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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital recruited BOD member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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Twelve Steps of Financial Independence for Doctors

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A Basic Guide

By Lon Jefferies  MBA CFP® CMP®

Lon JeffriesWant to get your finances in order? Consider this comprehensive 12-step guide to address each element of your personal financial situation. In most cases, you should not address a step until all previous steps are satisfied.

1. 401(k) 403(b) Match: Without exception, if your employer matches 401(k) contributions, you should maximize whatever they’re offering. If it’s a dollar-for-dollar match, that’s an instant 100 percent return! Even the 50 percent return of a two-for-one match is irresistible.

2. Consumer Debt: Pay off your credit cards and all other unsecured loans, prioritizing the debts with the highest interest rates. Credit cards frequently charge rates as high as 30 percent. Paying off a card with 30 percent APR is comparable to getting a 30 percent investment return. Not completing this step will hamper your entire financial plan.

3. Cash Flow: You can’t develop wealth if you spend more than you make. Construct and follow a written budget to ensure you are living within your means. Your budget should include saving at least 10 percent of your gross income for retirement. Constantly compare actual spending with your budget and hold yourself accountable! Mint.com is an excellent free tool for this step.

4. Emergency Reserve: Develop a liquid savings account consisting of enough money to cover three to six months of expenses. These funds should only be utilized in crisis such as a job loss or medical emergency.

5. Life Insurance: If you have dependent children, you likely need life insurance. Cost-efficient coverage can frequently be obtained via your employer. To calculate the amount of coverage to purchase, first determine how much money your survivors would need to maintain a comfortable lifestyle, and then subtract any income they will generate as well as any savings you’ve accumulated. Alternatively, if you don’t have children in your household and your spouse is self-sufficient, you may not need life insurance coverage.

6. Disability Insurance: Getting hurt can completely derail your financial planning. A loss of income halts your savings and likely leads to increased debt. Obtain enough disability coverage to bridge the gap between earnings and expenses in the event of an injury. Coverage can frequently be purchased through your employer.

7. Estate Planning: Obtain a power of attorney, medical directive and living will. These documents allow you to designate the person you would like to make decisions for you if you become incapacitated. They also specify your preferences regarding life-prolonging medical treatments. Ensure both primary and contingent beneficiaries are assigned to your retirement accounts. Finally, develop a will or trust to ensure all other assets are distributed as you desire when you die.

8. Retirement Contributions: With risk exposures covered, it’s time to return to retirement planning efforts. Again, a 401(k) is an attractive retirement vehicle because it frequently offers an employer match and allows large annual contributions ($18,500 or $25,000 for individuals over age 50). If your employer doesn’t offer a 401(k), you can still contribute up to $6,500 (or $7,000 if over age 50) to an IRA. IRA contributions can be made on behalf of both spouses, even if only one is employed.

9. Traditional or Roth: The type of account that is best for you depends on when you want to pay taxes. A traditional retirement account allows an immediate tax deduction, the investments grow tax deferred, and the money isn’t taxed until the funds are withdrawn from the account. Alternatively, taxes are paid on Roth contributions immediately, but both contributions and growth are completely tax free when withdrawn during retirement. Put simply: will you be in a higher tax bracket now or when you withdraw the funds?

10. Asset Allocation: The most important investment decision you can make is how much of your portfolio will be invested in stocks versus bonds. A higher proportion of stocks leads to increased risk, but the potential for greater returns. The more time you have until the funds are needed, the more risk you can usually afford to take. Consequently, you should reduce the proportion of stocks in your portfolio as you approach retirement in order to minimize your risk factor. Identify an asset allocation that is aggressive enough to accomplish your investment goals while exposing you to an acceptable level of risk.

11. Get Caught Up: According to a recent Fidelity study, your nest egg should be one times your salary by age 35, three times your salary by 45, five times your salary by 55 and seven times your salary by 67.

12. Education Planning: Only after your retirement savings is where it should be can you focus on your children’s college education. At this point, explore a Utah Educational Savings Plan 529 (uesp.org) or a Coverdell Education Savings Account, both of which offer tax advantages if used for schooling.

Assessment

Does this mean you don’t need a financial advisor? Of course not! A qualified, comprehensive financial planner can add value, address shortcomings, and answer questions in each of these areas. Once you have completed each of these steps, you can be confident you have your financial ducks in a row.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

On the Cash Conversion Cycle for Healthcare Organizations

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Understanding Why Cash Flow is King

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

The manager, administrator or COO of a hospital’s working capital, or physician executive of a private medical practice, strives to optimize the amount of cash on hand to ensure daily operations. Too much cash generates little return, while too little may jeopardize the healthcare enterprise, incur borrowing costs or cause missed investment opportunities.

Also, the extent to which current assets cover current liabilities, determines whether the entity is considered liquid and thus able to meet its payment obligations on time.

The Balancing Act

When faced with the management balancing act of current assets and current liabilities, the alternative with the highest net present value (NPV) and internal rate of return (IRR) is typically selected. This is often a difficult balancing act since providing healthcare services generates little immediate cash, and then cash receipts are variable depending upon payers or other third parties.

Yet, each hospital or practice distribution transaction requires immediate liquid cash for employees, vendors, debt holders, and investors in the form of dividend payouts or retained earning disbursements. The cash conversion cycle (CCC) length measured in days is composed of two ratios:

  1. The first is the average inventory holding period (ending inventory divided by revenues per day),
  2. The second is the collection period (ending ARs divided by revenue per day). For both ratios, faster is better.

CCC Averages

Sample CCCs for an industry-average hospital (45 days average-non-electronic) are:

1. hospital admission to patient discharge (5 days);

2. patient discharge to hospital bill completion (5 days);

3. hospital bill completion to insurance (third-party administrator or TPA) payor receipt (5 days);

4. receipt by TPA to mailing of hospital payment (25 days);

5. payment mailed to receipt by hospital (3 days); and

6. payment receipt by hospital to bank deposit (2 days).

Assessment

Naturally, healthcare managers, administrators, physicians and hospital executives should be interested in motivating changes in the behavior of staff such that processes within the control of the enterprise can be streamlined and completed in less time.

For example, a day or two reduction in the amount of time it takes from patient discharge to hospital bill completion, as achieved with the use of electronic charts and medical records systems, can significantly increase cash flow. Likewise, the use of electronic funds transfers and/or lock box collection mechanisms can reduce the amount of time it takes for an account receivable to make it into the bank.

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Essential Insights on Successful Physician Budgeting

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Avoiding Common Cash Flow Budget Mistakes

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

[By Hope Rachel Hetico; RN, MHA, CMP™]

[Publisher-in-Chief and Managing Editor]dave-and-hope4

Although some doctors might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a practice. We emphasize the keys to smart budgeting and how to track spending and savings in these tough economic times.

Money and Happiness

There is an aphorism that suggests, “Money cannot buy happiness.” Well, this may be true enough but there is also a corollary that states, “Having a little sure reduces the unhappiness.” Unfortunately, today there is more than a little financial unhappiness in all medical specialties; not just the specialty of podiatry – where this article first appeared as a free-lance writing project. The challenges range from the commoditization of medicine, aging demographics, Medicare reimbursement cutbacks and increased competition to floundering equity markets, the home mortgage crisis, the squeeze on credit and declines in the value of a practice. Few doctors seem immune to this “perfect storm” of economic woes.biz-book2

Most Doctors Financially Hurting Today

Far too many physicians, dentists and other medical providers are hurting and it is not limited to these above-average earning professionals. However, one can strive to reduce the pain by following some basic budgeting principles. By adhering to these principles, most physicians can eliminate the “too many days at the end of the month” syndrome and instead develop a foundation for building real wealth and security, even in difficult economic climates like we face today.

Three Budget Types

There are at least three major budget types. [1] A flexible budget is an expenditure cap that adjusts for changes in the volume of expense items. [2] A fixed budget does not. [3] Advancing to the next level of rigor, a zero-based budget starts with essential expenses and adds items until the money is gone. Regardless of type, budgets can be extremely effective if one uses them at home or the office in order to spot money troubles before they develop.

fp-book2

Assessment

For the purpose of wealth building, medical professionals may think of a budget as a quantitative expression of an action plan. It is an integral part of the overall cost-control process for the individual, his or her family unit or one’s medical practice.

Read the entire article: http://www.podiatrytoday.com/essential-insights-on-successful-budgeting

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Physician Cash Maximization Rules

One Doctor- Advisor’s [How-To] Diatribe

[By Dr. David Edward Marcinko; MBA]

[Publisher-in-Chief] www.CertifiedMedicalPlanner.orgdr-david-marcinko4

For some doctors – even more than laymen – cash management is the pivotal issue in the financial planning process. Accumulation of investment assets cannot occur if cash inflows do not exceed cash outflows. On the other hand, accumulated assets are eventually spent to fund expenses during planned time periods when cash outflow exceeds inflow.

Inflation

Traditionally, financial advisors have opined that inflation has a dramatic impact on both ends of the cash management spectrum because inflation has a compounding effect. That compounding effect means that a mere ¼% change in planning assumptions about anticipated inflation can have more significant influence over long-term projected outcomes than a 5% change in the amount of a particular item of budgeted income or expense. Well, true enough if projected linearly using some Monte-Carlo type software simulation. But, in the real word, economists appreciate cost and efficiency improvements [email over snail mail] and the potential for substitution of goods [diesel fuel for gasoline – chicken for steak, etc].

fp-book2

Be More Like … my Dad

On the other hand, far too few of my fellow medical colleagues – and financial advisors – are like my dad. Not well educated by academic standards, but with common sense that seems a precious commodity, today.

Dave, he used to tell me – and still does at age 84:

“Invest your money for growth carefully – and take some risks – but don’t be too afraid of inflation.”

 Why not, dad?

“Because; if you’re not a conspicuous consumer, you’ll have less to worry about.”

Cash Management

Well, most of us are not like my dad; me included. But, his depression-mentality has never completely worn off. A doctor’s household can maximize the cash available for investing by setting up the account in this manner.

1. The first step is to open a checking account, money market account, and a brokerage account. The money market account is often included in a brokerage account.

2. The second step is to initiate electronic direct deposit of the paycheck into the money market account.

3. The third step is to determine the amount of cash reserve needed. As mentioned elsewhere on this ME-P, we are suggesting 3-5 years of cash-reserves on-hand, as an emergency fund for most medical professionals.

Once, when, and if, the amount of the reserve is determined and achieved, any extra money should be transferred to the brokerage account and invested according to personal goals, objectives and risk-tolerance. A small balance of a few thousand dollars can be kept in the checking account to prevent overdrafts. Beyond the few thousand dollars, the checking account should serve as a pass-through account where money is transferred from the money market account to cover checks written for the budgeted expenses.

Example of Managing Cash Reserve Amountsbiz-book1

A physician client recently asked me to help him increase his savings. He explained that he had a very detailed realistic budget, but had a hard time staying within the budget when cash was available; as he lectured occasionally and was fortunate to have a few extra dollars every now and then.

Recommendations

As a financial planner, and the founder of an online educational-certification program for physician focused advisors, I recommend that he set up his checking, money market and investment accounts and have his medical practice directly deposit his paycheck in the money market account. He then was to transfer only enough money to his checking account each month, to cover his very carefully budgeted and spread-sheet driven expenses. Furthermore, his money market account was to be equal to our predetermined cash reserve needs, with any excess cash transferred to his investment account and according to his financial and investing plan.

Assessment

Of course, his carefully constructed budget included no cash reserves or emergency fund!  He forgot to budget cash! And so; the usual conundrum ensued.

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Hospital Revenue Cycle Management

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Augmentation thru Technology Adoption

[By Karen White PhD, and Staff ]

Several major hospitals, or healthcare systems, have filed bankruptcy this fiscal quarter. These include a two-hospital system in Honolulu; one in Pontiac, MI; Trinity Hospital in Erin, Tennessee; Century City Doctors Hospital in Beverly Hills, and four hospital system Hospital Partners of America, in Charlotte. 

And so, since cash flow is the life blood of any healthcare revenue cycle management initiative, it is important for physician executives and healthcare administrators to appreciate the impact of modern health information technology systems on this vital function.

Functional Area Targets

Technology plays a key role across all health entity revenue cycle operations. By functional area, the following are key targets:

Patient Access

This is the front-end of a hospital’s revenue cycle. It is made up of all the pre-registration, registration, scheduling, pre-admitting, and admitting functions. Enhancing revenue cycles in this area requires the following:

  • a call center environment with auto dialing, faxing, and Internet connectivity to quickly ensure and verify all pertinent information that is key to correct and timely payment for services rendered;
  • Master Person Index software to eliminate duplicate medical record numbers and assist with achieving of a unique identifier for all patients;
  • registration and admission software that scripts the admission process to assist employees in obtaining required elements and check that insurer-required referrals are documented;
  • denial management definition, including focus on how to obtain all the correct patient information up front while the patient is in-house; and
  • imaging of data up front.

Health Information Management

This is the middle process of a hospital revenue cycle and is often still referred to as “Medical Records.” This area is made up of chart processing, coding, transcription, correspondence, and chart completion. Better control of revenue cycles requires the following recommended technology:

  • chart-tracking software to eliminate manual outguides and decrease the number of lost charts;
  • encoding and grouping software to improve coding accuracy and speed and improve reimbursement;
  • auto printing and faxing capabilities;
  • Internet connectivity for release of information and related document management tasks; and,
  • electronic management of documents.

Patient Financial Services

This is the back-end process of a hospital revenue cycle. The operations include all business office functions of billing, collecting, and follow-up post-patient care. Recommended technology to optimize these functions includes the following:

  • automated biller queues to improve and track the productivity of each biller;
  • claims scrubbing software to ensure that necessary data is included on the claim prior to submission; and
  • electronic claims and reimbursement processing to expedite the payment cycle.

Automation

Automation can lead to decreased paperwork, process standardization, increased productivity, and cleaner claims. In 2004, Hospital & Health Network’s “Most Wired Survey” found that the 100 most wired hospitals — including three out of the four AA+ hospitals in the country — had better control of expenses, higher productivity, and efficient utilization management. Today, these top hospitals tend to be larger and have better access to capital in these times of credit tightening.

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Assessment

The positive return on investment in technology increases allocation of funding to technology. This correlation is important because it begins to link the investment in information technology with positive financial returns in all areas of a hospital’s business, including the revenue cycle.

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