently am. He popped the hood one day and I marveled at the near showroom appearance of the ~ 28 year old engine bay. I asked the same questions many of you have about getting the various components and systems wet.

The owner of the car was quite talented with most things automotive, especially the electrical systems as he was a professional car audio install technician with a high end audio shop. The sound system in that car was phenomenal even by today’s standards. He was quite confident that the water would not cause problems. That engine bay got a rinse with nearly every car wash and a regular washing. I was still skeptical. I carefully tried it myself starting out away from wiring and the alternator gradually becoming more confident until the entire engine bay was squeaky clean. It looked great then and still does.

I’ve never had a problem with getting any electrical items wet – even a distributor. A modern engine bay is engineered to get somewhat wet during normal use. Assuming your engine bay is in reasonably good shape, with no defects in the electrical, crankcase ventilation and intake systems you will most likely have no problems as well. This works best and is easiest when a car is new as dirt and oxidation never have a chance to start. Even an older engine – dare I say a Jaguar – bay can be transformed with a little extra work.

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Jag DEM (2)

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Jag DEM (1)

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This ME-P is being provided as a guide only – I cannot guarantee you will not experience difficulties. Wash your engine bay at your own risk.

This is what works very well for me …

Start with a cold engine. A warm or hot engine will cause any detergent you spray on to quickly evaporate. Letting it sit and soak is what gets things clean. I cover electrical components, and have put a plastic bag over open exposed conical air filters.

Obviously, do not spray liquid directly into the air intake. Use a garden hose with a variable nozzle to go from a fine spray to a concentrated stream depending on what you are hosing down. A pistol grip style of nozzle is the easiest and fastest to use. A high pressure car wash hose is asking for trouble. Common sense is called for here.

I wash the underside of the hood first. I removed the fiber insulation the day I got my Jaguar home as I have with all of my previous cars. I personally believe the insulation is largely for sound suppression. It becomes a dirt magnet if left on and seems logical to assume it also promotes heat soak. I have not observed any engine heat related effects on the exterior hood paint with/out it.

But, the Jag is not my daily-driver. Hose down the hood, fenders, windshield and engine hosing off loose debris. Spray liberal amounts of full strength Simple Green all over, especially in the inaccessible areas. You would probably see good results with diluted Simple Green as well. Hose off any overspray from the fenders as Simple Green is too harsh for polished waxed surfaces. Let soak for ~5 minutes or so.

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bay

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While I wait – I have a few odd brushes I use to scrub around where I can. Thoroughly hose off all areas (with common sense) until all traces of the detergent are gone. Some areas can take higher pressure, like the intercooler and around the firewall. Once the car / engine wash has been completed I take the car on a drive to heat and dry the engine bay out. I repeat this maybe twice a year – that’s all it takes to keep everything looking showroom clean. The Jaguar under engine cover does a great job in keeping dirt out of the engine bay. 

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Possible Food Poisoning Sickens 100 at Food Safety Summit?

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Food Safety Summit in Baltimore, Maryland

[By Dr. David Edward Marcinko MBA]

According to reporter Joel Aleccia, more than 100 people have now reported they got sick with suspected food poisoning at a national Food Safety Summit held earlier this month in my home town of Baltimore, Maryland.

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DEM at Aquarium

[Dr. David Edward Marcinko visiting the Maryland Convention Center and National Aquarium at Harbor Place]

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Definition of “Irony”

“Irony is an incongruity between what actually happens and what might be expected to happen, especially when this disparity seems absurd or laughable”.

Link: http://www.nbcnews.com/health/health-news/possible-food-poisoning-sickens-100-safety-summit-n91631

Conclusion

Although this case of irony is not at all laughable, it is still frankly absurd and illustrative of a teaching moment.

And so, 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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“Claying” Your Own Luxury Vehicle

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How to Remove Bonded Surface Contaminants

[By Dr. David Edward Marcinko MBA]

Dr. DEMClaying is the process of removing bonded surface contaminants from your car that cannot be removed by washing alone and that need to be eliminated before the polishing process, using synthetic poly clay.

It works by gently pulling and lifting the bonded contaminants off the surface which then become encapsulated in the clay.

A detailing spray, or designated clay lube is used to lubricate the surface to prevent the clay bar from inflicting damage as it is drawn across the surface.

The Process

One panel at a time is worked and once the clay has picked up contaminants it can be folded and remolded to reveal a fresh, clean surface and prevent any contaminants being drawn over the surface.

Claying is primarily used to remove bonded contaminants from the paintwork of your car but can also be used on glass, metal and other parts of your car depending on the grade of the clay being used.

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clay-bars

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You should clay your car if you are looking to achieve the best possible results. The depth of shine and reflection of a polished and waxed vehicle may be compromised if bonded surface contaminants have not been removed. It is important to clay your car before polishing because if the contaminants are picked up during the polishing process they may be drawn over the surface inflicting light scratches and swirl marks.

It is also important to ensure bonded contaminants are removed because they will act to attract and accumulate other dirt and debris and if left bonded to the surface for a long enough period of time may even weaken the paintwork underneath.

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DEM Jag

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Preparing Your Car’s AC for Hot Weather

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Summer is Near

[By Dr. David Edward Marcinko MBA CMP™]

[By Nalley Lexus Roswell, GA]

Dr. DEMAir conditioning systems are specifically designed to be largely maintenance free, but small issues can grow into big problems without regular checks. In short, it pays to be prepared for the unexpected in hot weather conditions. If you want to keep your cool during your daily commute or on an upcoming road trip, here is a handy checklist to help you prepare your car’s air conditioning system for spring and summertime driving.

Timing is everything

Don’t wait until the hot weather has arrived to start using and testing your air conditioning. Use the system regularly throughout the year, and particularly in the spring, when you have a few weeks before the hot weather kicks in to get any remedial work carried out. Test the air flow in the system. Turn the air conditioning on high and manually inspect each of the vents. Is air coming out of every vent? Is the air pressure the same around the car, or are some vents weaker than others? Change the temperature of the system. Is the air cooling down as you would expect?

Listen for strange noises

This isn’t about things that go bump in the night, but more about ticks, rattles, or knocking sounds that might indicate there’s a problem with the system. Listen at each vent and also at the dashboard when the car is idle, and when you put your foot on the gas. It’s quite possible that there is a small obstruction (such as a leaf or twig) somewhere in the system, or there could be a more serious problem.

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Jaguar 2000 V8-L

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Check out unusual smells

Excessive oily, mechanical smells could indicate that the system is damaged or underperforming in some way and may need mechanical attention. Stale or unpleasant odors may indicate that the air filter needs replacing or that something is caught somewhere in the system. Your owner’s manual will be able to tell you how to change the filter, or get your mechanic on the case if you’d rather not do it yourself.

Check the coolant level

If the air is powerful but doesn’t appear to cool properly, you may have a problem with the coolant level in your air conditioning system. This will naturally deplete over time, but low levels may also indicate a leak in or damage to the system. The owner’s manual for your car can probably give you instructions on how to check, but if you’re unsure, consult a trusted mechanic for a second opinion.

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JAG Bay

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Assessment

Though your vehicle’s air conditioning system may not require frequent attention, scheduled maintenance checks are the key to keeping the cabin comfortable and your bank account safe from costly repair bills

Boys and their Toys

Doctors and their Cars

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Tips on Purchasing a Vehicle

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An Economic and Ethical Decision?

[By Dr. David Edward Marcinko MBA CMP™]

Dr. DEMWith the possible exception of the handgun, the automobile represents the greatest single item of ownership that is capable of inflicting death, injury and damage. America’s fascination with the automobile has resulted in a marked increase in the power and potential speed of our vehicles.

The latest trend in Sports Utility Vehicles (SUVs) has also witnessed a substantial increase in damage due to their higher ground clearance and heavier frames. The owners and operators of any vehicle must be financially able to respond to any resulting claims, or they need to transfer the risk through insurance. All states require some minimal coverage for personal vehicles.

Purchasing the Vehicle

Typically, car buyers who wait until the end of the year can score a deal. Buying at the end of the month can also increase negotiating power as dealerships look to move volume, and shoppers in the late summer and early fall may be able to get a deal when the new-model-year vehicles enter inventories.

JAG 2 (1)

Also, cold or rainy weather can work to a doctor’s advantage, since bad weather can discourage people from walking around a lot to look at vehicles, potentially giving those who do show up a bit more negotiating power. Even a serious buyer who goes to a dealership near the end of the day may receive a better price as the dealer makes concessions to speed things up so everyone can go home.

JAG 2 (2)

Assessment

So, if you time your car purchase right, and you aren’t buying one of the more popular models or colors, you might save $500 to $2,000 just by waiting until the end of the month or day to make your purchase.

Beware my [premium] gas guzzler above; not an EPA favorite, but she passes annual emissions inspection like a champ!

Conclusion

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By Ann Miller RN MHA

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Conclusion

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How to Stop Winter Road Salt Vehicle Damage

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Act quickly to prevent rust and undercarriage damage

[By Dr. David Edward Marcinko MBA and Nalley Lexus, Roswell GA]

DEM blue tieEach year, physicians and all drivers face the same challenge in the aftermath of wintry weather: potential rusting and other vehicle damage due to the buildup of road salt, ice, and grime. And, this winter was particularly severe; even here in Georgia.

Salt Rage

Road salt serves an important function by actively melting snow and ice that may have formed on the surface of the highway in addition to preventing snow and ice from settling in the first place, improving traction for road users and helping to keep the traffic flowing more safely. The main disadvantage of road salt is that, if left unchecked, it can potentially cause damage to your car.

When road salt builds up on your vehicle, don’t wait to get your vehicle thoroughly cleaned as soon as possible, or use a professional cleaning and detailing service.

Prevention is key to avoid long-term damage

Many experts recommend applying a coat of protective wax, followed by a coat of wax sealant, before road salt buildup, since it is far more difficult to prevent damage to the car after the fact. These products help protect the paintwork from the corrosive effects of road salt.

But it’s not just the paintwork that requires protection. Your brake and fuel lines are very susceptible to damage from corrosion. Therefore, road salt cannot only have damaging aesthetic implications—it can have a significant impact on your vehicle’s safety as well.

Get salty deposits removed quickly

When you have been driving on salted roads, it is important to remove salt deposits as soon as possible. A simple car wash may not always be the most effective option. With professional detailing services though, you can count on getting a thorough cleaning which will help protect your vehicle against possible damage. Additional services like steam cleaning and undercarriage cleaning offer even more peace of mind.

Professional detailing services may be more affordable than you think, especially when you consider the long-term damage that can result if road salt is left unchecked. After the cleaning, we recommend getting your vehicle re-waxed and sealed to protect your vehicle against any future wintry conditions during the season.

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Jag

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Jag interior

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JaguarBoot

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Assessment

Take a look at my 2000 Jaguar XJ-V8-L touring sedan above; pristine!

Conclusion

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The 2000 Jaguar Touring Sedan [One of the finest luxury cars ever built – yesterday]

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About the JAGUAR XJ-V8-L [circa 2000]

By Dr. David Ewdard Marcinko MBA CMP™

Dr. David E. Marcinko MBAProof is in the long haul, of course [more than a decade for me], but it appears as if Jaguar finally threw off the curse of unreliability. Credit typically goes to many sources, but leading the pack has to be Jaguar’s prior owner, Ford, which has brought its mighty engineering and quality suppliers into the Jaguar picture. Tata Motors, today.

Based on my experience, the XJ8L represents the highest point in Jaguar’s history. Many think it’s one of the finest luxury sedans ever built. The Vanden Plas, named for a famous British maker of custom automobile bodies, is the most luxurious XJ8L, swathed in chrome, walnut and lambs wool.

As the XJ8 designation suggests, this is a V8-powered Jag. The V12 and inline 6-cylinder engines were discontinued with the 1999 models. The 4.0-liter V8 called a sweetheart was refined in 2000 to reduce emissions. Performance was not affected.

Jaguar’s XJ8 was available in four versions in 2000: Originally priced at $55,780 XJ8, the $60,830 long wheelbase XJ8L, the even more luxurious $64,880 Vanden Plas and the $69,030 supercharged and fully loaded XJR. Those prices compared favorably to those of the $66,970 BMW 740iL and the $74,495 Mercedes-Benz S420; back in the day.

2

Walkaround

Regardless of trim line, Jaguar’s XJ is a beautiful car. It is stately without being stuffy, and the soft lines are uniquely Jaguar. The 2000 XJ8 continued the design theme set in 1986; Jaguar tried horizontal, contemporary-looking headlights in the 1980s, but they were so universally assailed that the company came back with round lights and they are critical to the overall look.

The Vanden Plas shares the longer wheelbase with the XJ8L, which is 117.9 inches. The standard XJ8 and the XJR ride on a 113-in. wheelbase. Visually, that wheelbase extension is reflected in the length of the rear windows.

The powertrain, suspension and electrical system were new to the sedan. Tata now owns Jaguar and has brought financial support and technology to the company, which greatly benefited the XJ8. Electrical systems, electronics and other traditional Jaguar problem areas have been eliminated since Ford got involved.

The 4.0-liter V8 has double overhead-cams and four valves per cylinder. It produces 290 horsepower at 6100 rpm and 290 pound-feet of torque at 4250 rpm.

That impressive power is delivered to the rear wheels through a five-speed automatic transmission. This electronically controlled automatic adapts to varying driving conditions; it senses whether the driver is cruising along the highway, hot-footing down a back road or climbing a long grade and it varies shift points accordingly for optimum power and efficiency.

The transmission also had a self-regulating adaptive capability; it compensates automatically for the effects of aging by adjusting shift quality based on any slippage it detects. Sport and standard modes can be selected by the driver: The standard PRNDL pattern can be used, or shifts can be made manually by moving the stick to the left.

Automatic Stability Control comes standard on all Jaguars. ASC operates at all speeds, using engine intervention to reduce wheel spin on slippery roads. If a rear wheel starts to spin, the anti-lock brake (ABS) controller signals a computer, which controls the spinning by reducing throttle, retarding ignition timing or cutting fuel to the cylinders. This feature has been a bit problematic for me; and others.

An optional traction control system includes all ASC functions plus brake intervention. This system comes as part of the All-Weather package, which also includes heated front and rear seats. Both types of traction control can be switched off.

The front suspension is fully independent with unequal-length upper and lower wishbones, coil springs, shocks and an anti-roll bar. Double wishbones are also used at the rear with the drive shafts acting as upper links.

They are arranged for anti-lift under braking and anti-squat under acceleration. Variable-ratio rack-and-pinion power steering is speed-sensitive.

1

Interior

Jaguar’s uniqueness is especially evident inside my vehicle. Getting in is like sliding into an English gentleman’s club, with yards of supple leather, luxurious deep-pile carpeting, and polished wood on the doors, instrument panel and steering wheel. The instruments are simple and understated in keeping with the elegant mood.

Memory functions automatically adjust the driver’s seat, steering wheel and outside mirror. The driver’s seat moves back when Park is engaged for easy exit. It moves back to the last position it was set when the ignition is turned on. A [fragile] cup-holder pops out from the console, but any drinks in it tend to get in the way of shifting.

Thanks to the long wheelbase of the Vanden Plas, or L model, the rear compartment is huge and legroom is expansive. The bench seat has two depressed seating areas, but a third person would be comfortable in the middle. Airplane-like tray tables fold down from the front seatbacks. A small pod with two rocker switches on the left side of the passenger seat allows rear-seat passengers to move the seat fore and aft and adjust the angle of the seat back. Headroom is just as generous as legroom.

4

Driving Impression

The unique looks of the XJ8 and L are complemented by a driving experience all its own. Mercedes and BMW share a ride that is more on the firm side and generally feel tight and buttoned up. Lexus and Infiniti offer a softer ride and a more relaxed atmosphere. The XJ8L is wonderfully comfortable with an elegant feel.

Acceleration performance is startling with instant throttle response. On dry pavement, the Jag will light the rear tires up if the traction control is turned off. In a handful of seconds it’s hurtling past the speed limit. Jaguar says the XJ8 can accelerate from 0 to 60 mph in 6.9 seconds, an impressive feat given its size and weight at 290-horse-power. (The 370-horsepower XJR can do it in a mere 5.4 seconds.)

Shifting is silky smooth, even at full throttle. You can almost feel the transmission signaling the engine to reduce power slightly because a shift is coming. It’s an almost imperceptible pause as the shift is made.

I had some fun with the manual shifting mode, but it seemed superfluous with a transmission that does such a great job on its own. The manual operation is electronically controlled to prevent downshifting at an inappropriate speed. The gear can be selected, but the shift won’t be made until speed has dropped sufficiently.

Differences between Normal and Sport suspension modes are perceptible on rough surfaces and in hard cornering. The Sport setting lets a little more road roughness come through the steering, but gives the car a slightly flatter stance in cornering.

Driving on narrow roads, I discovered that the fenders loom large from the driver’s seat. The left front fender obscures the center line and the right front fender masks the verge to give the driver a feeling the car is taking up all the lane and more. But it isn’t; and we never posed a threat to mail boxes or other vehicles.

The steering lets the driver feel connected to the road, providing a strong sense of control. The wheels do not straighten by themselves after a tight maneuver; they must be brought back in line by turning the steering wheel, just like a race car.

Quiet is an expected part of the luxury quotient, but we didn’t expect this much quiet. It is so quiet inside it’s almost eerie. No wind noise, no road noise, no harmonics from various systems. You can hear the transmission as it reaches a shift point, and there is a sound you realize must be the engine, but it is more like an electric motor humming than a V8 combusting.

Visibility is good in all directions; but I find the headrests make it a bit cumbersome. The C-pillars are quite thin, so rear visibility is above average for cars this size.

Overall, my 2000 XJ-8L provides a very pleasurable driving experience.

3

Assessment

This is certainly one of the finest cars built – yesterday. Ford’s involvement has undoubtedly had a lot to do with that achievement. The old quality bugaboo seems to be just a memory.

BMW and Mercedes and the rest really can’t be compared with the XJ8, other than in price, because the Jaguar offers something altogether different. In price, however, the XJ8 or L was very competitive. For luxury with a difference, drive a Jaguar XJ8 or L series.

Conclusion

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An ME-P Thanksgiving Day 2013 Tribute

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A Letter from the Publisher-in-Chief

By Dr. David E. Marcinko; MBA, CMP™

Washington, DC: “I do therefore invite my fellow citizens … to set apart … a day of thanksgiving and praise to our beneficent father who dwelleth in the heavens.”

— Abraham Lincoln

Dear ME-P Readers & Subscribers

These words were spoken in the middle of Lincoln’s Thanksgiving Proclamation on Oct. 3, 1863 while the country waged a horrific civil war. In light of the political and macro-economic challenges we’ve been confronting in our country today, and the accompanying rancor in the healthcare industrial complex, this is the perfect time to revisit those wise and carefully chosen words.

Thanksgiving Proclamation

And so, I’ve included Lincoln’s Thanksgiving Proclamation in its entirety below. From my way of thinking, it should be required reading by every American every Thanksgiving. In particular, our target market of medical professionals and financial advisors should reflect on the lifestyle opportunities afforded to those who work hard, work smart, and who work to serve their patients and clients in a fiduciary capacity.

October 3, 1863

The year that is drawing towards its close, has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature, that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever watchful providence of Almighty God. In the midst of a civil war of unequaled magnitude and severity, which has sometimes seemed to foreign States to invite and to provoke their aggression, peace has been preserved with all nations, order has been maintained, the laws have been respected and obeyed, and harmony has prevailed everywhere except in the theatre of military conflict; while that theatre has been greatly contracted by the advancing armies and navies of the Union. Needful diversions of wealth and of strength from the fields of peaceful industry to the national defense, have not arrested the plough, the shuttle or the ship; the axe has enlarged the borders of our settlements, and the mines, as well of iron and coal as of the precious metals, have yielded even more abundantly than heretofore. Population has steadily increased, notwithstanding the waste that has been made in the camp, the siege and the battle-field; and the country, rejoicing in the consciousness of augmented strength and vigor, is permitted to expect continuance of years with large increase of freedom. No human counsel hath devised nor hath any mortal hand worked out these great things. They are the gracious gifts of the Most High God, who, while dealing with us in anger for our sins, hath nevertheless remembered mercy. It has seemed to me fit and proper that they should be solemnly, reverently and gratefully acknowledged as with one heart and one voice by the whole American People. I do therefore invite my fellow citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens. And I recommend to them that while offering up the ascriptions justly due to Him for such singular deliverances and blessings, they do also, with humble penitence for our national perverseness and disobedience, commend to His tender care all those who have become widows, orphans, mourners or sufferers in the lamentable civil strife in which we are unavoidably engaged, and fervently implore the interposition of the Almighty Hand to heal the wounds of the nation and to restore it as soon as may be consistent with the Divine purposes to the full enjoyment of peace, harmony, tranquility and Union. In testimony whereof; I have hereunto and caused the seal of the United States to be affixed.

Blessed to be Americans

We are blessed and thankful to be Americans. And yes, we are blessed to be living in a country that has afforded so many wonderful opportunities; like publishing this ME-P.

That said, I think it is important to revisit the birthing of our beloved Thanksgiving holiday. If only we had Lincoln’s leadership and greatness to help us through our challenges of today.

But, if Father Abe was alive and editing this ME-P, he’d likely tell you a story, send in a post or comment, share a humorous but poignant anecdote, interject his kindness, and/or tell you to take advantage of the opportunities of today, both in healthcare and personal financial planning for medical professionals.

IOW: Engage, contribute and opine on our ME-P platform to the fullest extent possible. Promote it and hold us accountable.

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Assessment

If you have any topic suggestions or special requests, please contact us at: MarcinkoAdvisors@msn.com

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Understanding NYSE / NASD Minimum Credit Requirements

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A Primer for Physician Investors and Medical Professionals

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

[Editor-in-Chief]

[PART 8 OF 8]

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

We have seen that there are rules which stipulate that no brokerage firm may arrange for any credit to any client whose margin account does not have an equity of at least $2,000. The principal application of this rule is to initial transactions in newly opened margin accounts, however, it does apply at all times. 

Example: A doctor buys 100 shares, at $15, in a new margin account. His margin call is $1,500.

Rationale: $2,000 would be too much to require as it exceeds the total purchase price. However, a loan to the doctor isn’t allowed to be extended until, and unless, the account has equity of $2,000. The trade is simply paid in full -100% of the purchase price is the margin call. 

Example: A doctor buys 200 shares, at $15, in a new margin account (assume Regulation T = 60%).

His margin call is $2,000 

Rational: Regulation T 60% would be $1,800 (60% x $3,000). Since this would be $200 shy of the minimum equity level of $2,000, the call is the $2,000 minimum equity. 

Example: A doctor buys 300 shares, at $15, in a new margin account. (assume Regulation T = 60%) His margin call is $2, 700. 

Rationale: The account will have equity of $2, 700 (60% x $4,500), which is more than the $2,000 minimum. Therefore, the Regulation T initial requirement prevails.

The important points to remember about minimum credit requirements are:

1. You are not called upon to pay more than the purchase price.

2. You cannot be granted a loan until the account has an equity of at least $2,000.

3. If a decline in the market value of an existing account puts the equity below $2,000, there is no requirement to bring the equity back up to $2,000.

4. You may not withdraw money or securities from the account, if in doing so, you either:

  1. bring the equity below $ 2,000, or
  2. bring the equity below the maintenance level

These are the only times SMA may not be withdrawn from an account

The Short Sale

Selling short is engaged in by medical professionals who anticipate a market decline. By selling borrowed property (shares of stock) at the current market value, the doctor expects to return the borrowed property (shares of the same issuer bought in the marketplace) to the lender, normally the investor’s brokerage firm, when the market price is lower, thus profiting from the drop in price.

Essentially this is the buy low, and sell high philosophy. However, when executing a short sale one is selling high initially, then buying low later to “cover”, or close out the deal by buying low and selling high in the reverse order .

Bear in mind that the short seller is borrowing property, not money. However, due to the high degree of risk inherent in short selling, it is permitted only in a margin account. A Regulation T call is required as a show of good faith, a way the client demonstrates the financial wherewithal to buy back the property. Let’s look at a short sale transaction and the subsequent effects of market fluctuations on equity, as we did previously with buying on margin (long margin).

Credit Balance and Equity

A doctor shorts (sells short) 100 shares at $100 per share with Regulation T at 60%. The margin account would be credited with the proceeds of the sale, though the doctor has no access to these monies at this point in the deal. The account should also be credited with the doctor’s required Regulation T margin call. Therefore, the credit balance in a doctor’s margin account is the sum of the  proceeds of the short sale, plus the Regulation T margin call. This number will not change, regardless of future market fluctuations. The credit balance in a short margin account is a constant.

What does change with market fluctuations?

  1. the cost of buying back the borrowed property to cover the short sale.
  2. the equity in the account.

Equity in a short margin account is computed as follows:

Credit of  $ 16,000 – CMV  $10,000 equals $ 6,000 equity.

Now, let’s evaluate the effect of appreciation in the market price

If the stock rises to $120 per share, then the credit of $16,000 – CMV $ 2, 000, equals $ 4,000 equity.

Remember, the credit balance does not change when CMV fluctuates. The equity in this account is no longer Regulation T.

Let’s determine the amount by which the account is restricted (remember, any margin account with equity below Regulation T is restricted). Or, 60% X $12,000 = $ 7,200 – $ 4,000 = $ 3,200

Also, it should be clear, the equity percentage of this account is less than 60%, by the formula:

Equity / CMV = $ 4,000/$ 12,000 = 33.33%

This is the basic principle of the short sale; as the market price of the shorted stock increases, the equity decreases. The reverse is also true; as the price declines, the equity rises. Remember, short sellers are anticipating a market decline. Also, when buying long, or selling short, any change in market value causes a dollar for dollar change in equity.

Minimum Maintenance Requirements (Short) 

If the market continues to appreciate to $160 per share, the equity drops to zero.

Suppose that the market price rose to its theoretical maximum, or infinity? The doctor’s loss would be infinite. Remember, the maximum potential loss on a short sale is unlimited!

To protect against such an occurrence, industry Self Regulatory Organizations (SROs) developed regarding the minimum equity that must be maintained in a margin account. The minimum maintenance in a short account is equity of 30% of CMV. Note that this is higher than the 25 % figure for long margin accounts due to the nature of extreme risk of loss in the short sale.

Given that the CMV has risen to $160 per share ($16,000 total CMV), the minimum equity required to be maintained under SRO rules is 30% x CMV or  $4,800 equity. The doctor would receive a $4,800 maintenance call to bring his equity from -0- to the $4,800 minimum.

Remember, as in (cash) long accounts, there is no requirement to bring a margin account up to Regulation T equity. The maintenance equity is the percentage up to which the account must be brought when and if equity drops below the 25% or 30% levels.

Excess Equity (SMA) and Buying Power

We have seen what market appreciation does to a short seller. Let’s evaluate the effects of market depreciation in value. If the declines to $85, per share, then $ 16,000 credit – CMV $ 8,500 = $ 7,500 equity. Again, market fluctuations don’t affect credit balance. The equity in the account is now higher than Regulation T, and SMA (excess equity) has just been created.

And, as before, excess equity (SMA) can be used to buy more securities. Couldn’t it also be used as the Regulation T down payment on another sale? Yes, this is another use of SMA that is called shorting power or “selling power”. The formula for buying power as well as shorting power is exactly the same: Remember, it’s SMA / RT to use buying power.

In this case, $2,400 / 60% = $4,000 of buying (shorting) power after the decline to $85, the doctor could buy long or sell short another $4,000 worth of stock and use his SMA to meet his 60% ($2,400) Regulation T Margin call. Recall, the margin call for a short sale is the same as for a long purchase.

Cheap Stock Rule

The SROs created a set of special maintenance rules in short margin accounts to protect against unreasonable risk in low-priced issues. These rules are appropriately labeled the “cheap stock” rules.

At all times, a doctor must maintain equity in a short margin account of the greater of the following:

  1. 30% of the CMV (SRO Minimum Maintenance Requirement)
  2. $2,000 (SRO Minimum Credit Requirement)

3.   Equity as required under the rules  below

The cheap stock rules are as follows:

Stock Price                                     Minimum Maintained Equity

0 – $2.50 per share             $ 2.50 per share

$2.50 – $5.00 per share      100% of per share price

$5.00 per share and up       $ 5.00 per share

Example: A doctor shorts 1,000 shares of a $1.50 per share stock. How much must he deposit initially and how much must be maintained in the account?

First, since Regulation T won’t come into play until equity hits $2,000, the SRO minimum credit requirement of $2,000 should come into play. However, since this is a cheap stock, we determine if the requirements of those special rules require more than $2,000. They do, and require a minimum be maintained in this short margin account of at least $2.50 per share sold short (1,000 shares at $2.50 each = $2,500 minimum that needs to be in this account at all times to comply with SRO rules).

Furthermore, if the market begins to rise, the cheap stock rules would require that at all times the amount of money in the account be at least 100% of the price per share until the stock hits $5. For example, if the stock rose to $4 per share, the doctor would have to have $4,000 in the account to carry the position (1,000 shares times 100% of CMV, $4 per share in this case).

Day Trading and the Internet

Internet day trading has become something of an, investment bubble of late, suggesting that something lighter than air can pop and disappear in an instant. This has occurred despite the fact that most lay and healthcare professionals who engage in such activities, do not appreciated even the basic rules of margin and debt, as reviewed review. History is filled with examples: from the tulip mania of 1630 Holland and the British South Sea Bubble of the 1700’s; to the Florida land boom of the roaring twenties and the Great Crash of 1929; and to $ 875 an ounce gold in the eighties and to the collapse of Japans stock and real estate market in  early 1990’s. To this list, one might now add day Internet trading

The cost of compulsive gambling, arising from internet day trading activities, may be high for the physician, his family and society at large. Compulsive gamblers, in the desperation phase of their gambling, exhibit high suicide ideation, as in the case of Mark O Barton’s the murderous day-trader in Atlanta. His idea actually became a final act of desperation. Less dramatically is a marked increase in subtle illegal activity. These acts include fraud, embezzlement, CPT up-coding, medical over utilization, excessive full risk HMO contracting, and other “alleged white collar crimes.”  Higher healthcare and social costs in police, judiciary (civil and criminal) and corrections result because of compulsive gambling. The impact on family members is devastating. Compulsive gamblers cause havoc and pain to all family members. The spouses and other family members also go through progressive deterioration in their lives. In this desperation phase, dysfunctional families are left with a legacy of anger, resentment, isolation and in many instances, outright hate.

Recent Updates

Since most people, including medical professions,  initially loose at day trading, they give up and decide not to do it anymore. As there is a minimum amount of money, about $ 25,000-50,000 of trading capital needed to start, this loss is a powerful de-motivator. Still, scared by the Barton incident, the NASD and NYSE have recently proposed new rules for those who engage in questionable day trading activities.  One proposal would provide that a minimum equity of $ 25,000 be maintained at all times, versus the current $ 2,000 for other margin accounts. If the amount of a pattern day trader fell below the new threshold, no further trading would be permitted until the threshold was maintained.

Options Trading

Stock options are contracts that obligate medical investors to either buy or sell a stock at a specific price, by a specific date. For example, a put option is a bet on falling prices. Let’s suppose Dr. Jane Smith holds a put option on XYZ stock, with a $ 50 exercise price, and the stock falls to $ 45. The value of the put rises in the options market because it lets her sell a $ 50 share, which is above the market price. A call option, on the other hand, is a bet on rising prices. Again, Dr. Smith holds a call option on XYZ stock, with an exercise price of $ 50. If the share rises to $ 55, the value of the option increase since she may buy for $ 50, a stock now worth $ 55.

In 1999, Charles Schwab, the biggest on-line brokerage executed more than 30 million option trades. Due to this demand, Schwab launched other complex services, such as the on-line simultaneous buying and selling of options. Also crowding the options field, are new upstart on-line brokerages, such as: Interactive Brokers, Preferred Capital Markets Technology and CyberCorp. They provide powerful software which will allow options in the future to trade as effortlessly and efficiently as stocks.

In  mid-2000 the Reuters Group PLC Instinet Corporation, the electronic network most widely used by institutional investors, opened an Internet brokerage aimed at consumers, including healthcare practitioners. Instinet will let retail clients place orders alongside institutions, and will offer access to charts, news and research. Thus, artificially empowering the individual investor, as well as again tempting the compulsive prone addict.

Acknowledgements

The assistance Mr. James Nash, of the Investment Training Institute, in Tucker, GA is acknowledged in the preparation of this ME-P.

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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Web Sites of Interest

http://www.tradehard.com

The ultimate super site for investment bankers and traders. Started by a group of well known stockbrokers, day traders, and money managers. This site offers advice about how to work the market to your advantage.

http://www.internetinvesting.com

This is an investor’s guide to on-line brokers, discount brokers, day trading and after hours investing. The site offers stock quotes, financial news, investment banking strategies, a book list and daily commentary about the market. This is a serious text heavy resource.

References and Readings

  • Atkinson,  W., and Crawford, AJ.:  On-line investing raises questions about suitability. Wall Street Journal, November, 28, 1999.
  • Farrell, C.: Day Trade On-line. John Wiley & Sons, New York, 1999.
  • Friedfertig, M.: Electronic Day Trader’s Secretes. McGraw-Hill, New York, 1999.
  • Gibowicz, Peter: Registered Representative (Study Program ,Volume II). Edward Fleur Financial Education Corporation, New York, 1998.
  • Gibowicz, Peter: Quick Seven. Edward Fleur Financial Education Corporation, New York, 1998.
  • Gibowicz, Peter: Registered Representative (Study Program, Volume I). Edward Fleur Financial Education Corporation, New York, 1998.
  • Kadlec, CW.: Dow 100,000: Fact or Fiction. New York Institute of Finance, New York, 1999
  • Nash, J: Securities Markets. In, Nash, J: (International Training Institute Manual). Atlanta, 1999.
  • Nassar, DS: How to Get Started in Electronic Day Trading. McGraw-Hill, New York,
  • 1999.
  • Schmuckler, E:  The Addictive Personality. In, Marcinko, DE (2001 Financial Planning for Medical Professionals. Harcourt Professional Publishing, New York, 2000. 

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Underwriting US Government Securities Issues

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A Primer for Physician Investors and Medical Professionals

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

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

[PART 4 OF 8]

Dr. Marcinko at Emory University

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

The underwriting of US Government securities is the largest underwriting market in the world, but are issued a bit differently than we have seen to date, in this series..

For example, there is no such thing as a negotiated underwriting on a US Government security. All offerings of the Treasury are sold by auction. The auction is conducted by the Federal Reserve Bank of New York in accordance with a published schedule. Unfortunately, they are not open to the public, just primary dealers. A bank or investment dealer is appointed by the president of the Federal Reserve Bank of New York and are the only entities authorized to buy and sell government securities in direct dealings with the FED. One becomes a primary dealer through qualifications of reputation, underwriting capacity, and adequacy of staff and facilities.

Currently, 13 and 26-week treasury bills are offered every week on Mondays, while 52- week bills are auctioned once a month. Treasury notes and bonds are auctioned much less frequently on a schedule that will not be asked on your exam. Those dealers wishing to acquire a particular Treasury security enter bids on a yield basis rather than at a specific  price. This method is sometimes called a Dutch auction. As a practical matter, about a week or so before the proposed auction, the Treasury announces the following four items: amount, maturity date, nominal or coupon rate anticipated, and  the minimum denominations available (except for T bills which don’t have interest coupons and always carry a minimum denomination of $10,000).

Can the individual medical professional purchase newly issued Treasuries? Yes! Rather than turning in a competitive bid, as the primary dealer does, the individual will turn in a non-competitive bid. Competitive bidding with governments is similar to the other competitive bidding discussed above. The underwriter turning in the lowest bid, wins. Due to the enormous size of Treasury offerings, it is extremely rare that the lowest bidder is able to take the entire issue. That being the case, the Treasury moves to the next best and the next best bidders, until most of the issue is taken. There is always a small portion left over for the non-competitive bidders.  Non-competitive bids may only be made in amounts of $1 million or less.  All non-competitive bids are automatically filled at the average yield of the competitive bids which have been accepted.

Underwriting  State Issues (Blue Sky Registration)

Unlike Federal issues, there are three types of State registration that are important for the medical professional to know:

Notification: This is the simplest form of registration and is used by a an issuer who has been in continuous operation for at least the previous three years.  Most, but not all, states permit registration by notification. 

Coordination: This occurs when an issuer wishes to coordinate a Federal registration under the Securities Act of 1933 with Blue Sky registration in one or more states. Under most circumstances, the Blue Sky registration automatically becomes effective when the Federal registration statement becomes effective.

Qualification: Any security may be registered in a state by qualification, but it’ s most commonly used by those issuers who are unable to use notification or coordination. Registration by Qualification becomes effective when so ordered by the State Administrator.

Exempt Securities

There are many securities which are exempt from the Act of ’33 registration and prospectus requirements. They include:

  • US Government and  Federal Agency issues.
  • Municipal, State issues and commercial paper with a maturity not in excess of 270 days.
  • Intra-state offerings (Rule 147)  because they are blue-sky chartered within the state.
  • Small Public offerings (Regulation A) if the value of the securities issued does not exceed $5,000,000 in any  12 month period. An issuer using the Regulation A exemption does not make the normal filings with the SEC in Washington. Instead, they file a simplified disclosure document with their SEC Regional Office, known as an Offering Statement. It must be file at least 10 business days prior to the initial offering of the securities. No securities may be sold unless issuer has furnished an offering circular (full disclosure document) to the purchaser at least 48 hours prior to the mailing of confirmation of the sale, and, if not completed within 9 months from the date of the offering circular, a revised circular must be filed. Every 6 months, issuers must file a report with the SEC of sales made under the Regulation A exemption until offering is completed.
  • Traditional insurance policies are considered to be securities and are exempt, as are fixed annuities. However, some of the newer forms of life insurance, like variable life, as well as variable annuities, have investment characteristics and, therefore are not exempt from registration.
  • Commercial paper and banker’s acceptances (9 month or shorter maturity), since they are money market instruments.

US capitol

The Private Placement (Regulation D) Securities Exemption

Since the Securities Act of 1933 requires disclosure of all public offerings (other than the exemptions just described), it should make sense that any securities offering not offered to the public would also be exempt. The Act provides a registration exemption for private placements, know as Regulation D.

Since one of the stated purposes of the Act of 1933 is to prevent fraud on the sale of new public issues, an issue which has only a limited possibility of injuring the public may be granted an exemption from registration. The SEC just doesn’t have the time to look at everything so they exempt offerings which do not constitute a “public offering”. Strict adherence to the provisions of the law, however, is expected and is scrutinized by the SEC. This exemption provision of the Act of ’33 lies within Regulation D.

Regulation D describes the type and number of investors who may purchase the issue, the dollar limitations on the issue, the manner of sale, and the limited disclosure requirements. Bear in mind at all times that from the issuer’s viewpoint, the principal justification for doing a private, rather than public offering, is to save time and money, not to evade the law. Remember, it is just as illegal to use fraud to sell a Regulation D issue as it is in a public issue. However, if done correctly, a Regulation D can save time and money, and six separate rules (501-506).

Rule 501: Accredited investors are defined as: corporations and partnerships with net worth of $5,000,000 not formed for the purpose of making the investment; corporate or partnership “insiders”; individuals and medical professionals with a net worth (individual or joint) in excess of $1,000,000; individuals with income in excess of $200,000 (or joint income of $300,000) in each of the last two years, with a reasonable expectation of having income in excess of $200,000 (joint income of $300,000) in the year of purchase; and any entity 100% owned by accredited investors.

Rule 502:  The violations of aggregation and integration are defined:

Aggregation: Sales of securities in violation of the dollar limitations imposed under Rules 504 and 505 (506 has no dollar limitations).

Integration: Sales of securities to too large a number of non-accredited investors, in violation of the “purchaser limitations” set forth in Rules 505 and 506 (504 has no “purchaser limitations”).

Rule 503: Sets forth notification requirements. An issuer will be considered in violation of Regulation D, and therefore subject to Federal penalties, if a Form D is not filed within 15 days after the Regulation D offering commences.

Rule 504: Enables a non-reporting company to raise up to $1,000,000 in a 12-month period without undergoing the time land expense of an SEC registration. Any number of accredited and non-accredited investors may purchase a 504 issue.

Rule 505: Enables corporations to raise up to $5,000,000 in a 12-month period without a registration. The “purchaser limitation” rule does apply here. It states that the number of non-accredited investors cannot exceed 35.

Rule 506: Differs from 505 in two significant ways. The dollar limit is waived and the issuer must take steps to assure itself that, if sales are to be made to non-accredited investors, those investors meet tests of investment “sophistication”. Generally speaking, this means that either the individual non-accredited investor has investment savvy and experience with this kind of offering, or he is represented by someone who has the requisite sophistication. This representative, normally a financial professional, such as an investment advisor, accountant, or attorney, is referred to in the securities business as a Purchaser Representative.

Obviously, we would have few problems if only medical investors in private placements were accredited investors, but that is not always the case. Since we are limited to a maximum of 35 non-accredited investors, how we count the purchasers becomes an important consideration. The SEC states that if a husband and wife each purchase securities in a private placement for their own accounts, they count as one non- accredited investor, not two. It would also be true that if these securities were purchased in UGMA accounts for their dependent children, we would still be counting only one non- accredited investor.

In the case of a partnership, it depends upon the purpose of the partnership. If the partnership was formed solely to make this investment, then each of the partners counts as an individual accredited or non-accredited investor based upon their own personal status, but if the partnership served some other purpose, such as a law firm, then it would only count as one purchaser .

Regulation D further states that no public advertising or solicitation of any kind is permitted. A tombstone ad may be used to advertise the completion of a private placement, not to announce the availability of the issue.

As a practical matter, however, whether required by the SEC or not, a Private Offering Memorandum for a limited partnership, for example, is normally prepared and furnished so that all investors receive disclosure upon which to base an investment judgment.

If any of the provisions of the Securities Act of 1933 are violated by an issuer, underwriter, or investor, this is known as “statutory underwriting”, underwriting securities in violation of statute. One who violates the ’33 Act is known as a statutory underwriter. One all too common example of this occurs when a purchaser of a Regulation D offering offers his unregistered securities for re-sale in violation of SEC Rule 144, an explanation of which is given below:

In simple English, SEC Rule 144 was created so that certain re-sales of already-existing securities could be made without having to file a complete registration statement with the SEC. The time and money involved in having to file such a registration is usually so prohibitive as to make it uneconomical for the individual seller. What kinds of re-sales are covered by Rule 144 and are important to the medical investor? Let’s first define a few terms.

Restricted Securities: Unregistered Securities purchased by a medical or other investor in a private placement. Also called Letter Securities, Legend Securities, referring to the fact that purchasers must sign an “Investment Letter” attesting to their understanding of the restrictions upon re-sale and to the “Legend” placed upon the certificates indicating restriction upon resale.

Control Person: A corporate director, officer, greater than 10% voting Stockholder, or the spouse of any of the preceding, are loosely referred to as Insiders or Affiliates due to their unique status within the issuer .

Control Stock: Stock held by a control person. What makes it control stock is who owns it, not so much how they acquired it.

Non-Affiliate:  An investor who is not a control person and has no other affiliation with the issuer other than as an owner of securities.

Rule 144 says that restricted securities cannot be offered for re-sale by any owner without first filing a registration statement with the SEC:

  1. unless the securities have been held in a fully paid-for status for at least two years;
  2. unless a notice of Sale is filed with the SEC at the time of sale and demonstrating compliance with Rule 144
  3. unless small certain quantity apply.

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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Modern Office Management Skills for Savvy Physicians

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“Learning” about The Business of Medical Practice in Modernity

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How the Medical Executive-Post Survived to our 8th Anniversary?

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And … Why the American Medical News was Shuttered after 50 Years!

[Some Musing on our Eighth Anniversary]

Ann Miller RN MHA

[Executive-Director]

Happy BirthdayAccording to well known healthcare industry journalist Kevin B. O’Reilly, a dramatic drop in medical-publishing revenues caused the recent closure of the American Medical News, effective with a final edition of the newspaper published just last month.

Published for more than five decades, AMNews was hit hard by industrywide trends. The newspaper’s revenue fell by two-thirds during the last decade, as reported by Thomas J. Easley, senior vice-president and publisher of periodic publications for the American Medical Association [AMA].

Unsustainable financial losses forced the move despite the newspaper’s editorial quality, the AMA’s senior management reportedly said. But, the Association’s other news operations will be enhanced.

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amn

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What the Death of American Medical News Says About the Future of American Medicine

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How we survive!

We’ve been online for eight years now. We have a skeleton staff, a scalable business model, an almost free distribution model, no print analog, and a tiny electronic advertising revenue stream.

Oh, let’s not forget some brilliant essayists, contrarian contributors, insightful commentators and controversial opinions that are often the elephant in the virtual room. 

Our gratitude to you all is without limits.

So, how else do we do it?

Interestingly – Our print books are good, better and best sellers. We’ve been releasing one major, semi-peer reviewed text each year …. and sales are brisk. And, we are now negotiating to begin our next and ninth volume for 2014-15. We maintain our own copy-rights, perform in-house editing, seek out the best contributing authors, and reduce the cost of numerous channels of distribution. How do we do it, year after year? In a word, professional crowdsourcing.

Our consulting business is increasingly robust, too. Cudos to healthcare reform, managed care, and the PP-ACA!

And … another thing

I ask again. How do we do it? How do we stay in business?

Here are some more ways to help-us, do just that:

  1. Subscribe to the ME-P site
  2. Tell a friend or colleague about us
  3. Visit our Blogroll list
  4. Use our classified ads or advertise with us
  5. Purchase a printed handbook, dictionary, software product or textbook
  6. Use our career and educational resources
  7. “Ask a Consultant” for free advice
  8. Request a strategic competitive consultation
  9. Hire us for a medical practice valuation or revenue enhancement review
  10. Request a medical business planning RFP
  11. Purchase a practice management checklist
  12. Seek out our financial planning advice
  13. Ask for second opinion; hire our thought-leaders
  14. Request a healthcare econometrics review
  15. Seek out our practice management or business advice
  16. Become a Certified Medical Planner™ www.CertifiedMedicalPlanner.org
  17. Request a speaker for a pharmaceutical seminar or health convention
  18. Attend a seminar, sponsor or take a learning-teaching cruise with us
  19. Donate to us …  and repeat
  20. Buy a link … and repeat again
  21. Send a thank you note to our Publisher-in-Chief and Managing Editor
  22. Visit us often to review, read, rant and rave.

Bottom Line Eight Years Out

The ME-P is an austere … Labor of Love.

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Assessment

So, does the demise of the American Medical News really say anything at all about the ME-P; in addition to the future of domestic medicine? How do we avoid the same fate? Please tell us. Question Everything … Trust No One … Paddle your Own Canoe … Keep the Faith!

Conclusion

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The Doctor’s Path to Wealth?

And … for us all

By Rick Kahler CFP® http://www.KahlerFinancial.com

Rick Kahler CFPAfter three decades as a financial planner, working with successful wealth-builders, you’d think I would have a clear idea of the right path for creating wealth.

Instead, what I’ve learned is that there is no such thing. Here are just a few of the paths that aren’t the sure routes to wealth they might seem to be:

Several Paths

1. Education and career choices. Going into a field like law or medicine might seem to guarantee financial success. Not necessarily. I’ve seen many physicians, for example, who have accumulated significant wealth. I’ve seen just as many who live paycheck to paycheck.

2. High earnings. Again, this isn’t the reliable predictor of wealth it would seem to be. True, someone who spends decades in low-wage jobs is unlikely to be able to accumulate much financial security. But a person earning $1 million a year will not necessarily have a larger net worth than someone earning $75,000. I’ve seen people who worked as janitors, nurses, and mechanics become millionaires. I’ve worked with others, earning a hundred times more in careers like sales or entertainment, who reach retirement age with absolutely nothing.

3. Owning your own business. Many hard-working, creative entrepreneurs build successful businesses that provide wealth, not just for themselves, but for their children and grandchildren. Others might see a business or even a series of businesses fail. Still others might work hard all their lives but never achieve more than the equivalent of an average salary in their field.

4. Investment choices. Some people have had great success investing in various types of real estate, businesses, and commodities. Others have lost everything they ever owned investing in those same vehicles.

Some Commonalities

So, sorry, I can’t give you a simple list of the top ways to build wealth. There’s little commonality in how my successful clients have made their money. What I can suggest are a few ways to help you find your own path to accumulating wealth.

1. Define “wealth” in your own way. Maybe you’re willing to live frugally in order to accumulate enough money to feel secure that your needs will be met even if you live to be 100. Maybe wealth to you is living a lavish lifestyle and being willing to work hard to pay for it. You might see wealth as the satisfaction and responsibility of having your own business. Maybe it means being able to give generously. Or perhaps you define wealth as the freedom of owning little and traveling around the world on a bicycle.

2. Know what you are willing to sacrifice—and what you are not—in order to accumulate wealth. There’s nothing wrong with earning a high salary doing work you hate for a time, as part of an overall strategy to get you to doing something you love. But doing so for a lifetime is hardly the road to either happiness or wealth.

3. Think long term. The most reliable way to build lifetime wealth, with the lowest risk, is through a long-term commitment to diversified investing. Yet even those who are successful on riskier paths to wealth take the long view. Business owners may fail more than once before they succeed. And those who have made fortunes in high-risk investments have also lost fortunes. They understand that success is about taking calculated risks.

4. Learn to make conscious financial decisions. I’ve seen many intelligent, capable people stuck in financial chaos and poverty because of emotional pain and dysfunction. Emotional health may not be essential for building financial wealth. It is, however, essential if you want to use that wealth to support a rich and satisfying life.

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Conclusion

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

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Remembering the Boston Tragedy

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My Thoughts on the Unthinkable

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

A POEM

In memory of those who died

[Copyright by Nicholas Gordon]

In memory of those who died.

We weep and walk away.

Tears run into swollen streams.

No trace of us remains.

Even those who grieve are gone, and those that grieve who grieve, and those whose lives are ravaged by afrantic urge to be.

And those who wander silently among the empty rooms – immortality is theirs, though they must vanish, too.

We bear astonished witness to the passage of the soul.

No bridge exists that can connect our passion to the whole.

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Fenway Park Dr. Marcinko

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Assessment

Tragedy is defined as a form of drama based on human suffering that invokes in its audience an accompanying catharsis or pleasure in the viewing.

But, we shall not succumb to it; we shall not give up; we will revisit Boston and run a marathon again. And, as free Americans, we will live, love and … thrive!

Conclusion

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Books for Savvy Doctors and their Financial Advisors and Management Consultants

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Feel free to write a review and tell us what you think?

Conclusion

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What to do if You Rear End the Car in Front of You?

 
   

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By Dr David Edward Marcinko MBA via Nalley Collision Center

[Editor-in-Chief]

dr-david-marcinko21As a doctor, driver and former insurance agent, I know that any car accident, no matter the point of impact, is frightening and inconvenient. But, rear-end accidents (frequently referred to as “fender benders”) are a common occurrence on the road and form a significant proportion of all road collisions.

According to a report on the Science Daily website, there were nearly two   million rear-end collisions in 2006, comprising nearly 30% of all crashes on   U.S. roads. Here’s how to deal if you rear-end another vehicle on the road.

First Things First

In the event that you rear-end the car in front of you, you will likely be very dazed or shocked, especially initially. Unless there are life-threatening reasons why you must exit the vehicle immediately, try to pause for a moment in an effort to gather your breath and calm down. You will   need to be able to make a number of decisions related to the situation, and the clearer your head, the more likely you are to act appropriately.

Your first consideration must always be to the welfare and safety of yourself and your passengers, as well as the passengers in any other vehicle involved in the accident.

According to the severity of the accident, the range of personal injuries caused by rear-end collisions can be significant, ranging from bruises and grazes to whiplash, broken bones, and even death. When you rear-end a car, the impact from your vehicle is transferred to the car in front, lifting passengers and drivers sharply forwards and upwards at the same time. Whiplash injuries are common, difficult to treat, and may not be immediately obvious. If you are in any doubt as to the severity of any injury incurred during the collision, call the emergency services and request an ambulance. Some injuries can be worsened if the injured party is moved awkwardly, for example.

When exiting the vehicle, ensure that you and your passengers can move to a safe place, away from any remaining traffic. Move completely off the road or highway, and as far away from the vehicles as you can. If the impact is minor, you may be able to drive the vehicle to the side of the road, or onto a side road, but remember that, in some states, it is illegal to move your car from the scene of a collision until the police have attended, so don’t do anything hasty. Regardless of where your car is, ensure that when leaving the vehicle you do not exit into moving traffic. Pay particular attention to children or animals who may be frightened by the collision, and will require additional supervision.

If you have an emergency kit, use this to alert other drivers to your vehicle. Ensure that the engine is turned off, that your hazard lights are on and that you have placed emergency cones or warning triangles at an appropriate distance from the car.

Road traffic safety regulations stipulate that, regardless of the driving conditions, you must be able to stop safely if the car in front of you comes to a halt, even if that car brakes very sharply. It is only in the event that a vehicle rear-ends your vehicle, causing you to shunt into the car in front, that your insurance company may not conclude that the accident was your fault. Like any other type of   collision, you will need to surrender your insurance and driver details to the other driver. Even if you are assuming that the accident was your fault, you will need to collect the other driver’s details, too. You will need their license number, their name, address, phone number, insurance company, insurance policy number, and license plate number. You should also establish whether the other driver owns the vehicle.

If possible, and if it is safe to do so, take photographs of the accident scene with your cell phone, showing the road conditions, the position of the cars, and any specific damage noted.

Remember that most modern mobile phones include a camera. Insurance companies suggest that you do not admit liability (and that could mean not even apologizing). They also often request detailed descriptions of what happened and the scene of the incident so try and write down some notes.

Once you have established that nobody needs medical attention, taken all the relevant details, and the police have attended the scene (if necessary), you will need to think about taking your car away. A breakdown recovery service may be needed if the damage is extensive, but you should also contact your insurance company as soon as possible, as they may have specific instructions on where to take your vehicle, outlining which dealers can and cannot carry out any necessary repair work.

###

DEM in his 1990 Miata

Assessment

A rear-end collision may be inconvenient and embarrassing, and it could even be traumatic and dangerous. Keep a cool head, complete all the steps necessary to ensure the safety of your passengers, and ensure that you comply with both the law and the requirements of your insurance company to insure that it doesn’t escalate into a bigger problem.

More: Automobile Safety, Financial and Related Topics of Import for Physicians

Conclusion

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Crafting a Business Plan and Starting a Medical Practice “Live” Audio Conference

Medical Office Business PlanCrafting A Business Plan And Starting A Medical Practice
Speaker: Dr. David Edward Marcinko MBA CMP
Live Audio Conference
Date:Wednesday, January 30, 2013 Time: 1 pm Eastern | 12 pm Central | 11 am Mountain | 10 am Pacific Length: 60 Minutes
 Order
Do you need money to start or Grow your medical practice?
The “Business Plan” is a key tool for raising start-up capital for a new medical practice, or financing a medical / surgical service line extension for a mature one. It is also used for acquiring loans to finance growth of an existing practice. Although long recognized as a quintessential business tool, its’ formal structure and mental rigor are only now being recognized in the medical community as competition increases in the healthcare industrial complex. There are many reasons to write a medical practice business plan. The process of gathering, compiling and analyzing information is an invaluable experience to the beginning practitioner, or experienced veteran physician. Our expert Dr. David, will discuss all these, step by step in this 1-hour enlightening event. See the steps below:

  • Determine the feasibility of a new practice start-up.
  • Raise money from investment bankers for a new practice.
  • Obtain financing to expand an existing office or turn-around a declining satellite.
  • Develop an operational strategic plan and conduct due diligence.
  • Create a budget, time frame or business direction for a practice.
  • Unmask potential problems, risks or benefits of a medical practice.
  • Focus on market opportunities by determining revenue centers or cost drivers.
  • Persuade third party payers, networks and insurance carriers that your practice has a future and represents a viable synergistic partner for their organization.
  • And more
As a attendee you will get:

  • Power Point slide presentation.
  • Time-line checklist to new medical office launch.
  • Topical comprehensive white paper.
  • Electronic blog forum for further information.
  • And more
Dr. David in this 60-minute conference will present to you:

  • Executive Summary: Where you concisely state the purpose of the loan, the exact amount of money required, an explanation of what the loan will be used for and why it’s needed.
  • Pro-forma Cash Budgets and Financial Statements:You’ll learn to how effectively use your data and underlying assumptions to prepare information that your banker can easily read and buy into.
  • Doctor’s Personal Financial Statements: Learn how to use copies of the last 3 years of personal tax returns for the bank as well as identify the collateral being pledged as security for the loan.
  • Representation: Here is where this presentation is invaluable.
  • And more
Order
Call 1-866-458-2965 and mention code STCIGH02
Ask a question at the Q&A session following the live event and get advice unique to your situation
About Our Speaker
Dr. David Edward Marcinko MBA CMP is founding CEO of the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com and Publisher of the Medical Executive-Post www.MedicalExecutivePost.com iMBA Inc is a leading national scope provider of real time medical practice management reports, books, dictionaries, journals, financial planning and advisory opinions, Fair Market Value appraisals and educational seminars www.CertifiedMedicalPlanner.org  The firm serves physicians, nurses and medical societies; financial advisors, wealth managers and CPAs; emerging healthcare entities, hospitals, clinics, IPAs and their CXOs; the press, media and all related organizations. Read more
Get $20 Off On Registering NOW!(Use Codé “David20” at Checkóut )

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Certified Medical Planner

The Evolution of Automobile Safety

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Technology Rolls On

By Dr. David Edward Marcinko MBA

By Matthew Pelletier [safety consultant]

DEM in his 1990 MiataMost ME-P readers are aware that I am a vintage Jaguar and automobile [sober] fanatic. And, after years of covering the local Emergency Room, I am glad to be retired from that job … Much better suited for the next-gen ED physician.

Perhaps, that’s why we occasionally post such leisure and lifestyle info-graphics for our audience and members.

History

Fortunately, much progress has been substantial since the automobile first made its mark on the transportation of people. The technology in auto safety has accelerated, especially over the last ten years, and with better engineering and consumer demand for safer vehicles there has been a reduction in the number of deaths and injuries from automobiles.

The Olden Days – Not so Golden

It seems absurd to hear people say cars aren’t made the way they used to be. Enhanced safety features show how inferior vehicles from the past are. Seat belts, overall structure, airbags and crash tests have saved lives and made car transportation safer for all drivers. Many find driving safety videos also help make everyone safer.

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Evolution-Of-Auto-Safety

Review

The above infographic provides information on the changes in safety to automobiles throughout history.

• Government legislation and automakers have continually worked on improving automobile safety features over the last 100 years.
• States like Michigan implement drivers education programs before licenses are issued helping to educate in safe driving practices.
• New technology and engineering meet consumer demand and show automakers are listening to their customers by designing safer cars with the newest and best safety systems available.

Continuing Development of Safety Features

The continuing development of safety features and engineering are driving car makers to give consumers the safety features and peace of mind they want for themselves and their families when they travel on the road. Automakers and engineers understand crashes and vehicle motion which then applies to a better and more advanced understanding during the design and constructing of new vehicle models.

Assessment

Be safe GOMER … and Get Out of My Emergency Room … with these helpful links:

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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How to Start a Private Medical Practice

Our Next e-VENT

###

[Writing a Medical Practice Business Plan for Capital]

Speaker: Dr. David Edward Marcinko MBA CMP

 A Live Audio Conference with QA Session

Date: Wednesday, January 30, 2013 Time: 1 pm Eastern | 12 pm Central | 11 am Mountain | 10 am Pacific Length: 60 Minutes

 Dr. David E. Marcinko MBA

 

Live Audio Conference

Date: Wednesday, January 30, 2013 Time: 1 pm Eastern | 12 pm Central | 11 am Mountain | 10 am Pacific Length: 60 Minutes

Product Details

Hear Dr. Marcinko on Audio-Educator [Do you Need Money to Start or Grow Your Medical Practice?]

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Crafting a Business Plan and Starting a Medical Practice [A “Live” Audio-Conference]

Conference Registration: http://www.audioeducator.com/hospitals-and-health-systems/business-plan-for-medical-practice-013012.html

Wednesday, Jan 30th, 2013 at 1 PM, EST for 60 minutes

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By Staf Reporters www.CertifiedMedicalPlanner.org

Dr David E Marcinko MBAThe “Business Plan” is a key tool for raising start-up capital for a new medical practice, or financing a medical / surgical service line extension for a mature one. It is also used for acquiring loans to finance growth of an existing practice.
Although long recognized as a quintessential business tool, its’ formal structure and mental rigor are only now being recognized in the medical community as competition increases in the healthcare industrial complex.

Reasons for the Plan

There are many reasons to write a medical practice business plan. The process of gathering, compiling and analyzing information is an invaluable experience to the beginning practitioner, or experienced veteran physician. Our expert Dr. David E. Marcinko MBA CMPwill discuss all these, step by step in this 1-hour enlightening event.

See the steps below:

  • Determine the feasibility of a new practice start-up.
  • Raise money from investment bankers for a new practice.
  • Obtain financing to expand an existing office or turn-around a declining satellite.
  • Develop an operational strategic plan and conduct due diligence.
  • Create a budget, time frame or business direction for a practice.
  • Unmask potential problems, risks or benefits of a medical practice.
  • Focus on market opportunities by determining revenue centers or cost drivers.
  • Persuade third party payers, networks and insurance carriers that your practice has a future and represents a viable synergistic partner for their organization.

Medical Office Business Plan

As an attendee you will get:

  • Power Point slide presentation.
  • Time-line checklist to new medical office launch.
  • Topical comprehensive white paper.
  • Electronic blog forum for further information.

Dr. Marcinko in this 60-minute conference will present to you:

  • Executive Summary: Where you concisely state the purpose of the loan, the exact amount of money required, an explanation of what the loan will be used for and why it’s needed.
  • Pro-forma Cash Budgets and Financial Statements: You’ll learn to how effectively use your data and underlying assumptions to prepare information that your banker can easily read and buy into.
  • Doctor’s Personal Financial Statements: Learn how to use copies of the last 3 years of personal tax returns for the bank as well as identify the collateral being pledged as security for the loan.
  • Representation: Here is where this presentation is invaluable.

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? Medical students, interns, residents and fellows, New, mid-career and mature medical practitioners, Office managers, clinic administrators, healthcare CXOs and physician / nurse executives, All doctors who wish to be employers; not employees.

http://businessofmedicalpractice.com/chapter-3-2/

Why use AudioEducator?

  • Save money on travel. Our conferences are available from the comfort and convenience of your own office or meeting room.
  • Meet your specific training needs. Whether you attend a live event, load up one of our encore broadcasts, or purchase a CD or PDF transcript — you’ll get the information you need on your schedule.
  • Keep learning after the event. Every conference purchase includes the speaker’s materials so you can keep learning long after the conference is over.
  • Save time training your whole staff. Gather around a speaker phone or computer and enlighten your entire team for one low price.
  • Do you work with a virtual team or multiple locations? Ask our customer specialists about discounts for your whole staff.

REGISTER HERE

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###

 Product Details

www.BusinessofMedicalPractice.com

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Doctors and Speeding Tickets [Myth versus Reality]

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Maximum Speed by State

By Matthew Pelletier [safety consultant]

By Dr. David Edward Marcinko MBA

Dr. Marcinko 1972 VetteThe need for speed across the United States means 100,000 drivers will have a police officer write them a ticket for speeding every day. That works out to 36,500,000 speeding tickets to Americans yearly.

Now, with the average cost per ticket at $150.00, it’s easy to understand the revenue that can come from catching those who disobey the maximum speed limits on the road. 95% of drivers never even contest their speeding tickets, they just pay it and continue on down the road.

Many drivers ignore the fact that speeding tickets raise car insurance rates and drop fuel economy.

The Big Ticket Pay-Off

Because there are so many drivers who break the speed laws, states are required to employee officers who are paid higher salaries than school teachers because each officer writes an average of $200,000 dollars worth of tickets annually. It is safe to say the tickets pay for their salaries.

The Graphic

The infographic below backs up the above information and shows us how the maximum speed limits in states across America differ.

###

 max-speed-limit-by-us-state

Review

  • 1 state, Utah, has a maximum speed limit of 80 mph.
  • 1 state, Texas, has a limit of 85mph which is 25mph faster speed allowed than Hawaii.
  • 19 states have a limit of 70mph, this is the highest majority for a speed limit.
  • 14 states have a 75mph speed limit.

Safety Training

Many states have dot safety training and by requiring driving safety training the importance of obeying speed limit laws and hopefully reducing the number of speeding tickets written can begin to take place. Gradually over time Americans have seen speed limits increase, this is due also to safer cars being manufactured.

Assessment

Doctors and medical colleagues; How do you feel about being the number one target of the traffic cops?

Conclusion

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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The Perils of Distracted Driving

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Risks Varied and Increasing this Holiday Season

By Dr. David Edward Marcinko MBA

[ME-P Editor-in-Chief]

Editor-in-ChiefOur daily lives have become easier over the years. Just take a look at the gadgets we own and the amount of corners we cut.

One of the major problems of this new daily ease is high distractions. These distractions can be deadly when it comes to driving, in which case, there should not be any corners to cut.

So, here is a visual guide to the true cost of driving while distracted. It may be especially important during this holiday season.

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Distracted-Driving

Assessment

Are doctors especially culpable with their tablet computers, smart phones, eHRs, PCs and CPOESs, etc?

Conclusion

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Letter from the Editor on Sandy Hook Elementary School

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A Painful Op-Ed Piece

By Dr. David Edward Marcinko FACFAS, MBA, CMP™

[Publisher and Editor-in-Chief]

Dr David E Marcinko MBAThe tragedy which struck the Sandy Hook Elementary School in Newtown, Connecticut last Friday left this Medical Executive-Post, and the entire nation, stunned. So many deaths of far too young victims! It is difficult to comprehend, explain or manage. It is not so difficult to feel some of the enormous loss of the parents, families and friends of the victims.

And, I’m sure it is unnecessary for me to encourage you to keep them in your thoughts and prayers. You, like me, have probably thought of little else since Friday.

At the ME-P, we will remember the people and families in Newtown, CT. Like the rest of the nation, our home-page flag will be at half-staff through this week.

If you have children of elementary school age, you may need some opportunities to process their reactions to this tragedy. Perhaps all they need is someone to listen, or to reassure them that these tragedies are rare events. We trust your local clergy, pediatricians and counselors are available to assist you or your child if that would be helpful.

More: www.CertifiedMedicalPlanner.org

In closing, I would like to share with you a Judeo-Christian reading which might bring some comfort during these difficult days:

A Prayer

The Spirit of the Lord God is upon me, because the Lord has anointed me to bring good news to the poor …  to comfort all who mourn; to grant to those who mourn in Zion— to give them a beautiful headdress instead of ashes, the oil of gladness instead of mourning, the garment of praise instead of a faint spirit; that they may be called oaks of righteousness, the planting of the Lord, that he may be glorified.

Assessment

ME-P Textbook: Chapter 07: Workplace Violence

We trust the deep knowledge and expertise on this topic by ME-P thought-leader Gene Schmuckler is available to you, as needed.

Fraternally,

David Edward Marcinko

Conclusion

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

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Doctors and Financial Advisors “Working 9 to 5”

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What an “Old” Way to Make a Living

[Challenging the Current Business Process Model and Scheduling Paradigm]

By Dr. David Edward Marcinko FACFAS MBA CMP™

[Editor-in-Chief]

First off – my apologies to Dolly Parton for bastardizing the title of her song

My dad worked for General Motors; the 11-PM to 7-AM shift to be precise. The company ran 3 shifts [8hr. X 3da. = 24 hrs / day / 7 days / week]. He was always home during the day for his children. In fact, it seemed as though he never slept. My mom worked the 9-AM to 5-PM  shift / 5 days / week as a banker. What a great arrangement; loving parental child care 24/7/365.

Then, after my own medical school, internship, residency training, fellowship, clinical practice and business school, I often wondered why corporate America and her white collar workers used the 9-5 work day paradigm and not the traditional blue collar 3 shift [24/7/375] manufacturing model – like  GM?

Working

With a 24/7/365 work day schedule [3 shifts/day], fixed office costs would remain the same, while variable costs would increase slightly but be compensated for by increased revenues, less HR stress, fewer utilities and reduced private and public infra-structure maintenance, etc [old styled B-school pedagogy]. This would increase operating capacity and output [patient/client output, CPT® codes, hourly fees, AUMs, etc]. You know – real top line revenue and bottom line profits. And, that’s a good thing for business and commerce.

But, is this 3 shift model applicable to the healthcare industrial complex and the financial services industry? If not – why not? And, I mean real work – examining and treating patients and interviewing clients – not automatic websites or interactive blogs, etc. Doctors, consultants and FAs actually interacting with real folks; not avatars!

An Old but Novel Idea?

As a medical business process consultant, my simple idea is more than two decades old. Yet, it remains largely untested and still considered novel … Perhaps until now! Offering extended hours is one way that physicians – can position themselves for the changes coming in the new healthcare era. How else will we accomodate 34 million new Medicaid insured patients.

In fact, so should financial advisors and medical management consultants. Shoot, why can’t most professionals use this model. Why be constrained to person, place and time [3-Dimensions]?

The Decision

This decision, however, should not be taken lightly and should be evaluated both from a provider, patient, civics, cultural and business standpoint. So, please read this essay for an elegant description of this model.

Then, our ME-P text books can be used to go granular into the nitty-gritty details; with real-life tools, templates, case models and checklists, etc.

Assessment

Link: Ready to offer extended patient hours?

Link: New Medical Practice Entrepreneurial Business Rules for Young Physicians [circa 2012]

Conclusion

Your thoughts and comments on this ME-P are appreciated. Colleagues – when not if – are you going 24/5 … or 6 … or 7?

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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The Science and Some Medicine Behind Seat Belt Use

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It’s All About Saving Lives and Ankle Bones

By Muhammad Saleem, and

By Dr. David Edward Marcinko FACFAS MBA CMP™

[Editor-in-Chief]

Vintage 2000 Jaguar XJ-V8-LWB Touring Sedan

The Ankle Bone is Connected to the Foot [er –ah] Leg Bone

The talus is one of the important bones that makes up the ankle joint. Over one half of the talus is covered with cartilage–it serves as an important link between the leg and the foot. The talus moves not only at the ankle joint, but also below the ankle and in the midfoot. Therefore, injuries to the talus can affect motion of the ankle and foot joints.

‘Aviators Astragalus’

Talus [astragalus ankle bone] fractures were almost unheard of a hundred years ago. The first series of talus fractures was described, by Dr. WD Coltart, in men who were injured in the British Royal Air Force in the early 1900s. The term ‘aviators astragalus’ was used to describe these fractures that happened as old war planes made crash landings.

Original Historic Reference Link: AA

Today, talus fractures are seen in high speed car accidents when you don’t-buckle up that seat belt or shoulder harness. I’ve seen far too many during my days covering the local Emergency Room.

So, here is an infograhic on the science behind seat belts. It contains some interesting and some encouraging facts that we wanted to share with our ME-P readers and subscribers.

Mechanism of Injury: Hawkins classification Talar fractures (C) iMBA Inc

The Facts

  • National seat belt use has increased from 69% in 1998 to 84% in 2010.
  • Automotive fatalities rank third in terms of lives lost per year, behind cancer and heart disease.
  • Seat belts are responsible for saving between12,000 to 16,000 lives each year.
  • Most crash deaths occur within 25 miles of home and at speeds below 40 miles per hour.

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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###

Taxes and the SCOTUS ACA Decision

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My Synopsis for Physician Investors

By Dr. David Edward Marcinko FACFAS MBA CMP™

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

I was at Emory University this past weekend for an unrelated colloquium. But all the chatter, of course, was about SCOTUS, taxes and the just announced ACA decision.

Most doctors I know – just don’t like paying needless taxes. So, what’s the buzz for physicians and other medical professional investors, and their financial advisors [FAs]?

The Synopsis

The taxes to pay for the Affordable Care Act include a new tax on medical devices that will increase costs to individuals and healthcare providers.

There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains.

If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%.

In addition to dividend seeking investors, the increase in capital gains rate may also influence charitable gifts of appreciated property in 2013.

Assessment

Please weigh-in all you FAs and healthcare focused CPAs. What is a physician investor supposed to do, now?

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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On Rising Used Car Prices

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Good News if You’re a Seller

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]Dr David E Marcinko MBA

Smart doctors, nurses and medical professionals never buy a new car; they let someone else take the economic depreciation hit. I did and loved restoring my vintage Jaguar 2000-V8-LWB European touring sedan. What a class act – it doesn’t click – it ROARS!

Yet, used car prices are starting to fall after rising steadily for much of the year. Easing gas prices in much of the nation, and more trade-ins coming back to dealers because new car sales have picked up, are behind the decrease.

How Much?

Used car prices are expected to decline 2 percent in June from May, according to the National Automobile Dealers Association Used Car Guide. Used truck prices are expected to dip 1 percent.

Read more: http://www.bankrate.com/finance/auto/used-car-prices-up-and-staying-strong.pdf

Assessment

Some cars, especially fuel-efficient autos, will see much larger drops, the National Automobile Dealers Association said, as falling gas prices reduce demand for the vehicles.

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:

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

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Cash May Soon be King in Hospital Care

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Forget About Health Insurance, Darling!

Only the little people pay with insurance.

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Like many other doctors, I remember my dismay when I saw uninsured patients paying full price for their medical care. Insurance companies used their market clout and patient volumes to negotiate discounts for their insureds that have always been unavailable to the uninsured, MSA, HSA participants or individual healthcare consumers.

The Insider Gossip

There is even industry hearsay that some charity-care and non-profit hospitals charge their indigent patients up to four times more than their insured patients in order to have huge write-offs [bad-debt expenses] so as to secure private and public monetary grants. After all; many non-profit CEOs are well paid, indeed.

But, the tide may be turning on the healthcare institutional level as cash becomes king in the new economy and world of healthcare 2.0

Cash Patients Rule – Insured Patients Drool

Of course, we’ve written about direct care, concierge care and cash care medical practice business models before on this ME-P. And, I’ve been ranting and raving, opining and testifying, as well.  It is being written about in the blog-o-sphere, on the hospital level, increasingly.

Link:  http://www.kevinmd.com/blog/2012/06/hide-health-insurance-status-pay-cash.html

We even have an entire Chapter 29 devoted to the codified topic in our newest book The Business of Medical Practice.

Link: http://businessofmedicalpractice.com/chapter-29/

Source: Austin Frakt PhD’s TIE cartoon via Brad Flansbaum.

The Coming Payment Apocalypse

The days of paying more when paying cash may be coming to an end. Doctors and hospitals are starting to do what every other business has done since the beginning of time – give a discount for cash. States are beginning to require pricing transparency and hospitals and physicians are starting to publish their “cash prices” for all to see.

And, why not when it can take up to two years to be reimbursed a fraction of the billed amount from Medicaid and Medicare payers, and CMS, etc? Now, don’t get me started on some highly discounted private payers and managed care plans.

Assessment

What do you think of this trend as a healthcare provider; Financial Advisor, medical management consultant or patient? Are you in favor of this private business arrangement; or do you favor the proposed public Obama Care business model?  Is it even legal? How about keeping the status-quo?

Conclusion

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Reasons Why Doctors Should Get New Automobile Tires

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My Diatribe on Saving Lives

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

Even though the price of crude oil, and hence gasoline is down of late, we’ve had an excellent response from doctor readers regarding our recent ME-Ps on automobiles, car insurance, driving costs, and fuel efficiency, etc. So, while not a forum for auto enthusiasts –  it is Memorial Day weekend after all – I’ll try to give our readers what they want with this personal essay.

Tires

Regardless of how well you care for your tires, the time will come when you must replace them. Safety as well as convenience is at stake. You don’t want a flat tire, but driving with worn tires also makes your car more difficult to control, especially in bad weather. Although many doctors get so busy they forget to check their tires, others do not know how to tell when they need to replace their tires. The following pointers will help you learn how:

Tread Depth

As tires roll over highways, the friction between them and the road wear down their treads. When tires have inadequate tread depth, they will not grip the road well and can lead to unsafe driving conditions, especially in the rain. The National Highway Transportation Safety Administration says the minimum safe depth of a tread is 1/32 of an inch. You may not have a ruler handy to measure your tread, but a simple technique makes checking your treads easy.

Take a penny and insert it into the tread groove with Lincoln’s head pointed downward toward the center of the wheel, facing outward. If you can see Lincoln’s forehead, the tire still has useful life. If you can see Lincoln’s hair on top of his head, you will soon need a replacement. Finally, if you can see the top of Lincoln’s head or the empty space above it, you should replace the tire as soon as possible.

Tire Inflation

tires

Wear Indicators

In the United States, tires have wear bars that provide a visual signal when they need replacement. Wear bars are shorter than healthy treads, so they are not noticeable to most drivers. When treads wear, the wear bars become visible and look like bridges across the tread grooves. When this happens, you need to buy new tires. Some doctors have trouble identifying wear bars at first, so if you can’t see them on your tires, ask a service technician or your local mechanic to show you.

***

tires

***

Age

Tires lose their integrity with age. Heat, sunlight, chemicals from the road, and gases from the air cause tires to corrode and oxidize, making them unsafe for use. This problem can especially affect spare tires which often sit in trunks unnoticed and unused for prolonged periods. Develop a replacement plan for any cars you own that get little use and for your spare tires. Tires wear at different rates depending on how often the car is driven and how many miles are put on it each year, so there is no exact time frame for tire replacement.

Other Signs of Wear

Not all tires wear evenly, so all medical professionals should periodically inspect every part of their tires. Look for uneven wear and flat spots on the edge of the tread. Replace tires that bulge on the sides. Visible wires signal that a tire has gone too far. The wires you see come from the metal belts that strengthen tires; manufacturers do not intend for this part of a tire to contact the road.

To avoid problems with your tires, inspect them regularly or have your mechanic or dealership inspect them anytime you go in for service or an appointment. Try adding a reminder to your task list, calendar, or schedule to make sure your tires never leave you stranded or put you or your car in danger.

My Tires

My own luxury weekend “fun” vehicle is a vintage European, pearl white, touring Jaguar XJ -V8- LWB. I love the control, precision and feel of my high-performance Pirelli P6 tires. It’s how I roll.

GOMER [Get Out of My Emergency Room]

I covered the emergency room for more than a decade; auto accidents due to poor tire tread are endemic especially at night and in the rain. So, please check your tires, and replace them if needed; today. We want our ME-P readership to grow. The life you save may be your own.

Assessment

This ME-P is a follow-up, by reader request, of a prior popular essay of mine. How Smart Doctors Can Save Big at the Pump I appreciate your interest.

More photos: https://medicalexecutivepost.com/wp-content/uploads/2012/04/dems-jaguar.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.

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

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Tips from a Doctor for Optimizing Automobile Fuel Efficiency to Save Money

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Here’s How I Can Afford Gasoline for My Vintage Jaguar XJ-8-LWB

Dr. Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

Dammit Spock! I’m a doctor – not an auto mechanic!

But, as the cost of fuel increases, more and more physician drivers are thinking about ways to maximize their gas mileage. As well as reducing the cost of fuel in the doctor’s pocket, optimizing fuel efficiency helps reduce the environmental impact of driving and conserves a resource that is only getting scarcer. This is especially true when you drive a luxury European touring sedan that has been said to be one of the finest in the world – like me!

There are a number of different ways drivers can increase their gas mileage. Advice and tips on fuel efficiency fall into a number of key categories.

My Tips and Pearls 

1. The car that you drive can make a big difference when it comes to fuel efficiency. Clearly, the larger and more powerful the vehicle is, the lower its gas mileage is likely to be. Car manufacturers are increasingly looking to new technology to help improve fuel efficiency, and if your car is quite old then it might be time to consider switching to a new model. Fuel efficiency statistics are now commonly published and compared on driving websites, and you should consider this before buying a new, or used, car.

2. Ensuring that your car is well-maintained is also a significant factor in the fuel efficiency that you will experience. Something as small and innocuous as spark plugs, for example, can reduce your gas mileage by as much as 12%. Over the course a year, the cost of the gas you waste is likely to be far more than the cost of replacing the part. If you are in doubt, talk to a trusted mechanic about maintenance, and alway have your car serviced at the recommended intervals.

3. Tire pressure can also have a significant impact on fuel efficiency. Low tire pressure can affect the vehicle’s performance, reducing gas mileage markedly. At the same time, it is also worth remembering that having the pressure too high can also have a negative effect. Ensure that you check your tire pressure on a regular basis. Talk to your mechanic if you are unsure about the optimum pressure value for your tires.

4. The way you drive your car also impacts your overall gas mileage. The official U.S. government website for fuel economy recommends that you always observe the speed limit, noting that for each 5 mph that you drive over a 60-mph speed limit, you are likely to paying an additional $0.29 per gallon of gas. Aggressive driving can reduce your gas mileage by as much as 33% on the highway. Carrying unnecessary weight in your car also uses more fuel, and you should always turn off your engine when the car is idle.

5. By changing the way in which you use your car, you can also save money. By combining multiple short trips into single, multi-purpose outings, you can prevent wasted mileage. Commuters can consider car sharing schemes, whereby drivers take it in turns to provide transport for fellow workers, reducing the number of cars on the road. You may even choose to switch to public transport on certain days of the week, to reduce the burden on your car.

6. You can even improve gas mileage by being careful about where and when you purchase fuel. Gas is at its densest during the coolest times of day. That means that by purchasing fuel early in the morning, or after dark, the volume of gas that the pump dispenses per unit will be moderately higher than at other, warmer times of day. Be savvy about prices in your local area too, keeping an eye out for the cheapest gas stations, but don’t go out of your way to purchase fuel. The money that you save at the pump is likely to be wasted on the additional mileage spent driving to the station.

7. As the cost of gas fluctuates on such a frequent basis, learning to optimize your fuel efficiency is a great way to ensure that you get the most out of the money you spend on fuel. Ensure that your vehicle is as efficient as possible, moderate your driving behavior, and moderate the amount of driving that you do to see the biggest improvements in your gas mileage.

Assessment

This ME-P is a follow-up, by reader request, of a prior popular essay of mine. How Smart Doctors Can Save Big at the Pump I appreciate your interest.

More photos: https://medicalexecutivepost.com/wp-content/uploads/2012/04/dems-jaguar.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.

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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How Smart Doctors Can Save Big at the Pump

Easing the Pain of High Gas Prices

By Dr. David Edward Marcinko MBA CMP®

[Editor-in-Chief]

We published a popular post on Easter Sunday 2012 about high gas prices. It was well received. So, since medical professionals often drive expensive, and inefficient cars [read expensive gas guzzlers], I thought it might be a good idea to relay my personal driving tips on how medical and all ME-P colleagues [MDs and FAs], can save big [or at least a bit] at the gas pump.

Link: https://medicalexecutivepost.com/2012/04/08/pain-at-the-2012-easter-sunday-pump/

Guilty – as Charged?

Look, I am a doctor and financial advisor, as well as journalist, editor, surgeon and expert legal witness. I wear many hats and my one indulgence is my pearl white Jaguar XJ-V8-LWB. This classic baby was a gift from my wife who bought it from a singular previous owner [software mogul] in pristine physical and engineering condition after years of meticulous and loving garaged care.

In other words, she let some someone else take the huge depreciation hit on a luxury European touring vehicle that originally sold for up to $100,000 direct from Coventry England. Fortunately, this is not a primary vehicle and I use it only on the weekends, weather permitting. What a joy to drive. Smooth and quiet; just like a hybrid vehicle. And, it is not unusual for nearby folks to stop, stare and even wave at me as I drive by.

 

Why?

So, if rising gas prices are making a huge dent in your wallet, I have a solution to save you money at the pump! Try these simple tips and you’ll find the savings quickly add up.

Tips and Quips

* At least once a month, make sure your tires are properly inflated according to the vehicle’s specifications. Over-inflating tires by even a pound or two might improve fuel mileage in the short run, but it causes tires to wear prematurely. The money you save in fuel is less than what you would pay to replace the tires. But, I am guilty of this tactic because I have Pirelli tires on my Jag.

* Buy the right octane. Look in your vehicle’s owner’s manual for the correct octane level for your car’s engine. Odds are that it will be regular unleaded. Your vehicle should run just fine on regular if that’s what the manual recommends; and it costs less. Again, I use and need 93 plus Octane.

* An annual full-vehicle inspection, including the air conditioning system, may help you avoid costly repairs. I detail and check out my automobile every quarter.

* Vehicles use less fuel the more slowly they travel. Try dropping your highway speed by 10 mph to see big savings at the pump. Here, I follow the rules.

* Extra weight in your vehicle makes it work harder, hence less fuel mileage. If you have a trunk full of junk, empty it out for better fuel economy and to save money. My Jag weighs 4,800 pounds.

* Nothing can put a damper on spring travel plans more than unpredictable gas prices. Search for the best price before you go to fill up. I use a smart-phone and auto navigation system for this chore.

Assessment

With such gorgeous weather, driving your car with sunroof open might be the first thing on your mind. So, just by taking a few small steps, you’ll save money on your vehicle, meaning more money stays in your wallet – while enjoying it more.

Conclusion

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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More photos: DEM’s JAGUAR

Should Dr. Marcinko Speak in Malaysia?

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Information Sought on Laures International

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Recently, I was pleased to be invited to speak at a Regional Public Workshop [RPW] for the healthcare clients of Laures International, in Malaysia, Kuala Lumpur. I don’t know if  I’m personally that famous, infamous, or our newest book is just garnering rave reviews.

“Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies].

In-Process from: (c) Productivity Press 2012 http://www.crcpress.com/product/isbn/9781439879900

The Firm

Briefly, Laures International is touted to be at the forefront in organizing strategic business intelligence in Asia and Middle East with headquarters in Petaling Jaya, Malaysia. As of 2011, they’ve supposedly held events in Kuala Lumpur, Singapore, Philippines, Thailand, Indonesia, China and Dubai.

Goals and Objectives

Representatives state their goal is to provide world class events with an uncompromising attitude towards quality. The aim of Laures is to provide a platform for delegates to be involved in discussions and case studies to enhance their understanding and to apply what they learn immediately to improve their performance when they return to their respective workplace. A worthy goal!

Offices

+603 – 78034444

www.LauresInternational.com

Assessment

Now, I like to speak and learn, and have done so frequently around the country and in Eastern Europe the last three decades. Usually, my presentations are for medical societies, financial services groups, pharmaceutical companies or other consulting firms.

But, Laures is heretofore unknown to me, and other than their contact and website review, I am concerned about their credibility. With all due respect, I’d frankly hate to be duped or ultimately “stuck” in Kuala Lumpur!

Conclusion

Your thoughts and comments on this ME-P are appreciated. Is Laures International credible? Is the region safe? I’d love to experience its’ culture, people, food, colleagues, sights, sounds and sites. Accept or not? Your ME-P crowd sourced experience and wisdom is 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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Healthcare Organizations: www.HealthcareFinancials.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 ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

ORDER HERE

http://www.crcpress.com/product/isbn/9781439879900

About ME-P Seminars

Book Dr. David E. Marcinko for your Next Seminar

By Ann Miller RN MHA

[Executive-Director]

Why Book Dr. DEM?

Dr. Marcinko believes nothing is purely management -or- medical -or- business -or- financial anymore – and nothing is purely personal.

Background and Credentials

David Edward Marcinko is CEO of the Medical Executive-Post [www.MedicalExecutivePost.com] and Founder of iMBA Inc [www.MedicalBusinessAdvisors.com] the parent holding company of several related communications firms [www.CertifiedMedicalPlanner.com].

He is a frequent education and motivational speaker on the business integration between medical practice management and financial planning for all healthcare professionals, in the US and Europe.

Understanding New Medical Practice Business Models

As a doctor, physician-executive and successful entrepreneur who transitioned out of clinical medicine, Marcinko understands how the practice and financial aspects of physician lives are tied together and how recognizing this makes it easier to make sound decisions in two areas; traditionally and for the new-wave narrative known as collaborative medicine and Health 2.0.

After all, he has been writing, speaking and publishing on all of it – and more – for the past three decades www.HealthcareFinancials.com

Interactive Philosophy

In his interactive seminars, participants can share as much or as little of their stories as they wish, but David describes them as being aimed at demonstrating where practice and money is concerned, nothing is purely “health economics”, nothing is purely “business management”, and nothing is purely “personal.”

Dr. Marcinko believes that only when this philosophy is understood, can doctors really take control of their present economic lives, current medical practices and future dreams.

Targeted Delivery

Dr. Marcinko’s presentations are generally aimed at a specific life-cycle: new practitioners, mid-life providers, and/or mature medical professionals.

Assessment

Dr. DEM is also available to speak to medical and financial services societies, at insurance or business development centers, pharmaceutical meetings and other like-minded organizations to deliver either contemporaneous seminars – or tailoring presentations to specific audience needs.

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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Stock Market Collapse or Earth Quake?

On the Road, Again!

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

A 5.8-magnitude earthquake rattled the East Coast on August 23rd and continued to produce aftershocks for several days. At least 18 aftershocks ranging in magnitude from 4.5 to as little as 2.0 followed the strongest earthquake to strike the East Coast since World War II, according to the US Geological Survey.

Aftershocks are smaller tremors that take place in the weeks and possibly months following a major earthquake like the one centered in Mineral, Virginia. They are usually felt in a smaller area than the original quake. The largest of the aftershocks so far was a 4.5-magnitude quake, according to the USGS. Tens of millions of people from Georgia to Canada were jolted by the initial tremor.

We felt it here in Atlanta too, as well as my home town of Fell’s Point, in Baltimore, Maryland [just north of Washington, DC], where I was visiting Johns Hopkins Hospital, engaging clients and lecturing at the time.

St. Patrick’ Church

Here is a reference file photograph of St. Patrick’s Roman Catholic Church in Baltimore, Maryland, before the quake and just down the street a bit from Johns Hopkins Hospital, toward the waterfront district.

 

Enter the Tremors

Now, here is the church on August 23rd, 2011, after a finial at the top edge of the spire fell, shattering a manhole cover far below.

The Damage Today

Fortunately, no one was injured.

This remaining damage is now the problem on this historic building.

Assessment

However, some ME-P readers and www.MedicalBusinessAdvisors.com clients are wondering if the finial collapse was due solely to the quake, or might the recent world-wide stock market tremors be involved in some way – you decide?

Conclusion

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

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

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Healthcare Organizations: www.HealthcareFinancials.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 ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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Dr. David E. Marcinko is “In-the-News”

Our ME-P Editor is an Industry “Mover and Shaker”

By Ann Miller RN MHA

[Executive-Director]

Link: http://www.physiciansmoneydigest.com/search?get1=search&get2=marcinko

Link: www.medicalbusinessadvisors.com_forum-books.asp

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Healthcare Organizations: www.HealthcareFinancials.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 ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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Dr. Marcinko Interviewed by PedSource.com

On … Medical Practice Mission Statements [“Use Them or Lose Them”]

By Jill Fahy

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You won’t find a formal mission statement posted on the website or framed on the wall at East Bay Pediatrics, in Berkeley, California.

Dr. Marcinko Speaks

But, you will find a few words on medical practice Mission Statements, from our ME-P Editor-in-Chief Dr. David E. Marcinko MBA CMP™, right here.

Assessment

http://www.pedsource.com/library/mission-statements-use-them-or-lose-them

About

PCC created PedSource, an online community for pediatricians, to share insights they’ve gained through their extensive experiences improving revenue and implementing technology in pediatric practices. Their vision is to share resources and build a community to improve the health of pediatric practices nationwide.

Conclusion

And so, 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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Let’s Consider Two New Emerging Medical Delivery Models

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Entrepreneurial, New-Wave and Outside-the-Box Competitive Models

Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.com

[Publisher-in-Chief]

I travel quite a bit in my professional and personal life. And, have been told possess an above-average curiosity in all things medical management. I look – see and report. So, what have I noted recently?

There are a number of new-wave health care delivery models now being explored to improve the manner in which medical care can be delivered. Let’s take a quick look at two emerging options at both the individual and institutional levels.

1. The Micro Medical Practice [MMP]

A micro medical practice [MMP] is a low overhead, high-tech, labor reduced and often mobile office model that allows more physician control and patient face-time [i.e., Dr. Ramona Seidel, Annapolis, Maryland]. This concept can be extended to those patients who want or need to pay cash for their health care; high deductible health insurance, health insurance with high co pays and residuals, etc.

Or, the concept may include that seen with the practice of physician-assistant Cheryl DeMonner PA-C at the Micro Medical Practice of Santa Cruz County. William Morris MD is her supervising physician.

Source: www.micromedsc.com

2. Satisfaction Guaranteed Medical Care

At the Detroit Medical Center, patient focused medical care is taken to a competitive extreme with this promise:

“If our patients are not absolutely satisfied with any aspect of their inpatient service or overnight stay in a DMC hospital, we will credit their patient pay balance up to $100.”

Guarantee applies to all inpatient (or overnight) stays and all surgery services provided at a DMC hospital. Adjustment/Refund is dependent upon the nature of dissatisfaction as follows:

  • Tier 1 ($25) Problems with physical facilities
  • Tier 2 ($50) Inadequate communication
  • Tier 3 ($75) Excessive wait issues
  • Tier 4 ($100) Poor service from employees

And, they have the twenty-nine minute emergency room guarantee.

Source: http://doctorandpatient.blogspot.com/2007/01/29-minute-er-guarantee.html

Assessment

If you were to take a good guess as to what sort of new healthcare delivery business model will spring up next, you would be well served by looking at smaller private and more entrepreneurial entities [personal and primary care], rather than behemoth organizations [secondary or tertiary care].

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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Book Dr. Marcinko to Speak

At Your Next Medical Management, Pharma or Financial Services Seminar  

Our Editor-and-Chief, Dr. David Edward Marcinko MBA CMP™ is a former medical practitioner and board certified surgeon [FACFAS], certified financial planner, stock-broker, insurance agent, Registered Rep, RIA representative, writer, editor, journalist, expert witness and healthcare economist who enjoys public speaking and gives as many talks each year as possible, at a variety of medical society, pharmaceutical and financial services conferences around the country and world.

Many Venues

These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars, pharma conventions and health systems, endnote lectures at city and statewide financial coalitions, and break-out lectures for a variety of internal and external yearly meetings.

Assessment

More info: https://medicalexecutivepost.com/dr-david-marcinko%e2%80%99s-bookings/

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Useful Managed Care Provider, Staffing, Activity and Financial Trends

Part Two

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

Dr. DEMIf you read this ME-P regularly or have read my earlier blogs, you know that I am writing a book on practice management for the private medical practitioner.

The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors]; third edition: www.BusinessofMedicalPractice.com

Link: Front Matter BoMP – 3

A recent story in the Chicago Tribune on the difficult business life of private practitioners today reminds me that I need to keep my nose to the grindstone.

For example, according to the sanofi-aventis Pharmaceutical Company Managed Care Digest Series, for 2008-10, the following patterns and comparative trend information has been empirically determined and may provide a basic starting point for medical practitioners to share business management, facilities, personnel, and records information for enhanced success www.managedcaredigest.com

Mid-Level Provider and Staffing Trends

  • Mid-level provider use increased among multi-specialty groups, especially in those with more than half of their revenue from capitated contracts. Use also rose with the size of the practice and was highest with OB/GYN groups.
  • Medical support staff for all multi-specialty groups fell and was lowest in medical groups with less than 10 full-time equivalent (FTE) physicians. However, groups with a large amount of capitated revenue actually added support staff. Smaller groups limited support staff.
  • Compensation costs of support staff increased and the percentages of total operating costs associated with laboratories, professional liability insurance, IT services, and imaging also increased. Support staff costs increase with capitation levels and more than half of all operating costs are tied to support staff endeavors.

Managed Care Activity and Contracting Trends

  • More medical group practices are likely to own interests in preferred provider organizations (PPOs) than in HMOs and the percentages of groups with managed care revenue continues to rise. Multi-specialty and large groups also derive more revenue from MCOs than single specialty or smaller groups.
  • Managed care has little effect on physician payment methods that are still predominantly based on productivity. Physicians were paid differently for at-risk managed care contracts in only a small percentage of cases.
  • Most medical groups (75%) participating in managed care medicine have PPO contracts. Group practices contract with network HMOs more often than solo practices. Single-specialty groups more often have PPO contracts.
  • Capitated lives often raise capitation revenues in large group practices. Group practices are more highly capitated than smaller groups or solo practices. Almost 30% of highly capitated medical groups have more than 15 contracts and 22% have globally capitated contracts.
  • Higher capitation is linked with increased risk contracting. Larger groups have more risk contracting than smaller groups.

Physician Health

Financial Profile Trends

  • Medicare fee-for-service reimbursement is decreasing. Highly capitated groups incur high consulting fees.
  • The share of total gross charges for OB/GYN groups associated with managed care at-risk contracts is rising while non-managed care, or not-at-risk charges are declining.
  • Capitated contracts have little effect on the amount of on-site office non-surgical work. Off-site surgeries are most common for surgery groups, not medical groups.
  • Half of all charges are for on-site non-surgical procedures.
  • Highly capitated medical groups have higher operating costs and lower net profits.
  • Groups without capitation have higher laboratory expenses than those who do.
  • Physician costs are highest in orthopedic surgery group practices. Generally, median costs at most specialty levels are rising and profits shrinking.

Assessment

Obviously, the above information is only a gauge since regional differences, and certain medical sub-specialty practices and carve-outs, do exist.

Part One: Useful Managed Care Patterns and Procedural Utilization Trends

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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Speaking and Opining at Health Conference Away Games

On the Road Again … with Me

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

I just returned from a quick unplanned trip to Baltimore, Maryland visiting several individual and corporate consulting clients.  There was also an antecedent side-trip to serve as a pharmaceutical company speaker and workshop conference mentor, as well.

Topics for the manager’s meeting in Atlanta Georgia included healthcare policy and reform, eMRs, economics, compensation and leadership. Not only was it held close to home and where I did my internship, residency and fellowship training, among other things; it was located near where I attended business school almost two decades earlier. So; how could a conference in such a storied location fail to be tons of fun? It can’t – and it didn’t.

[picapp align=”none” wrap=”false” link=”term=baltimore+maryland&iid=301134″ src=”http://view.picapp.com/pictures.photo/image/301134/buildings-the-waterfront/buildings-the-waterfront.jpg?size=500&imageId=301134″ width=”380″ height=”253″ /]

Impressive Venue

I was impressed with the Marriott Marquis hotel organization (lots of conference staff with directions to buildings and meeting rooms), the resources (catering, efficiently delivered and free WiFi everywhere), attendees, presenters, and beautiful downtown urban location.

Impressive Meeting

But, most of all I was impressed with the speakers, topics and content – and floored by the informal post-mortem discussions. I received good-excellent feedback on the slide-show I authored and presented, and even watched a few speakers take their licks, always kindly delivered (all in the name of progress) from an informed and engaged audience. If I’m ever able to perform half as well as the average discussant in the future, I’ll be very pleased, indeed.

Self-Learning Didactics

Of course, I gave and learned a much vis-a-vie the bilateral educational principles of andragogy and heutagogy, although nothing I’m ready to put into writing right now. Rest assured however, future ME-Ps will be of higher quality relative to the counterfactual that I didn’t attend the conference meeting.

Assessment

Finally, I met several colleagues who read, comment and post to the ME-P. All had kind words to say about this electronic forum. From what I heard, it’s beginning to feel like we are becoming a valuable resource to the community we serve. I’m delighted.

Please continue to send in ideas, alert us of important developments in healthcare administration and financial planning; and/or ping us when you see a good paper or topic idea that needs to be fleshed-out, or a book, product or service that deserves to be promoted; etc.

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Conclusion

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.

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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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Good Night H. Ed Roberts MD

Medical Inventor, Bio-Engineering Pioneer and Colleague

[September 13, 1941 – April 1, 2010]

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

According to Wikipedia, Henry Edward “Ed” Roberts MD was an American engineer, entrepreneur and medical doctor who designed the first commercially successful personal computer in 1975. He is most often known as the “father of the PC.” He founded Micro Instrumentation and Telemetry Systems [MITS]) in 1970 to sell electronics kits to model rocketry hobbyists, but the first successful product was an electronic calculator kit that was featured on the cover of the November 1971 issue of Popular Electronics magazine. The calculators were very successful and sales topped one million dollars in 1973. But, a brutal calculator price war left the company deeply in debt by 1974. Roberts then developed the Altair 8800 personal computer that used the new Intel 8080 microprocessor. This was featured on the cover of the January 1975 issue of Popular Electronics, and hobbyists flooded MITS with orders for this $397 computer kit. Bill Gates and Paul Allen joined MITS to develop software and Altair BASIC was Microsoft’s first product. Roberts sold MITS in 1977 and retired to Georgia where he farmed, studied medicine and eventually became a small-town doctor after commencing medical school at age 39.

Link: http://en.wikipedia.org/wiki/Ed_Roberts_(computer_engineer)

My Connection to Ed

Almost 20 years ago, I co-founded a small medical education software company, for a tiny niche market. My partner was a computer “whiz kid”. I was the chief executive, brain-child and enfant terrible. We are still in business today.

Nevertheless, I decided to contact Ed because I had just received my first PC [Intel® 286 microprocessor] from a publishing company who had contracted with me to write a medical textbook; remember DOS and WordPerfect? I was also very familiar with Microsoft lore, especially relative to business thought and competitive analysis. Regular readers of the ME-P may even recall my mention of attending lectures by Michael Porter PhD [father of competitive analysis] while dating a girl who was attending Wharton Business School while I was a medical student in Philadelphia, back-in-the-day.

Anyway, I took it upon myself to write Ed for some advice. Remember, this was before the commercial internet was widely available. I used medicine as a mutual point of interest. Anyway; after no response, the incident was quickly forgotten because of a busy lifestyle, new medical practice, book-project, etc. I follow-upped about a year later and this time received an encouraging written reply from Ed. I treasure the letter to this day, almost as much as the ones I have from Louis Rukeyser [TV fame-died in 2006] and his uber-investor guest, Sir John Marks Templeton [son is a surgeon] who died in 2008. In 2005, Templeton wrote a brief memorandum predicting that within five years there would be financial chaos in the world. It was eventually made public in 2010.

Assessment

Ed practiced as an internist until his death, in Cochran – a city near Macon, GA. The population was 4,455 at the 2000 census. It is a very poor county in South Georgia, and many, if not most of Ed’s patients were on Medicaid and/or Medicare. He loved them dearly, and they loved him, too!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Although perhaps not as famous as Gates and Allen; we say with all due respect and admiration – good night Dr. Roberts – and thank you for the personal computer … your love of medicine and mankind … and for reaching out to me so very long ago!

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Off Road Touring in Boston with Dr. Marcinko

How Doctors Get Paid

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Just before the Christmas Holidays, I flew up to Boston at the invitation of a pharmaceutical company to lead a managerial workshop entitled: “How Doctors Get Paid” [Treatment is only the beginning in the Changing Billing and Medical Reimbursement Climate].

Our goal was to inform drug representatives, and their regional managers, what value added information physician offices might expect from the pharmaceutical industry of the future.  

Topics of Discussion

The two hour interactive workshop included team projects, flip chart exercises, a mock role-playing session and the customary [hopefully energetic] ppt presentation. Other topics of discussion included:  

  • Health insurance payment evolution
  • Collapse of Medicare
  • Rise of managed care
  • Medical records documentation
  • ICD-9 and 10, HCPCS, DRGs and CPT® coding
  • ABNs, super-bills and HCFA 150 forms
  • Billing methodologies
  • Healthcare fraud, abuse and related policies
  • Capitation, HSAs, concierge medicine and RACs
  • Futuristic health 2.0 payment mechanisms, and more.

Assessment

Rest assured; these folks were a very knowledgeable and aggressive group; not like your father’s “detail men” of yore! They seek to … talk the talk, and walk the walk, of the Health 2.0 era.

Many thanks again to Helen, and Jon D, for the invite.

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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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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