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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 and 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”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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Navigating Relationships and Communication in 2020 (Web 2.0, 3.0 and beyond)

Navigating Relationships and Communication in 2020 (Web 3.0 and beyond)

By Joseph Prokop

CERTIFIED FINANCIAL PLANNER©

CERTIFIED MEDICAL PLANNER© (candidate)

http://www.CertifiedMedicalPlanner.org

 

We are able to connect and communicate in more ways than ever before, and yet we seem more disconnected, divided, and confused than ever before. Yet, if we get caught in the trap of watching the same news channels and getting our data from the same source, then it is ineventible that our views and perspectives start to be swayed in that particular direction. Almost everyone is on a social media platform of some sort if they aren’t on all of them. Once you share or like posts, the algorithms go to work to show you things they know you will like and engage in even if that puts you inside an echo chamber of ideas and thoughts that prevent us from having any meaningful dialogue around complex issues.

When it comes to investing and financial planning in 2020 there is an abundance of information and resources. There are discount brokerage firms that allow you to trade stocks for free. Firms are offering world class educational materials, webinars, seminars, etc. It seems everyone who can fog a window has articles on the internet about investment strategies and ideas – from pot stocks, to crypto-currency, to Roth conversions, etc. It can be daunting trying to figure out where to go and who you can trust.

The truth is there is no one best way to use these tools, resources, and the vast amount of technology at all of our fingertips. But there is just one rule – As the novelist E.M. Forster said, “Only connect.” I’ve been asked a million times if I have a ‘stock tip’ or ‘hot idea’ by friends, family, and clients. 

My recommendation as it relates to investing and financial health is always to develop a financial plan and stay the course. Just as there is no perfect solution for connecting and communicating, there is no perfect investment for everyone.

Now, regarding communication – you can take your pick: You can communicate via blogs, tweets, chat rooms, Facebook, and other social networks.

Or, when investing you can take your pick as well: you can do it yourself and utilize stocks, bonds, funds, ETFs, options, etc. Or, you can have someone do it for you to help keep the emotions out of investing and help keep your plans on track.

CONCLUSION: And so, whether we are talking about connecting and communicating online – or whether we are talking about financial planning or investing my main point is to get started. There are tons of benefits between social connection and good health. There is a ton of correlation between financial piece of mind and good health. So, take an inventory of the tools at your disposal, and let’s discuss some plans and goals for you, and let’s get to work.

***

***

NASDAQ 100

BIGGEST STOCKS [COMPANIES]

Courtesy: www.CertifiedMedicalPlanner.org

Enter the CMPs

CERTIFIED MEDICAL PLANNER®

“Medical Management and Health Economics Education for Financial Advisors”

CMP® CURRICULUM: https://lnkd.in/eDTRHex
CMP® WEB SITE: https://lnkd.in/guWSApq

Your thoughts and comments are appreciated.

***

0 (1)

***

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Atlanta’s Piedmont Hospital Pays $16 Million to Settle Kickback Allegations

Piedmont Pays $16 Million to Settle Kickback and Overbilling Allegations

By Health Capital Consultants, LLC

On June 25, 2020 Atlanta’s Piedmont Healthcare, Inc. agreed to pay $16 million to the federal government to resolve two False Claims Act (FCA) allegations of kickbacks and overbilling. The relator, a former Piedmont physician, alleged Stark Law and Anti-Kickback Statute (and subsequent FCA) violations of paying an amount that was above fair market value (FMV) and commercially unreasonable in Piedmont’s 2007 acquisition of Atlanta Cardiology Group (ACG).

Additionally, Piedmont’s payments settle allegations that the hospital admitted patients without medical necessity in order to bill Medicare and Medicaid for inpatient procedures that were recommended to be performed at the less expensive outpatient or observation settings.  (Read more…)

Assessment: Your thoughts are appreciated.

NOTE: I was on the courtesy medical staff of Piedmont Hospital in Atlanta for more than a decade = DEM.

“Medical Management and Health Economics Education for Financial Advisors”

CMP® CURRICULUM: https://lnkd.in/eDTRHex
CMP® WEB SITE: https://lnkd.in/guWSApq

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Another CERTIFIED MEDICAL PLANNER® “In The News”

YAHOO Finance!

Courtesy: http://www.MedicalExecutivePost.com

“The extensive experience of our professional team allows us to implement a rigorous process to identify ‘Best in Class’ opportunities in our focus areas,” said Amaury Cifuentes CFP®, CMP® one of the firm’s founders. “We assist in providing capital, innovative solutions and strategic expertise to our portfolio throughout the investment cycle.”

LINK: www.CertifiedMedicalPlanner.org

The partners in the firm include:

Amaury Cifuentes, CFP®, CMP® has 30 years of experience in banking and finance; financial planning and investments with an emphasis on business lending, real estate and private investments. He is a Certified Medical Planner®, giving him an enhanced knowledge of the medical industry’s specific needs.

LINK: https://finance.yahoo.com/news/bluekey-wealth-advisors-announces-formation-150000988.html

Assessment: Your congratulations are appreciated.

TEXTS FOR PHYSICIAN EXECUTIVES AND HOSPITAL CXOs:

1 – https://lnkd.in/eEf-xEH

2 – https://lnkd.in/e2ZmewQ

***

TEXTS FOR PHYSICIANS AND ADVISORS

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™

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****

How to become a board CERTIFIED MEDICAL PLANNER®

HOW TO BECOME A BOARD

CERTIFIED MEDICAL PLANNER®

[Two Program Matriculation Options Available]

http://www.CertifiedMedicalPlanner.org

CURRICULUM: Enter CPMs

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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

***

INVITE A PHYSICIAN – FINANCIAL ADVISOR TO YOUR NEXT EVENT

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***

Why are CERTIFIED MEDICAL PLANNER® Textbooks SO DARN Popular?

[By Dr. David Edward Marcinko MBA CMP®]

http://www.CertifiedMedicalPlanner.org

OK – I was a Certified Financial Planner® before my academic team launched the Certified Medical Planner™ online and on-ground chartered education and board certification designation program a few years ago. I am now CFP reformed and in remission.

MORE: Enter CPMs

Enter the Certified Medical PlannerChartered Designation

Today, we are of course, gratified that Certified Medical Planner™ mark notoriety is growing organically in the healthcare, as well as financial services, industry.

Even uber-blogger Mike Kitces MSFS, MTAX, CFP, CLU, ChFC, RHU, REBC, CASL has taken note of us in his musings on the Nerd’s Eye View website. And, the reality is that there are a growing number of CFP educational programs at the post-CFP niche market level.

But, none for healthcare industrial complex: for doctors … by doctors!

Popularity of our Text Books

However, it is our modern, innovative and proprietary Certified Medical Planner™ textbooks and dictionaries that have exploded in the academic marketplace.

In fact, they are now redacted in thousands of medical, graduate, law and B-schools and libraries, as well as colleges and universities throughout the nation. This includes the Library of Congress, National Institute of Health and  the Library of Congress.

What Gives?

We have been told that this textbook popularity and publishing success is because of their balanced and peer-reviewed nature; something not very widespread in the financial services industry that is prone to gross and overstated advertising, salesmanship and marketing hyperbole. And, for this we are very gratified.

But, is there another reason our books are so popular?

A bit of networking and research suggests that interested folks may be eschewing the actual course work in favor of just the high quality textbooks! UGH!

Another reason may be that our books and curricula are kept fresh and updated on our corporate website: http://www.MedicalBusinessAdvisors.com

Assessment

So, what do you think? Matriculation with the professional mark versus self study without the designation mark. Please opine.

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.

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

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™

Product DetailsProduct Details

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Product DetailsProduct Details

Adult Learners and Students:

Product DetailsProduct DetailsProduct Details

***

More on Medical Practice Business Costs

Unknown and Under-Appreciated by Many

By Rick Kahler CFP®

I recently talked with an administrator of a private medical practice about some of the financial challenges she faces in dealing with the medical system, insurers, and patients.

Some of the insights she gave me into the realities that private physicians face in providing medical care were rather disturbing.

***

Here are a few of them.

Let’s start with the insurers who account for the bulk of their revenue. Many payments for procedures from insurance companies (including Medicare) are below the cost of providing the service. This forces physicians to make up the difference on other procedures or find other sources of income to sustain the profitability of the practice.

Conversely, in markets that have just one hospital, the insurance companies have no leverage. If the insurers won’t pay what the hospitals demand, the hospitals can threaten to drop out of the network, leaving the insurers with nowhere to send their insureds in those markets. The insurers end up agreeing to pay the hospitals more.

Charges for services provided in-house at the hospital can end up being substantially higher than those same services done by outside providers.

Example:

She gave me an example of a lab test that cost $1,500 to $2,000 at the hospital lab but $35 to $80 at an independent lab. Patients do have the option to direct the hospital to use an independent lab. But, how many people know that and will have the presence of mind to make the request? While it makes financial sense to price-shop if you have a high deductible HSA plan, there isn’t much incentive if your plan has low deductibles.

Collections

Another challenge is collecting from patients. She says a surprising percentage of Americans maintain checking accounts with no money or keep checks from accounts which have long been closed. While writing bad checks is a crime, those who game the system know they can probably get by with writing a low-dollar check because the cost of pursuing justice is much more than the check is worth.

Most companies would never do business with such a person again. Healthcare professionals tend to have a bias toward giving everyone services, so these same people do return requesting care. She said she and her physician employer have had huge internal arguments about this. Her position is that these people take advantage of the physician in a premeditated fashion and don’t deserve to be extended services. The physician argues that everyone, even deadbeats, deserves healthcare. Since the practice doesn’t provide life-and-death services, she was able to get the physician to agree that if someone has an outstanding bill they need to settle it upfront, in cash, before any new services are provided.

Then there are those who use credit cards and then fraudulently dispute the charges. Some providers let this go because of the difficulty of proving that the charge is legitimate. It requires photographs of customers during the transaction, copies of driver’s licenses, customers’ signatures on the paperwork, and notarized statements from the provider verifying that this was the person who received services and presented the credit card.

***

http://www.CertifiedMedicalPlanner.org

***

SSNs

A final interesting point concerned patients’ Social Security numbers. She said the only time these are ever needed is when an outstanding bill is sent for collection. Otherwise, they are never accessed or used.

Assessment

Finally, she was quick to add that only a small fraction of their patients premeditate stealing from them. She also stressed that not all insurance companies or hospitals behave unethically, and some do wonderful, humane acts of kindness. Nevertheless, the lack of integrity that does occur on both sides is infuriating and adds to the cost of health services.

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

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, I.T, business and policy management ecosystem.

Product Details

***

Invite Dr. Marcinko

***

On “Financial Advisor” Salesmen and Saleswomen

UGH! Financial Services still not a real Profession

 

 

 

 

 

By Dr. David Edward Marcinko MBA MEd Certified Medical Planner™

http://www.CertifiedMedicalPlanner.org

Introduction

A few weeks ago I received the following unsolicited email job exhortation:

Dear David,

Our xxx/ooo office is currently hiring “Financial Advisors” with Series 7 and 63 Certifications. The minimum requirements include: high school diploma or GED equivalent, 6+ months of experience in customer service and experience in a sales environment. We offer paid training and access to full benefits.

Learn more about this position and apply today: xxx/ooo

***    *** 

Assessment

GED; a very high credentials bar, indeed!

NOTE: My friend and colleague, the late great Dick Wagner JD CFP™ who wrote extensively about financial planning as a “profession”, would be mortified.  

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:

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™

***

Top High Yield Dividend Stocks in the Financial Industry

Join Our Mailing List

The Financial Sector Yields

 tim

By TIMOTHY J. McINTOSH; MBA, MPH, CFP®, CMP™ [Hon]

The financial sector is a somewhat broad sector, although many of the industries within the sectors tend to move together.

In the last twelve months, the Financial Select Sector SPDR ETF (NYSE: XLF) increased 32%. This compared to an increase of 25% of the S&P 500 index. On a year to date basis, the sector is flat.

***

stock-exchange

Continue reading Top High Yield Dividend Stocks in the Financial Industry

***

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:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

Two New Books VITAL to Doctor’s Succes!

SPONSORED

http://www.CertifiedMedicalPlanner.org

Join Our Mailing List

PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET

***

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

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

Front Matter with Foreword by Jason Dyken MD MBA

Enter the CMPs

***

Risk Management for Doctors and their Advisors

Join Our Mailing List

By Staff reporters

Our New Book Release

http://www.CertifiedMedicalPlanner.org

***

92f91681-0f52-4bec-86db-3f9ab724560a

***

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

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

***

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:

***

DIRECT PAY MEDICAL PROVIDER RISKS

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[By staff reporters] http://www.CertifiedMedicalPlanner.org

The Three Basic Duties

A cash-based medical practice or direct care provider has these basic duties:

  1. * to comply with statutory duties such as the drug laws
  2. * to obtain proper consent for medical care
  3. * to render care that is not substantially inferior to that offered by like providers

A breach of any of these duties that causes harm to a patient can result in a malpractice suit. While the first two duties are important, it is the duty to render good quality medical care that is the basis for most malpractice lawsuits. The breach of this duty is most likely to result in a serious patient injury. The prevention of such negligent injuries is the responsibility of the individual provider, but it also basic to the institution’s quality control program.

From the individual provider’s point of view, quality control involves continuing education, attention to detail, and retrospective review of the course of the provider’s patients. The process is only loosely structured and is usually poorly documented. This lack of formal structure is less important for the individual provider because the provider’s actions are judged only within the context of the injured patient in question (although previous actions may be used to negate claims of accidental injury).

Assessment

And so, the legal questions is whether the care rendered the injured patient was negligent. It is not relevant to the case if the provider carried out an effective personal quality control program.

Conclusion

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:

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

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

***

HUMANITARIAN WISDOM IN PATIENT CARE AS A MORAL IMPERATIVE AND …

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…. A MEDICAL RISK MANAGEMENT TOOL in 2018!

***

DEM white shirt

[Dr. David Edward Marcinko CMP™ MBA MBBS]

http://www.CertifiedMedicalPlanner.org

EDITOR-IN-CHIEF

***

In SECTION ONE, of our newest textbook, on medical practitioner personal risk management issues, let us all recall the Canadian physician Sir William Osler MD, one of the founders of Johns Hopkins Hospital in my hometown of Baltimore Maryland, and where I played stickball in the parking lot as a kid. He left a sizeable body of wisdom that has guided many physicians in the practice of medicine. So, allow me to share with you some of that accumulated wisdom and the quotes that have served me well over the years.

From Dr. Osler, I learned the art of putting myself in the patient’s shoes. “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’ Realize, so far as you can, the mental state of the patient, enter into his feelings.” Osler further stresses that we should “scan gently (the patient’s) faults” and offer the “kindly word, the cheerful greeting, the sympathetic look.”1

“In some of us, the ceaseless panorama of suffering tends to dull that fine edge of sympathy with which we started,” writes Osler in his famous essay “Aequanimitas.”2 “Against this benumbing influence, we physicians and nurses, the immediate agents of the Trust, have but one enduring corrective — the practice towards patients of the Golden Rule of Humanity as announced by Confucius: ‘What you do not like when done to yourself, do not do to others.’”

Medicine can be both art and science as many physicians have discovered. As Osler tells us, “Errors in judgment must occur in the practice of an art which consists largely of balancing probabilities.”2 Osler notes that “Medicine is a science of uncertainty and an art of probability” and also weighs in with the idea that “The practice of medicine is an art, based on science.”3,4

Osler emphasized that excellence in medicine is not an inheritance and is more fully realized with the seasoning of experience. “The art of the practice of medicine is to be learned only by experience,” says Osler. “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”5

Finally, some timeless wisdom on patient care came from Osler in an address to St. Mary’s Hospital Medical School in London in 1907: “Gain the confidence of a patient and inspire him with hope, and the battle is half won.”6

Osler has also imparted plenty of advice on the business of medicine. In “Aequanimitas,” Osler says there are only two types of doctors: “those who practice with their brains, and those who practice with their tongues.”7

***

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

***

In a valedictory address to medical school graduates at McGill University, Osler suggested treating money as a side consideration in a medical career.8 “You have of course entered the profession of medicine with a view of obtaining a livelihood; but in dealing with your patients let this always be a secondary consideration.”

“You are in this profession as a calling, not as a business: as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man,” explains Osler in the address to St. Mary’s Hospital Medical School.6 “Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.”

It is not easy for doctors to combine a passion for patient care, a knowledge of science and the maintenance of business, according to Osler in the British Medical Journal.9 “In the three great professions, the lawyer has to consider only his head and pocket, the parson the head and heart, while with us the head, heart, and pocket are all engaged.”

While some aspects of practice may fall short or be devoid of appropriate financial remuneration, the giving of one’s time, expertise and experience in improving patient outcomes and the quality of their lives may be the greatest gift. “The ‘good debts’ of practice, as I prefer to call them … amount to a generous sum by the end of each year,” says Osler.9

***

http://www.BusinessofMedicalPractice.com

***

MEDICAL Ethics for Challenging Times

[Finding Your Moorings in an Era of Dramatic Change]

Marcinko Ethics

By Render S. Davis MHA

By David Edward Marcinko

***

And so, as you read and reflect on the chapter of SECTION ONE, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.

Dr. David Edward Marcinko; CMP™ MBA MBBS [Hon]

[Chief Executive Officer]

iMBA Inc., Norcross, GA

References

  1. Penfield W. Neurology in Canada and the Osler centennial. Can Med Assoc J. 1949; 61(1): 69-73
  2. Osler W. Aequanimitas. Chapter 9, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 159
  3. Bean WB. William Osler: Aphorisms, CC Thomas, Springfield, IL, p. 129.
  4. Osler W. Aequanimitas. Chapter 3, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 34
  5. Thayer WS. Osler the teacher. In: Osler and Other Papers. Johns Hopkins Press, Baltimore, 1931, p. 1.
  6. Osler W. The reserves of life. St. Mary’s Hosp Gaz. 1907;13 (1):95-8.
  7. Osler W. Aequanimitas. Chapter 7, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 124
  8. Osler W. Valedictory address to the graduates in medicine and surgery, McGill University. Can Med Surg J. 1874; 3:433-42.
  9. Osler W. Remarks on organization in the profession. Brit Med J. 1911; 1(2614):237-9.
  10. Jacobs. AM: PMNews, April, 2015.

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

Socio Economic Status, Payment Reform and Medical Records

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Yet Another Component of the Medical Record?

[Dr. David Edward Marcinko MBA CMP™]

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Dr David E Marcinko MBAHistorically, medical records [paper or electronic] were previously used to aid in the quality of medical care.

Now they are also the basis for payment for services, not as a record or reflection of the care that was actually provided, but as a separate justification for billing. The lack of appropriate documentation now no longer threatens just non-payment for services but risks civil money penalties and criminal charges.

Enter S.E.S.

Today, the idea known as Socio Economic Status [SES] is conceptualized as the social standing, or class of an individual or group. It is often measured as a combination of education, income and occupation. Examinations of socioeconomic status often reveal inequities in access to medical resources, plus issues related to privilege, power and control.

Assessment

SES is increasingly being considered as another payment component [CPT® codes] to medical providers, as reflected in the paper medical record, EMR and elsewhere.

***

eMRs

[Electronic Medical Records]

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How to Buy Securities On Margin

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How It Works and What Physicians’ Must Watch Out For

 Dr. David Edward Marcinko MBA CMP

“Buying on margin” is borrowing money from your stock-broker to buy a stock and using your investment as collateral. Physician-investors generally use margin to increase their purchasing power so that they can own more stock without fully paying for it. But, margin exposes all investors to the potential for higher losses.

https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

This ME-P discusses the basics of buying on margin, some of the pitfalls inherent in margin buying, whether this financial tool is for you and how you can best use it.

How Does Margin Work?

Let’s say you buy a stock for $50 and the price of the stock rises to $75. If you bought the stock in a cash account and paid for it in full, you’ll earn a 50 percent return on your investment. But, if you bought the stock on margin – paying $25 in cash and borrowing $25 from your broker – you’ll earn a 100 percent return on the money you invested. Of course, you’ll still owe your brokerage $25 plus interest.

The downside to using margin is that if the stock price decreases, substantial losses can mount quickly. For example, let’s say the stock you bought for $50 falls to $25. If you fully paid for the stock, you’ll lose 50% of your money. But if you bought on margin, you’ll lose 100%, and you still must come up with the interest you owe on the loan.

Caution: In volatile markets, investors who put up an initial margin payment for a stock may, from time to time, be required to provide additional cash if the price of the stock falls. Investors have been shocked to learn that a broker has the right to sell the securities that were bought on margin – without any notification, and at a potentially substantial loss to the investor.

Caution: If your broker sells your stock after the price has plummeted, then you’ve lost out on the chance to recoup your losses if the market bounces back.

The Risks

Margin accounts can be very risky and they are not for everyone. Before opening a margin account, be aware that:

  • You can lose more money than you have invested;
  • You may have to deposit additional cash or securities in your account on short notice to cover market losses;
  • You may be forced to sell some or all of your securities when falling stock prices reduce the value of your securities; and
  • Your brokerage firm may sell some or all of your securities without consulting you to pay off the loan it made to you.

You can protect yourself by knowing how a margin account works and what happens if the price of the stock purchased on margin declines.

Tip: Your broker charges you interest for borrowing money; take into account how that will affect the total return on your investments.

Tip: Ask your broker whether it makes sense for you to trade on margin in light of your financial resources, investment objectives, and tolerance for risk.

Read Your Margin Agreement

To open a margin account, you must sign a margin agreement. The agreement may either be part of your account agreement or separate. The margin agreement states that you must abide by the rules of the Federal Reserve Board, the New York Stock Exchange, the National Association of Securities Dealers, Inc., and the firm where you have set up your margin account.

Caution: Carefully review the agreement before signing.

As with most loans, the margin agreement explains the terms and conditions of the margin account. The agreement describes how the interest on the loan is calculated, how you are responsible for repaying the loan, and how the securities you purchase serve as collateral for the loan. Carefully review the agreement to determine what notice, if any, your firm must give you before selling your securities to collect the money you have borrowed.

***

margin risk

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Know the Margin Rules

The Federal Reserve Board and many self-regulatory organizations (SROs), such as the NYSE and NASD, have rules that govern margin trading. Brokerage firms can establish their own requirements as long as they are at least as restrictive as the Federal Reserve Board and SRO rules.

Here are some of the key rules you should know:

Before You Trade – Minimum Margin. Before trading on margin, the NYSE and NASD, for example, require you to deposit with your brokerage firm a minimum of $2,000 or 100 percent of the purchase price, whichever is less. This is known as the “minimum margin.” Some firms may require you to deposit more than $2,000.

Amount You Can Borrow – Initial Margin. According to Regulation T of the Federal Reserve Board, you may borrow up to 50 percent of the purchase price of securities that can be purchased on margin. This is known as the “initial margin.” Some firms require you to deposit more than 50 percent of the purchase price.

Tip: Not all securities can be purchased on margin.

Amount You Need After You Trade – Maintenance Margin. After you buy stock on margin, the NYSE and NASD require you to keep a minimum amount of equity in your margin account. The equity in your account is the value of your securities less how much you owe to your brokerage firm. The rules require you to have at least 25 percent of the total market value of the securities in your margin account at all times. The 25 percent is called the “maintenance requirement.” In fact, many brokerage firms have higher maintenance requirements, typically between 30 to 40 percent and sometimes higher, depending on the type of stock purchased.

Example: You purchase $16,000 worth of securities by borrowing $8,000 from your firm and paying $8,000 in cash or securities. If the market value of the securities drops to $12,000, the equity in your account will fall to $4,000 ($12,000 – $8,000 = $4,000). If your firm has a 25 percent maintenance requirement, you must have $3,000 in equity in your account (25 percent of $12,000 = $3,000). In this case, you do have enough equity because the $4,000 in equity in your account is greater than the $3,000 maintenance requirement.

But, if your firm has a maintenance requirement of 40%, you would not have enough equity. The firm would require you to have $4,800 in equity (40% of $12,000 = $4,800). Your $4,000 in equity is less than the firm’s $4,800 maintenance requirement. As a result, the firm may issue you a “margin call,” since the equity in your account has fallen $800 below the firm’s maintenance requirement.

Margin Calls

If your account falls below the firm’s maintenance requirement, your broker generally will make a margin call to ask you to deposit more cash or securities into your account. If you are unable to meet the margin call, your firm will sell your securities to increase the equity in your account up to or above the firm’s maintenance requirement.

Tip: Your broker may not be required to make a margin call or otherwise tell you that your account has fallen below the firm’s maintenance requirement. Your broker may be able to sell your securities at any time without consulting you first. Under most margin agreements, even if your firm offers to give you time to increase the equity in your account, it can sell your securities without waiting for you to meet the margin call.

  • Margin accounts involve a great deal more risk than cash accounts, where you fully pay for the securities you purchase. You may lose more than your initial investment when buying on margin. If you cannot afford to do so, then margin buying is not for you.
  • Read the margin agreement, and ask your broker questions about how a margin account works and whether it’s appropriate for you to trade on margin. Your broker should explain the terms and conditions of the margin agreement.
  • Know how much you will be charged on money you borrow from your broker, and know how these costs affect your overall return.
  • Remember that your brokerage firm can sell your securities without notice to you when you don’t have sufficient equity in your margin account.

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RISK MANAGEMENT, LIABILITY INSURANCE, AND ASSET PROTECTION STRATEGIES FOR DOCTOR AND ADVISORS

[Best Practices from Leading Consultants and Certified Medical Planners™]

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Skills Needed

If you are a physician, nurse, accountant, attorney, medical risk manager or healthcare executive, we need you.

Form below or contact us for details to peer-review, etc. MarcinkoAdvisors@msn.com

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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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SEEKING AUTHORS: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctor and Advisors [Book-in-Production]

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Contribute to Our Newest Textbook Project

By Professor Hope Rachel Hetico RN MHA CPHQ CMP®

[Managing Editor]

Prof. Hope R. HeticoDEAR ME-P READERS AND EXPERTS,

Here we go again: Now, we are just working on our newest text book proposal:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctor and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Format and Style

This is the most academic styled book we’ve ever attempted. We’ve already completed about 10 chapters. They are all fascinating. So, it seems a shame to leave so much great stuff on the cutting room floor. Therefore, we are seeking about 12-15 additional de-novo chapters from you, our esteemed ME-P readers, experts and subscribers.

Crowd-Sourcing the Book

Therefore, for the next few weeks and months we will be soliciting author-experts and contributions via this on-line Crowd Sourcing campaign to either update existing chapters; or submit totally new chapters, success stories and essays.

Of course, the existing chapters are more traditional in nature; while de-novo contributions will be more new-wave, innovative and grounding-breaking in their thought leadership risk management ideas.

We are Hoping you Can Help Us

If you have deep knowledge, experience or education in medical risk management, asset protection, malpractice liability, medical office compliance, or insurance planning; or an amazing story about how these modern topics are transforming and changing your medical practice, clinic or hospital – or advisory/consulting practice – for the better/worse; please do let us know. Either by posting a comment or emailing Ann, directly.

Tenor and Tone

These kinds of chapters can help bring a subject to life.

Format Specs and Style Sheet: © IMBA, Inc. All rights reserved.

Author SPECS Risk Management

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Our Deep Healthcare Niche Notoriety

And, our books have used by professional organizations like the Medical Group Management Association (MGMA), American College of Medical Practice Executives (ACMPE), American College of Physician Executives (ACPE), American College of Emergency Room Physicians (ACEP), Health Care Management Associates (HMA), and PhysiciansPractice.com;

And by academic institutions like the UCLA School of Medicine, Northern University College of Business, Creighton University, Medical College of Wisconsin, University of North Texas Health Science Center, Washington University School of Medicine, Emory University School of Medicine, and the Goizueta School of Business at Emory University, University of Pennsylvania Medical and Dental Libraries, Southern Illinois College of Medicine, University at Buffalo Health Sciences Library, University of Michigan Dental Library, and the University of Medicine and Dentistry of New Jersey, among many others.

All books are archived in the Library of Congress, Institute of Health and Library of Medicine.

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Assessment

Regardless of your decision to contribute, we remain apostles promoting our mutual core interests whenever possible.  And, we are all doing our best to make it a fascinating and important book, and appreciate your help.

If interested in contributing, updating or as a peer reviewer; please contact Ann; or you may use the contact form below:

Ann Miller RN MHA [Project Manager]

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To All [unhappy] Financial Advisors, JDs, CPAs and Physician-Focused Insurance Agents

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AVOID COLLATERAL ECONOMIC DAMAGE OF HEALTH CARE REFORM – AS A CERTIFIED MEDICAL PLANNER PROFESSIONAL

By Eugene Schnmuckler PhD MBA MEd CTS

[Academic Provost and Dean]

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http://www.CertifiedMedicalPlanner.org

ME-P Doctors, Advisors and Consultants

The healthcare industrial complex represents a large and diverse collateral support industry, and the livelihood of synergistic professionals who advise doctors depend on it. So, if you want to be an outstanding financial advisor in the healthcare space, you better read this book and learn something about physician specific financial planning.

Better yet! Combine financial planning and practice management and become a Certified Medical Planner ™. Then, integrate this knowledge, and CMPmark of distinction, into your current financial advisory or healthcare consulting practice.

Or, as some of the following financial services professionals are learning, you might just become more collateral economic damage in the current managed healthcare debacle, if you don’t.

Certified Public Accountants

The nation’s 330,000 or so CPAs know little about the new healthcare dynamics and financial planning. Many often feel as though they are laboring away in obscurity and that their doctor clients do not appreciate what they do or how hard they work.

If you are a CPA, your workweek is ridiculously long, especially January through April; and you often deliver bad news to your doctor clients. You do not earn a generous salary, but you do receive their ire for your efforts. Even ex-SEC chief Arthur Levitt said, “Accounting is clearly a profession in crisis”, after reviewing Arthur Andersen, LLP’s role in Enron Corporation’s collapse, in 2002; not to mention the Global Crossing Ltd, Vivendi Universal, Warnaco, Martha Stewart and WorldCom fiascos.

So, you begin to scratch your head and ponder, quietly at first, and then out loud. Perhaps advising and managing the medical practice of a physician, or providing consulting services to other medical professionals is an opportunity that won’t require a new client base? You can keep your accounting practice during the first four months of the year, and supplement your income with something that may actually earn more than you are making now.

A light then goes off in your head. Epiphany! Enter iMBA’s Certified Medical Planner(CMP) professional certification program, exhorting accountants to “integrate personal financial planning with medical practice management”, through an additional 500 hours of online managerial and planning experience.

However, terms such as capitated medicine; per member-per month fixed fees; payment withholds’; activity based costing with CPT codes; utilization and acuity rates; and more investment and financial nomenclature is likely quite unfamiliar to you.

Furthermore, you may not have the temperament to be responsible for the financial affairs of others. Then you realize that CMPs along with MBAs and CFPs may actually be the new denizens of the healthcare bean counting and practice management scene. Rather than present numbers of the historic past, they make logical and mathematical inferences about the future.

Slowly, you realize that this has occurred because these professionals are proactive, not reactive, as the accounting profession is loosing its premier advisory position within the medical profession. Since doctors are paid a fixed fee amount, regardless of the number of services performed, these futuristic projections are the most important accounting numbers in healthcare today.

In fact, your research suggests that as a result, nearly every major accounting firm has created a financial advisory unit, or acquired one. Moss-Adams acquired Financial Securities in Seattle. Plante and Moran’s advisory unit is one of the largest and most successful in Michigan. And, 1st Global now offers a turnkey program that allows nearly every accounting firm to create its own advisory unit overnight.Even, the AICPA is providing encouragement to CPAs who wish to provide more professional client services by uniting with Fidelity to serve as a professional vendor. And, the PFS designation is about to be abandoned by the AICPA.

Doctor Advisor Teamwork

Tax Attorneys and Lawyers 

As a tax planning, health-law or estate attorney, you already know that almost every legal magazine around has articles or advertisements proposing that you become a financial planning professional or business consultant to your physician clients. Moreover, lawyers of all stripes are being pushed toward interdisciplinary alliances by encroachment on their turf by the Big Four consulting firms. With audits of publicly held companies now a commodity, the giant law firms are getting more of their revenues from consulting fees; and that puts them into direct competition with you and other legal professionals.

Of all careers, you know how absolutely onerous it is to practice medicine today, and are finally thankful that you did not take that career route many years ago. So, like your neighbor the accountant, you begin to explore that potential of developing a service line extension to your legal practice, in order to assist your medical colleagues who have been hit on hard economic times.

In fact, you soon realize that more than 90,000 trust, probate and estate planning attorneys like yourself are interested in pursuing financial planning in the next decade. Sure, you know its difficult to get a CLU or variable annuity license, or become a Certified Financial Planner (CFP), but earning your law degree was no cinch either. And, you reckon, advising physicians has got to be easier than law, or less stressful than the corporate lifestyle of your CMP trained brother-in-law, right?

So, you set out to stretch your legal horizons with an online Certified Medical Plannercertification program and explore the basic legal nuances of those topics not available in law school when you were a student. Things like medical fraud and abuse; managed care compliance audits and Medicare recoupments; PP-ACA, RACS, OSHA, DEA, HIPAA and EPA standards; anti-trust issues; and managed care contract dilemmas or de-selection appeals.

What a brave new world the legal profession has become! Even the American Bar Association’s commission on multi-disciplinary practice has recommended that lawyers be permitted to share fees and become partners with financial planners, money managers and other similar professionals.

As a real life example, the venerated Baltimore brokerage firm of Legg Mason, Inc, has recently teamed up with the Boston law firm of Bingham Danna, LLC, to create one of the first marriages between a law and securities firm. If you want in on the challenge, and bucks, you’d better acquire at least a working knowledge of health care administration, or perhaps help craft some new case law, or assist your doctor-clients in some other fashion; otherwise, you will remain a legal document producer.

Financial Planners and Investment Advisors

As a CFP, CFA, investment advisor or general securities representative, you realize that the financial service sector is going to become the next great growth opportunity of the 21st Century, despite the fact that the stagnant stock market in 2003-2004 set profits for the securities industry back by seven years.

Even H & R Block, and the Charles Schwab Corporation are trying to build medical professional interest in their respective firms and compete with your independent practice. They are fervently wooing away one group or another to interface with their embryonic financial advisory programs. Meanwhile, more than 260,000 of the nation’s brokers are moving into the investment advisory and financial planning business, as transactions have become commoditized.

A recent survey conducted for the Financial Planning Association clearly demonstrated the dominance of registered investment advisors, over stockbrokers, among clients 35-49 years old. With the average Merrill Lynch private client well over 60, it’s easy to spot the future vulnerability of this business model.

When asked to determine the added value of key industry players, baby boomers in a recent Dalbar study ranked financial planners first, followed by stockbrokers, CPAs, mutual fund companies, insurance agents, and commercial bankers, respectively. Even if you are a CFP, and despite the proliferation of investment advisors, evidence suggests that your individual impact is still narrow.

Furthermore, another Prince & Associates study of 778 affluent individuals including physicians, each with more than 5 million dollars to invest, examined the relationship between clients and their providers of five key financial services; retirement planning, estate planning, investment management, executive benefits and health-disability insurance. Prince found that 59 percent of the clients had been serviced in only one area by a particular advisor. Despite the significant assets of each client, the advisers have been unsuccessful at broadening these relationships– a key indicator that many affluent clients do not have a primary financial adviser.

Among the challenges you face to broaden your influence is to offer your clients value added services, perhaps by establishing your expertise in the medical niche and capitalize on being different (your unique knowledge-based value proposition). You must not remain just another of the more than 250,000, or so individuals who claim to be financial planners, with a collective universe of an additional 700,000, who purport to be financial advisors, in some fashion or another. You must begin to develop the strategic competitive advantage of practice management knowledge to synergize with your existing financial services product line.

Like the physicians you advise, you must consider becoming a specialist. In the highly coveted healthcare space, this specialist to high net worth doctors, is known as a Certified Medical Plannerpractitioner.

Integrated practice management and financial planning will also become much more competitive among physicians because they are aware of the above fusion. No one is suggesting therefore, that you abandon your core financial advisory business for medical practice management. It is merely a fact that healthcare has drastically changed during the past decade, and the knowledge you used yesterday will no longer be enough for you to get by on in the future.

Medical practice management is the natural outgrowth of traditional financial planning services, and investment advice in turn, is central to the implementation of a unified medical office and personal financial plan. The most successful financial planners therefore, may be CMPs and CFPs who incorporate medical management services into their practices.

cmp-program1

Insurance Agents and Counselors

As a traditional life insurance agent, it seems that almost all your colleagues are acquiring a general securities license, or CFP designation in addition to the CLU or ChFC after their name. Currently, there are more than 3 million insurance agents, half of which are independent. They are being pressured to move toward financial planning, as distribution of insurance products over the Internet spreads like wildfire.

Meanwhile, the same insurance and investment companies that are knocking on your door are also courting the medical professionals with their practice enhancement programs. Even if you are not interested in going into the financial planning business, you have seen the status of the American College erode of late, even as your own insurance business has declined because of the World Wide Web and various discounted insurance companies.

And, in the eyes of your former golden goose doctor-clients, you may have become a charlatan and everyone is clamoring for a piece of your insurance business and cloaking it in the guise of the contemporary topic of the day; medical practice management and financial planning. Think this is an exaggerated statement? An October 1997 survey conducted by Deloitte & Touche Consulting Group of New York, found insurance agents ranked last in having the trust of a wide selection of the public! Erosion has continued, ever since.

So, how do you regain this lost trust, and what about this new entity known as managed care? How do you learn about it at this stage in your career? What ever happened to the traditional indemnity health insurance, with its deductible and 80/20payment scheme? It was so easy to sell, provided good coverage, and the agent made a nice profit.

As an insurance agent, all you want to know is, can I still sell insurance and make a living? Like the struggling doctors you seek to advise, and the collateral advisors above, you find yourself asking, how do I talk the talk, and walk the walk, in this new era of medical insurance turmoil?

Slowly, as you read, study and learn about the Certified Medical Plannercertification program, you become empowered with the knowledge and ideas for new insurance product derivatives, that actually provide value to your physician clients. You are no longer just an insurance salesman, but a trusted medical risk management advisor.

Congratulations!

You can avoid the managed care economic ripple effect. Act now!

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MarcinkoAdvisors@msn.com

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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I’m a 47 year old MD – Can you help me?

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A Real-Life Case Model

By Ann Miller RN MHA

http://www.CertifiedMedicalPlanner.org

As a generic financial advisor, how would you answer this client prospect’s inquiry?

QUESTION: I’m a 47 year old MD – Can you help me?

TRADITIONAL ANSWER: I am a stock-broker [aka financial advisor] or insurance agent, and I sell financial products and insurance policies on a commission basis.

What do you want to buy?

CURRENT ANSWER: I am a financial planner, and I charge a percentage amount on the assets I “manage” for you. But, I have a minimum portfolio amount.

So how much money do you have to invest?

DEEP NICHE ANSWER: Yes! I am a fully CERTIFIED MEDICAL PLANNER™ practitioner.  I understand holistic financial planning for medical professionals and current health industry tumult. And, as an informed fiduciary – with transparent fees – I can help with your medical practice, business and/or personal financial planning matters.

When can we meet to discuss your needs?

***

Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

ENTER THE CMPs

Enter the CMPs

Conclusion

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Congratulations to Ken Chi Yeung MBA CMP™

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Meet Our Newest Certified Medical Planner™

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Ken Chi Yeung MBA CMP

Ken is a hospital administrator and financial consultant for the Tseung Kwan O Hospital, in Hong Kong. He speaks English, Cantonese, Mandarin and Chinese.

diploma

Assessment

Certified Medical Planner

Link: http://www.CertifiedMedicalPlanner.org

NEW BOOK: Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Conclusion

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OUR NEWEST BOOK:

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Low Interest Rate Traps

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IRs at Historic Lows

[By David K. Luke MIM CMP™ http://www.NetWorthAdvice.com]

David K. LukeWhile our economy is still in a “Land of Make Believe”, despite the “mini-crash” today and with interest rates still at historic low levels, now is a good time to remind ourselves of a couple tempting financial missteps:

Taking On New Debt

Debt is Debt!

When you borrow money to buy that second home, nice boat, or remodel the kitchen, it is easier to justify considering the lower monthly payments at 3 to 6%. That $110,000 Sea Ray 300 Sundeck boat you have always wanted is only $729 a month (240 months @ 5% no down). Affordable, right?

Whether or not it easily fits within your budget is one thing, but the low interest rate does not negate the fact that you now have an $110,000 liability on your Balance Sheet. Depending on depreciation and resale factors, you may also be draining your net worth with such a purchase if you end up “upside down” on the value.

Neglecting Existing Debt

Your mortgage is under 3.5%. Your practice just scored a low interest rate on a needed new piece of medical equipment. Your local bank just quoted you 1.99% on a new car loan. Life is good for medical professionals!

Perhaps because the emotional benefits of paying off debt is difficult to quantify, paying off low interest rate loans is not usually a priority for most physicians. Professor Obvious states: “Once a debt is paid, you have freed yourself of future recurring interest costs and an outstanding obligation.” While this seems like a trite concept, the point is that funds that have been previously used to pay interest, no matter how low the rate was, can be used for other purposes. Unfortunately physicians and financial advisors, CPAs, estate planning attorneys tend to be over analytical and miss the “happiness factor” of getting out of debt and owning your abode and other assets. For the strictly number-oriented person or over analytical physician, this can be a sticking point. After all, why pay off a 3.5 % mortgage (that after tax is costing you around 2.5% or less)?

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Euro Debt

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A physician would never remortgage their home to invest in a mutual fund. In fact, it is now accepted by FINRA, the SEC, and other regulatory bodies in the financial services industry that a financial advisor that encourages a client to leverage principle residence equity (take out a 1st or 2nd mortgage) to make a security investment is akin to committing malpractice. Yet I hear the rationale that funds are being deployed to other “investments” rather than paying off a low interest rate mortgage.

Life Is Good!

From a financial planning perspective, avoiding new debt and retiring existing debt obligations as soon as reasonable gives a physician and his or her family more options. Taking a locum tenens position, retiring early, and working less hours are just a few of these options.

Assessment

With a little consideration and restraint on your personal debt situation, even at these low interest rates, financial freedom and the resulting empowerment is achievable earlier.

Conclusion

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Two Healthcare Sectors the Stock Market Got Wrong on Election Day 2012

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How various sectors in the Health Care Industry fared under the PP-ACA legislation?

[A SPECIAL R&D REPORT FOR THE ME-P]

By David K. Luke MIM, MS-PFP, CMP™ [Certified Medical Planner™]

Website: http://www.networthadvice.com

David K. LukeThere has been a lot of speculation since the words “Affordable Care Act” were first whispered years ago on how the various sectors in the Health Care Industry would fare under such legislation. I proposed that a good indicator would be to look at the performance of the individual health care sector stocks on the first trading day after the election.

(See With Obama Election Win, “Mr. Market” Weighs in on the ACA Equity Winners and Losers by David K. Luke on November 16, 2012).

Link: With Obama Election Win “Mr. Market” Weighs in on the ACA Equity Winners and Losers

The day after Pres. Obama’s reelection on Wednesday, November 7, 2012 the stock market was down over 2% as measured by the S&P 500 and the Dow Jones Industrial Average (DJIA). The common reason given was increased doubt that the impending “fiscal cliff” issue, which was splitting the House and the Senate, would be resolved. There was however, another big concern on investor’s mind: the future of the Affordable Care Act. While the election was close when measured by the popular vote with President Obama earning 51.06% versus Mitt Romney with 47.20%, the electoral vote showed a hands-down Obama victory with 332 versus 206 votes. Investors voted with their pocketbooks with that first trading session following the election showing certain healthcare sectors up in price, other healthcare sectors with moderate returns, and certain healthcare sectors down in price.

Disparate Health Care Sector Returns

It is interesting to look back now over a year and a half later and see how accurate those investor votes were on that first day of realization that health care reform was continuing forward at a much faster pace now that President Obama would be serving a second term. Keeping in mind that the day was a very negative day as a whole in the stock market, a number of healthcare sectors were up in price. This group includes Hospital Stocks and Medicaid HMOs. Note the phenomenal one-day returns (in a down 2% market!) on the sample stocks in these two groups:

Hospital Stocks

  • Health Management Associates (HMA) +7.3%
  • HCA Holdings Inc. (HCA) +9.4%
  • Community Health Systems Inc. (CYH) +6.0%
  • Tenet Healthcare Corp. (THC) +9.6%

Medicaid HMOs

  • Molina Healthcare Inc. (MOH) +4.6%
  • Centene Corp. (CNC) +10.1%
  • WellCare Health Plans Inc. (WCG) +4.4%

Such positive returns on a big down day in the market indicates investors assessing these healthcare sectors being good investments under an Obama presidency and a positive outlook for the implementation of the Affordable Care Act. The other up sector on that day was the Drug Wholesalers, up almost 1% on that negative day. (See “Selected Health Care Performance” Chart – below).

The market had a tepid response to the Pharmacy Benefit sector, as well as the Generic Pharmacy, Testing Labs, and Big Pharma. In my sample group, these sectors were down -.4%, -7%, -1.7%, and -1.4% respectively. It is important to note however that these sectors while slightly positive or barely negative still performed better than the general market that day.

Two Sectors

But, the two healthcare sectors that the stock market severely punished with the voting of substantially more sellers than buyers by investors on that first post-election day were the Medical Device Companies (down 2.5% in the sample group) and the Medicare Part D Companies (down 4.7% in the sample group). The thought at the time was that Medical Device Companies, facing an impending medical device excise tax of 2.3% on the sale of most medical devices in the United States, would be devastated, and that Medicare Part D Companies would face severe profit constraints with tighter-fisted government regulations imposed by the ACA.

***

Stock_Market

***

The Retro-Specto-Scope

In hindsight, investors were correct on two out of the three predictions based on stock market prices on the various healthcare sectors. Hospital Stocks, Medicaid HMOs, and Drug Wholesalers, the leading sectors indicated to be winners with the impending implementation of the ACA, are up 69.8%, 63.6% and 76.5% respectively in the sample groups since November 7, 2012. This remarkable and closely parallel return for these three sectors seemed to prove that the stock market on November 7, 2012 correctly picked the three winning health care sectors! The S&P 500 index for the same time is up 32.02%, a nice return for 1 ½ years but about half the return of these apparently huge benefactors of the ACA. The healthcare sectors that investors felt less positive about (but more positive than the general stock market) on that first postelection day were Pharmacy Benefit Companies, Generic Pharmacy Companies, Testing Labs, and Big Pharma. These four health care sectors are up 43.8%, 40.5%, 6.4%, and 20.5% respectively. Again, in terms of ranking the sectors, these four sectors performed in line based on the comparative returns of the other healthcare sectors.

Wisdom of Crowds

Amazingly, it appears that the emotional Mr. Market predicated quite accurately on Wednesday, November 7, 2012, in one day of trading, not just which health sectors would be good investments for the near future, but the actually ranking of the future performance of the sectors! It seems as though the stock market, as one large voting machine, precisely dissected the over 20,000 pages + of resulting legislation created from the original 906 pages (pdf here) of the PPACA law and distilled it down to profits and losses with the resulting winners and losers in the health care industry in one trading session.

Two [2] Big Misses

Investors however were way off on their concerns about Medical Device Companies and Medicare Part D Companies. The two sample groups were up 71.3% and 66.4% in the time of November 7, 2012 to May 19, 2014 respectively, more than double the S&P 500 for the same period, and in line with the best performing sectors! This is spite of the fact that stock sample of these two groups were the two worst performers on post-election day trading. What happened?

***

Bear + A Falling Stock Chart

***

The “Medical Device Excise Tax” Fable and the “Private Insurers Will Control Costs” Fairy Tale

Wall Street has sharpened their pencils in the last year and a half and realized they have gravely underestimated the profit potential of the Medical Device makers and the Managed Care Health Insurers, in spite of the ACA. Based on stock price performance of the sample group of major players in the past 18 months, fewer sectors look as profitable as the Medical Device Industry and the Medicare Part D Industry. What happened?

The Medical Device industry states that the tax will cost the US “tens of thousands of jobs” and that those jobs will be shipped overseas. A number of issues that are involved here however refute these claims (http://www.factcheck.org/2013/10/boehner-and-the-medical-device-tax/. It appears that any targeted reductions were not related to the implementation of the tax, which became effective January 1, 2013, in spite of heavy protest by the industry. Medical technology continues to have a bright future regardless of the tax.

The notion that the “Affordable” Care Act will help reign in the rampant cost increases of Medicare’s “Part D” program seem to be elusive. Private insurers have done a poor job of keeping drug prices down, especially when compared to the discounts the government gets for Medicaid. Medicare Part D companies wield significant influence on Capitol Hill, and impending steeper discounts look unlikely.

Everybody Wins, Except …

Before the ACA implementation, about 85% of Americans had health insurance. Currently with an additional 7 million Americans with health insurance thanks to Obamacare, an additional 2.2% of Americans now have coverage, or about 87% of all Americans. How can such a slight increase in new health care consumers be responsible for such large anticipated profits in the health care sector? It cannot. Wall Street is telling us that the new health law is not about new customers, but about increased profit margins for the health care industry. I can draw three conclusions:

  1. The Affordable Care Act may not be so affordable for health consumers
  2. Most companies in the Health Care Industry stand to gain financially with ACA. There is one sure loser with ACA: The physician, who can only look forward to increased workloads and mpending Medicare SGR pay cuts.

THE CHART [Research and Development]

Selected Health Care Sector Stock Performance Random Sampling of Publically Traded Companies From President Obama Re-election Date to Present

Chart

Conclusion

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Certified Medical Planner™ Program “In-the-News”

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Post-CFP® Subject Matter Expertise

By Ann Miller RN MHA [iMBA Inc., Executive Director]

Mike Kitces MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC an uber-financial services blogger over at www.Kitces.com had this to say about us in a recent essay: Finding Your Niche Or Specialization With Post-CFP Designations

The News Essay

CMP (Certified Medical Planner) – The CMP™ designation was created by Dr. David Edward Marcinko MBA CMP™ [reformed CFP®] and the team at the Institute of Medical Business Advisors, Inc., (who also produced the “Financial Planning Handbook for Physicians and Advisors“). It is intended for advisors who aim specifically to serve physicians and the medical community. Content focuses not only on the insurance and investment issues relevant to physicians, but also provides an understanding of the business of medical practices themselves so advisors can help work with their physician clients to have more successful businesses as well.

CMP™ Practitioner Testimonials

I am happy to give my unbiased, unpaid opinion on the CMP™ program to anyone considering the course.

David K. Luke MS-PFP, MIM, CMP™ [Net Worth Advisory Group]

9980 South 300 West, Suite 110 Sandy, Utah 84070

david.luke@networthadvice.com

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CMP™ Practitioner Testimonials

I am in favor and support the CMP™ program and curriculum … but just like any other academic curriculum, it is an “accretive academic” program rather than an instant “change of life” program.  I use the material that I learned on a regular basis, but I cannot say that I use it every day.  You will be more able to “talk-the- talk” of the physicians if you have completed the CMP™ curriculum. I would do it again!

Savant recently hired a physician, Dr. Brian Knabe MD as an advisor. He is leaving the medical field, transitioning out, and entering the field of financial services. He has enrolled in this curriculum. Let me know if you wish to discuss.

Thomas A. Muldowney MSFS CFP® ChFC CLU CRC CMP® AIF®

[Savant Capital Management, Inc®]

190 Buckley Drive – Rockford, IL 61107 Tel 815-227-0300 – Fax 815-226-2195

Tmuldowney@savantcapital.com

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Assessment:

Link: What Comes After CFP Certification? Finding Your Niche Or Specialization With Post-CFP Designations

Visit: www.CertifiedMedicalPlanner.org

Visit: Enter the CMPs

Conclusion

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Dr. Marcinko Interviewed on Physician Retirement and Succession Planning

imba inc

 

 

Physicians Have Unique Challenges, Opportunities

By Ann Miller RN MHA

[Executive-Director]

Medical Executive-Post Publisher-in-Chief, Dr. David Edward Marcinko MBA CMP™, and financial planner Paul Larson CFP™, were interviewed by Sharon Fitzgerald for Medical News, Inc. Here is a reprint of that interview.

Doctors Squeezed from both Ends

Physicians today “are getting squeezed from both ends” when it comes to their finances, according Paul Larson, president of Larson Financial Group. On one end, collections and reimbursements are down; on the other end, taxes are up. That’s why financial planning, including a far-sighted strategy for retirement, is a necessity.

Larson Speaks

“We help these doctors function like a CEO and help them quarterback their plan,” said Larson, a Certified Financial Planner™ whose company serves thousands of physicians and dentists exclusively. Headquartered in St. Louis, Larson Financial boasts 19 locations.

Larson launched his company after working with a few physicians and recognizing that these clients face unique financial challenges and yet have exceptional opportunities, as well.

What makes medical practitioners unique? One thing, Larson said, is because they start their jobs much later in life than most people. Physicians wrap up residency or fellowship, on average, at the age of 32 or even older. “The delayed start really changes how much money they need to be saving to accomplish these goals like retirement or college for their kids,” he said.

Another thing that puts physicians in a unique category is that most begin their careers with a student-loan debt of $175,000 or more. Larson said that there’s “an emotional component” to debt, and many physicians want to wipe that slate clean before they begin retirement saving.

Larson also said doctors are unique because they are a lawsuit target – and he wasn’t talking about medical malpractice suits. “You can amass wealth as a doctor, get sued in five years and then lose everything that you worked so hard to save,” he said. He shared the story of a client who was in a fender-bender and got out of his car wearing his white lab coat. “It was bad,” Larson said, and the suit has dogged the client for years.

The Three Mistake of Retirement Planning

Larson said he consistently sees physicians making three mistakes that may put a comfortable retirement at risk.

  1. The first is assuming that funding a retirement plan, such as a 401(k), is sufficient. It’s not. “There’s no way possible for you to save enough money that way to get to that goal,” he said. That’s primarily due to limits imposed by the Internal Revenue Service, which allows a maximum contribution of $49,000 annually if self-employed and just $16,500 annually until the age of 50. He recommends that physicians throughout their career sock away 20 percent of gross income in vehicles outside of their retirement plan.
  2. The second common mistake is making investments that are inefficient from a tax perspective. In particular, real estate or bond investments in a taxable account prompt capital gains with each dividend, and that’s no way to make money, he said.
  3. The third mistake, and it’s a big one, is paying too much to have their money managed. A stockbroker, for example, takes a fee for buying mutual funds and then the likes of Fidelity or Janus tacks on an internal fee as well. “It’s like driving a boat with an anchor hanging off the back,” Larson said.

Marcinko Speaks

Dr. David E. Marcinko MBADr. David E. Marcinko MBA MEd CPHQ, a physician and [former] certified financial planner] and founder of the more specific program for physician-focused fiduciary financial advisors and consultants www.CertifiedMedicalPlanner.org, sees another common mistake that wreaks havoc with a physician’s retirement plans – divorce.

He said clients come to him “looking to invest in the next Google or Facebook, and yet they will get divorced two or three times, and they’ll be whacked 50 percent of their net income each time. It just doesn’t make sense.”

Marcinko practiced medicine for 16 years until about 10 years ago, when he sold his practice and ambulatory surgical center to a public company, re-schooled and retired. Then, his second career in financial planning and investment advising began. “I’m a doctor who went to business school about 20 years ago, before it was in fashion. Much to my mother’s chagrin, by the way,” he quipped. Marcinko has written 27 books about practice management, hospital administration and business, physician finances, risk management, retirement planning and practice succession. He’s the founder of the Georgia-based Institute of Medical Business Advisors Inc.

ECON

Succession Planning for Doctors

Succession planning, Marcinko said, ideally should begin five years before retirement – and even earlier if possible. When assisting a client with succession, Marcinko examines two to three years of financial statements, balance sheets, cash-flow statements, statements of earnings, and profit and loss statements, yet he said “the $50,000 question” remains: How does a doctor find someone suited to take over his or her life’s work? “We are pretty much dead-set against the practice broker, the third-party intermediary, and are highly in favor of the one-on-one mentor philosophy,” Marcinko explained.

“There is more than enough opportunity to befriend or mentor several medical students or interns or residents or fellows that you might feel akin to, and then develop that relationship over the years.” He said third-party brokers “are like real-estate agents, they want to make the sale”; thus, they aren’t as concerned with finding a match that will ensure a smooth transition.

The only problem with the mentoring strategy, Marcinko acknowledged, is that mentoring takes time, and that’s a commodity most physicians have too little of. Nonetheless, succession is too important not to invest the time necessary to ensure it goes off without a hitch.

Times are different today because the economy doesn’t allow physicians to gradually bow out of a practice. “My overhead doesn’t go down if I go part-time. SO, if I want to sell my practice for a premium price, I need to keep the numbers up,” he noted.

Assessment

Dr. Marcinko’s retirement investment advice – and it’s the advice he gives to anyone – is to invest 15-20 percent of your income in an Vanguard indexed mutual fund or diversified ETF for the next 30-50 years. “We all want to make it more complicated than it really is, don’t we?” he said.

QUESTION: What makes a physician moving toward retirement different from most others employees or professionals? Marcinko’s answer was simple: “They probably had a better shot in life to have a successful retirement, and if they don’t make it, shame on them. That’s the difference.”

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Is Working with a Financial Advisor Worth It?

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The Future of Retirement, the Power of Planning

By Lon Jefferies CFP® MBA

Lon JeffriesHSBC recently published an article titled “The Future of Retirement, the Power of Planning” which compares the circumstances of investors who work with a financial planner to those who invest on their own. The goal of the study was to determine if there is a benefit to working with an investment professional.

The Survey

The survey categorized survey respondents as non-planners, advice-seeking non-planners, self-guided planners, and advice seeking planners.

The Psychological Profile

  1. Non-planners have done nothing by way of financial planning or obtaining financial advice. This group represented 38% of all respondents.
  2. Advice-seeking non-planners are individuals who do not have a financial plan, though they do seek professional financial advice from time to time. They are likely to seek advice about one particular need rather than taking holistic, comprehensive advice. This group made up 12% of all respondents.
  3. Self-guided planners have a financial plan in place but do not seek professional expertise to help them make sense of their finances. Members of this group are likely to be younger, internet savvy, and mid-to-high income earners. This group accounted for 22% of respondents.
  4. Advice-seeking planners have a financial plan and utilize a financial professional to help manage their finances. Members of this grouping are more likely to be approaching retirement or retired, and are typically more wealthy. They made up 28% of survey respondents.

Errors

The most glaring findings of the study is the importance of a financial plan. Those with advisor directed financial plans have nest-eggs that are over four times as large as those without plans. Further, consistently working with a financial planner seems to add significant value; Advice-seeking planners had nest-eggs that were 57% larger than self-guided planners.

Why?

The Financial Engines & AON Hewitt report that investors who manage their investments with the aid of a financial advisor are more diversified, take less risk, and obtain better returns than self-directed investors. In fact, advisor directed investors were found to increase their returns by 2.92% per year after expenses!

Lastly, if you are curious how the size of your nest-egg compares to that of the average American worker, you might be shocked.

Homestead

Excluding the value of a primary residence and defined benefit plans (pensions), 60% of American workers have less than $50k in savings and investments, according to the Employee Benefit Research Institute. Moreover, 79% have less than $100k saved. Only 10% of workers have accumulated a nest-egg of over $250k.

Now, how does this compare with doctors and medical professionals; of today and yesterday. How about you? What about a fiduciary focused Certified Medical Planner www.CertifiedMedicalPlanner.org?

Assessment

Conclusion

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With Obama Election Win “Mr. Market” Weighs in on the ACA Equity Winners and Losers

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The Wisdom of Crowds

By David K. Luke MIM, Certified Medical Planner™

Website: www.networthadvice.com

The first trading session following the election on Wednesday, November 7, 2012 gave us some clues on how different sectors of the health care market may be affected by the ACA, as Obama’s win confirms that health reform marches forward. “Mr. Market” has spoken.

“Mr. Market”

For those that may be unaware, “Mr. Market” was Benjamin Graham’s term for the stock market in explaining fluctuations. Graham is the father of value investing and Warren Buffet’s most influential mentor. According to Graham, Mr. Market is emotionally unstable but doesn’t mind being slighted. If Mr. Market’s quotes are ignored, he will be back again tomorrow with a new quote.

So, the point is that successful investors do not place themselves in emotional whirlwinds often created by the market. This first post-election trading session was such a whirlwind. Large groups of people (such as those that voted with their pocketbook in this telling stock market session) are smarter than an elite few, or so goes the premise of James Surowiecki’s Wisdom of the Crowds.

Now; what did we learn from the combined investing public wisdom about the future of healthcare companies profitability with ACA?

Keep in mind the overall market was down 2.4% on the day as measured by both the Dow Jones Industrial Average and the Standard & Poor 500. The biggest concern of the day was investor worry about the so called “fiscal cliff” and the debate over billions in spending and tax increases. Considering the total market on November 7th, health care stocks performed as a group better than the averages, but Mr. Market definitely parsed health care stocks by sector from “great” to “dreadful” based on the implications of impending health care reform:

Great:

Hospital Stocks

  • Health Management Associates (HMA) +7.3%
  • HCA Holdings Inc. (HCA) +9.4%
  • Community Health Systems Inc. (CYH) +6.0%
  • Tenet Healthcare Corp. (THC) +9.6%

Yes, there were stocks that went up stridently on the big down day. Not surprisingly, hospital stocks are expected to benefit from the estimated 30 million Americans who will line up for insurance coverage beginning in 2014, increasing profits and decreasing bad debts.

Medicaid HMOs

  • Molina Healthcare Inc. (MOH) +4.6%
  • Centene Corp. (CNC) +10.1%
  • WellCare Health Plans Inc. (WCG) +4.4%

Health insurers that typically focus heavily on Medicaid are up in line with ACA provisions to expand care for the poor. Mr. Market tips his hat to Centene Corporation, which has been successful in procuring multi-line coverage contracts with States including long-term care, vision, dental, behavioral health, CHIP and disability.

Good:

Drug Wholesalers

  • McKesson (MCK) +1.3%
  • Cardinal Health (CAH) +.5%
  • AmerisourceBergen (ABC) +1.0%

Growth in prescription drug spending means increased revenues for the drug wholesalers, so ACA should be a positive for this group. But because a majority of wholesaler profits come from generic drugs, and because wholesalers are indirectly affected by changes in pharmacies, pricing pressures will keep the wholesalers in check.

Fair:

Pharmacy Benefit Mangers

  • Express Scripts (ESRX) -0.4%
  • CVS Caremark Corp (CVS) -0.4%

As an intermediary between the payor and everyone else in the health-care system, PBMs process prescriptions for groups such as insurance companies and corporations and use their large size to drive down prices. These companies are incentivized to cut costs and have been thought to benefit greatly from ACA, and will expand prescription drug insurance plans sold through health insurance exchanges starting in 2014.

Generic Pharmaceuticals

  • Teva Pharmaceutical Industries Ltd ADR (TEVA) -0.7%
  • Mylan Inc (MYL) -0.8%
  • Dr. Reddy’s Labs (RDY) -0.6%

Health care reform is good for generic drugs with anticipated increased dispensing of drugs in general.  With more funds spent on Medicaid, the ACA will certainly be generic oriented and should fare better than the name-brand drugs. Pricing pressures are expected over the longer term however.

Testing Laboratories

  • Quest Diagnostics (DGX) -1.5%
  • Laboratory Corp of America (LH) -1.9%

More patients you would think would mean more medical tests. In a recent Gallup survey, physicians attributed 34 percent of overall healthcare costs to defensive medicine (think diagnostic blood tests/invasive biopsies, etc). ACA may curb this expensive part of medicine and appears to have very negative implications going forward as Labs will have intense pressure to reduce rates. However, these larger labs held up better than the market averages suggesting that lab work isn’t going away with ACA.

Big Pharmaceutical Companies

  • Pfizer Inc.  (PFE) -2.2%
  • GlaxoSmithKline PLC (GSK) -0.8%
  • Eli Lily & Co. (LLY) -1.2%

The name-brand large Pharmaceutical companies have agreed to rebate Uncle Sam on Medicaid purchases and must give the elderly discounts. But there will be a lot more of us taking drugs too.

I’ve ranked these 4 health care sectors “fair” considering that broader stock market averages were down 2.4% for the day and Mr. Market was kinder to this group with only a slight negative. Likewise, it appears that he is anointing this group as a benefactor of upcoming reforms.

Not Good:

Medical Device Companies

  • Medtronic Inc. (MDT) -3.0%
  • Stryker Corporation (SYK) -1.6%
  • Boston Scientific Corp. (BSX) -3.6%
  • Zimmer Holdings Inc. (ZMH) -1.8%

The 2.3% excise tax on revenue of medical-device companies is looking more inevitable, in spite of industry lobbying group efforts.

Dreadful:

Medicare Part D Companies

  • Humana Inc. (HUM) -7.9%
  • WellPoint (WLP) -5.5%
  • Cigna Corp. (CI) -0.7%

Even though managed-care companies should gain millions of new customers thanks to the ACA, profit margins are expected to decline significantly.  Mr. Market went easy on Cigna, perhaps because of the company’s focus on self-insured large employers.

Currently

Currently it is unclear how the increased revenue generated from more patients will affect the increased margins to the various sectors of the healthcare market. Also, too much weight should not be placed on this one day action by the market. One thing is clear however, and that is how Mr. Market and the market at large feels at first blush towards the impending implementation of the ACA based on the November 7, 2012 trading of the respective stocks.

Assessment

Remember: Mr. Market is temperamental and can change his mind anytime!

About the Author:

David K. Luke MIM, a Certified Medical Planner™, focuses on helping physicians, medical professionals, and successful retirees with financial planning, investment and risk management. He directs physicians through their complex planning needs, helping them foster a better medical practice and lifestyle. David is a fee-only financial planner.

Disclosure:

Percentage changes in price of stocks represent published change in price from closing price November 6, 2012 to closing price November 7, 2012. Stocks listed here are not considered to be past, present or future recommendations to buy or sell securities and is for educational purposes only. This information should NOT be considered as investment recommendations or advice but rather summary comments and opinions on the health care market by David K. Luke, MIM CMP™, who is entirely responsible for the contents of this article.

Link: www.CertifiedMedicalPlanner.org

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Medical Practice and Health 2.0 Risk Management is Now a Part of Financial Planning for Doctors

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Ann Miller RN MHA [Executive-Director]

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About Us

Our ME-P Editor, Dr. David Edward Marcinko MBA CMP™, is a nationally recognized healthcare financial and business advisor to physicians, clinics, hospitals and medical practices. Based in Atlanta Georgia, as a Certified Medical Planner™, Dr. Marcinko leads the industry delivering expert financial and managerial advice to all healthcare entities and stakeholders regarding managed care contracting, operations, strategic planning, revenue growth, health 2.0 business modeling and physician litigation support.

Dr. Marcinko is a sought-after author and speaker with three-decades of expert healthcare consulting experience. He has authored hundreds of healthcare business, finance, economics and management articles and dozens of text books. He is a chosen speaker among prominent national healthcare groups and financial services associations.

Committed to addressing the needs of each client, Dr. Marcinko and the iMBA Inc team takes great pride in personally leading every consulting team that produces effective response time and measurable results for satisfied colleagues and corporate clients www.MedicalBusinessAdvisors.com 

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Educational Inititatives

That’s why the R&D efforts of our governing board of physician-directors, accountants, financial advisors, academics and health economists identified the need for integrated personal financial planning and medical practice management as an effective first step in the survival and wealth building life-cycle for physicians, nurses, healthcare executives, administrators and all medical professionals.

Now – more than ever – desperate doctors of all ages are turning to knowledge able financial advisors and medical management consultants for help. Symbiotically too, generalist advisors are finding that the mutual need for extreme niche synergy is obvious.

But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now!

Enter the Certified Medical Planner™ charter professional designation www.CertifiedMedicalPlanner.org

Assessment

And so, for all financial services professionals interested in the fast-moving healthcare advisory space: Medical Practice and Risk Management is Now a Part of Financial Planning for Doctors

Certified Medical Planner

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Do Clients Trust Financial Advisors More than Doctors or CPAs?

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I Think … Not in My Universe

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Survey after survey has shown that the public does not trust the financial services industry; it was – in fact, the least trusted industry in a recent Rick Edelman survey.

John Hancock?

But, perhaps they were looking at the wrong industries, or maybe investors just don’t trust your firm. A new survey by John Hancock shows that investors with assets of $200,000 or more, trust their financial advisor [FA] more than their primary doctor, accountant, contractor/handyman, boss and real estate agent. It was penned by one young staff writer named Diana Britton.

Link: http://wealthmanagement.com/blog/clients-trust-you-more-doctors-cpas?NL=WM-04&Issue=WM-04_20120611_WM-04_597&YM_RID=marcinkoadvisors%40msn.com&YM_MID=1318408

My View Point is Pretty Unique

Now, I am a doctor and board certified surgeon who held Series #7, #63 and #65 securities licenses, and was a Certified Financial Planner® for more than a decade. I was registered with a BD, SEC and NASD/FINRA, and held life, health and PC insurance licenses. This is the so-called “dual registration” to earn commissions and fees.

And, I’ve got a current partner who is a doctor-CPA who has a Master’s Degree in Accounting.  So, I know from whence I speak.

An Insurance Company!

Now, I resigned all of the above financial services monikers because of their lack of education and fiduciary accountability. These are sales licenses, certifications to hold a certification, and related gimmicks, all. Insurance agents have a duty to the company, not the client. Always ask them to put your best interests ahead of their own – in writing before hire – and watch them run.

Assessment

I suspect this study from an insurance company is less than accurate. How do I know? My gut heuristics tell me. Agency law tells me. No surveys needed or damn statistics for me. How about you? OR, are the marketing and PR gurus winning the public opinion battle with their insurance company advertising chicanery? ie., Hancock’s the future is yours!

If really so, here is my razzy for them.

 
Note: It is for the above reasons, and more, that we started the www.CertifiedMedicalPlanner.org online education program for financial advisors and management consultants that truly want to be trusted.

Conclusion

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New-Age Physician Risks Courtesy of Health Information Technology

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Issues You May Not Have Considered

By David K. Luke MIM, Certified Medical Planner™

www.CertifiedMedicalPlanner.org

The entire nation continues to experience a medical malpractice liability crisis.

Facing physicians is the concern of frequency and severity of claims that either continues to rise or remains steady. And, much has been written about the impact of the liability crisis on physicians, the medical community, patients and access to care.

But, with health 2.0 connectivity, there are even more risks for doctors, and most all medical professionals, to consider.

So, here are a few fresh liability risks to your medical practice, to you, and to your patients courtesy of the health information age:

  1. Data breech risk. While not a new risk, the higher prevalence is new. The risks of a being fined by OCR due to the privacy rules of HIPAA because a practice had a data-breech with their EHR is becoming more common and very expensive
  2. Risks of telemedicine. As physicians become more technologically enabled in their practice of medicine, some are turning to real-time videoconferencing and other technologies. Some specialties such as psychiatry have been early adopters, but have to make sure they are still employing the same standards of care required by an in office visit (Cash 26). Also, the telephone can facilitate medical care but also result in adverse outcomes leading to telephone-related malpractice suits (Mondor, et al 517).
  3. Risks of new age medicine practices and their regulation. Case in point: Dry needling, which is like acupuncture, is a growing practice in places like Australia but is unregulated. Physicians should understand all regulatory and other risks when implementing new unregulated practices pushed by our new age society (Janz). Home births are on the rise in North America (even in Canada with government provided hospital delivery) but physicians end up dealing with the disasters and associated risks when they occur (Bochove 68).
  4. Reputation Risk. Reputation is a doctor’s most valuable asset. With the new age of internet and instant information, physicians must take great care in managing their reputation on such media sources as they are under increasing public and press scrutiny (Boyd 221).
  5. Communication risks to immigrants with limited non-native language proficiency. With today’s higher immigrant population in the United States, more medical practices are treating patients with limited English language proficiency. Clinicians now run the risk of not properly communicating medical risk information to these populations. A recent study shows that materials that include visual aids are being used by medical practices to effectively communicate with the patient (Garcia-Retamero, Rocio, and Mandeep, K. Dhami 47).
  6. The rise of the informed distrusting patient and related risks. With the ubiquity of medical information on the internet, the risks incurred by a medical practice in properly dealing with the newly informed patients with medical degrees from the University of Google Medical School are on the rise. Physicians must refine their “bed side manner” and improve their communication skills in order to deal with a more questioning patient population. Clinicians should actively discuss what patients have read on the internet when patients refer to their internet diagnoses (Lam-Po-Tang, John, and Diana McKay 130).

Works Cited

  • Bochove, Danielle. “Don’t Try This At Home.” Maclean’s 124.33/34 (2011): 68. MasterFILE Premier. Web. 27 Apr. 2012.
  • Boyd, M. “Managing Risk To Reputation.” Clinical Risk 15.6 (2009): 221-223. CINAHL Plus with Full Text. Web. 27 Apr. 2012.
  • Cash, Charles, D. “Telepsychiatry And Risk Management.” Innovations In Clinical Neuroscience 8.9 (2011): 26-30. CINAHL Plus with Full Text. Web. 27 Apr. 2012.
  • Garcia-Retamero, Rocio, and Mandeep, K. Dhami. “Pictures Speak Louder Than Numbers: On Communicating Medical Risks To Immigrants With Limited Non-Native Language Proficiency.” Health Expectations 14.(2011): 46-57. CINAHL Plus with Full Text. Web. 27 Apr. 2012.
  • Janz, StephenAdams “Acupuncture by Another Name: Dry Needling in Australia.” Australian Journal Of Acupuncture & Chinese Medicine 6, no. 2: 3-11. Alt HealthWatch, EBSCOhost. Web. 27 Apr. 2012
    • Lam-Po-Tang, John, and Diana McKay. “Dr Google, MD: A Survey Of Mental Health-Related Internet Use In A Private Practice Sample.” Australasian Psychiatry 18.2 (2010): 130-133. Academic Search Complete. Web. 27 Apr. 2012.
    • Maureen Mondor, et al. “Patient Safety And Telephone Medicine.” JGIM: Journal Of General Internal Medicine 23.5 (2008): 517-522. Academic Search Complete. Web. 27 Apr. 2012

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A Survey to Shape the Definition of Physician-Focused Financial Planning

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Send us Your Thoughts

By Dr. David Edward Marcinko MBA CMP®

[Chairman, Founder and CEO]

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The Institute of Medical Business Advisors, Inc is re-defining the role of “physician focused financial planning” and how the concept fits within the financial services industry.

Crowd-Sourcing Insights and Opinions

But, we can’t do it without your help. As a medical provider or seasoned financial professional, our readers can provide valuable input to determine exactly what constitutes a physician focused financial advisor in today’s complex healthcare industrial complex landscape.

For example, is it business as usual for FAs today; does it fall under the auspices of the Certified Medical Planner™ professional rubric, or is it something else?

Be a pioneer and help shape the industry’s definition of medically focused financial advice by sending us your thoughts on competency tasks and areas of subject matter expertise.

Results

The results will enhance iMBA’s Certified Medical Planner designation, which is designed to help financial advisors address the needs of physicians, medical professionals and all allied healthcare personnel; and help define the role of physician focused financial planning in the coming decade.

Learn More

To learn more about this growth specialty and designation, click here: www.CertifiedMedicalPlanner.org

Assessment

Please be assured that if you take the survey, your responses are confidential; we won’t share your contact information with third parties. Thank you for your participation!

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How to Become A Financial Advisor [Learned Profession or Professional Sales Force?]

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A Recent E-mail that I Received

By Dr. David Edward Marcinko MBA, CMP™

www.CertifiedMedicalPlanner.com

[Editor-in-Chief]

As a former certified financial planner for almost 15 years, I was surprised to recently receive the following unedited e-mail correspondence.

Dear Marcinko,

If you are clever, have a way with people, or are a born salesperson, then becoming financial advisor could be your ticket to paradise.

Maybe not exactly paradise, but you could definitely have a ticket to a rewarding career. If you’re thinking about starting out as a new financial advisor – you may already be half the way there.

Why?

Because it’s an occupation where your life challenges will give you the understanding and empathy needed to work with your clients. Have you ever been in the position where you had to figure out a budget for your children’s education? Or manage an over extended credit card? These life situations will aid an individual on the path to become a financial consultant.

Requirements to Be a Financial Advisor

Even though a formal education is not a necessity to become financial adviser, it helps if you’ve taken certain courses.

What degree do you need to become a financial advisor? A bachelor’s degree in Finance, Economics, Accounting, Commerce, Business or Marketing would be a good start. A degree won’t assure you of a startling career but it may help get your foot in the door.

Rumor has it that a degree in psychology is also an asset as financial advising is as much about counseling as it is about advising. There are a plethora of people with all sorts of emotional entanglements around their financial lives.

Licenses

So, what licenses do you need to be a financial advisor? Some companies will assist a newbie in the financial advisory business and place them into a special program that will help them to obtain the required regulatory licenses such as a Series 66, this license permits them to vend annuities and mutual funds. It’s also possible to manage your own training. You can take part-time courses in order to qualify for the CFP (Certified Financial Planner) exam.

There are roughly over 286 universities and colleges that will assist you in preparing for the CFP exam. How long does it take to become a financial advisor? In order to qualify for the exam you will also need three years full-time working experience with a financial planning establishment.

Statistics state that over 40% regularly fail this all important exam. Its worth the time and effort as with this certification you are deemed as a certified financial planner and demand a higher salary.

Assessment

Hot tip: Stay away from insurance companies for financial employment. They’ll insist that you sign everyone including the dog and your grandmother. Then get rid of you if you don’t procure sufficient business. Banks are better they will bring in the clients for you.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Are financial advisors true professionals; or a truely professional sales force?

Please 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. Are financial advisors true professionals, or a professional sales force?

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Are Health 2.0 and Financial Services 2.0 Organizationally Related?

Similar Business Models Emerging!

By David K. Luke, MIM

Investment Advisor

http://networthadvice.com

Defining Health 2.0

Health 2.0 is healthcare with the full involvement of the patient and the doctor. New web technologies, enabled by information, software, and social networking help increase participation and openness between the players. This will permit health care professionals to work in a more suitable “patient-centric” demand driven environment. Health 2.0 is evolving fast as the technology evolves.

Defining Financial Services 2.0

The same technology deployment changes and increased public involvement are prevalent with Financial Services 2.0, including a quickly morphing investor driven landscape creating a more “investor-centric” atmosphere.

Tribulations and Detractors on Both Sides

The move to 2.0 in healthcare and financial services is proving to be beneficial to all parties, but not without tribulations and some detractors.

In Healthcare

Within healthcare, from the patient’s perspective, the ability for patients to have ready access to their medical records, review doctor’s notes, and engage in the process is refreshing and liberating. Older doctors may be unwilling to adapt their practices, however. Many practices are not equipped as strategic business units, which is required now to deal with the patient and is becoming the new norm. Practices will need to evolve and healthcare providers will need to adapt.

For example, nearly 7 out of 10 physicians in a recent study by The MEDSTAT Group and JD Power and Associates considered themselves “anti-managed care” indicating unhappiness with the financial reimbursement system. Some physicians are packing their bags and moving out of practice, into more lucrative business ventures and other pursuits. One criticism of the new Health 2.0 is that it is one more paradigm, one more monkey on the backs of already exhausted physicians.

Another criticism is that some patients are not equipped with the knowledge or experience to interpret correctly all the newly available information, making it difficult for physicians to implement a proper course of action with the patient.

Nonetheless, early adopting physicians to Health 2.0 are having success and utilize e-mail office visits, video-conference appointments, and matching online patient visits with convenient neighborhood locations. The wise physician realizes that Health 2.0 is here to stay, and must be confronted and dealt with.

In Financial Services

Adoption of the new technologies within Financial Services 2.0 has been rapid. The number of Financial Advisors (FA) in the United States has started to shrink as the end investor is increasing access to information and making more decisions without intermediaries. Advisors that are surviving, indeed thriving in this environment are adapting and implementing new technologies. Interactive websites with video, account and investment option access, and reductions in transactions costs while increasing services all seem to benefit the new consumer in Financial Services 2.0. Advisors that are slow to adapt criticize the ease with which investors can now make investment decisions often at their own peril.

Assessment

Some players on both sides of the issue believe that the transaction cost savings touted by new “do it yourself” investing and medical information websites may not be worth the potential [many fold] losses that await the inexperienced investor or patient.

As with physicians and the new realities of Health 2.0, the wise FA is adapting their practice to Financial Services 2.0 not just to cope but also to thrive.

Editor’s Note: David K. Luke is currently enrolled in the online http://www.CertifiedMedicalPlanner.org chartered professional designation program.

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Physicians … Beware the Medical Management Consultants?

Desperate Doctors – Desperate Measures!

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

Are you a doctor desperate for practice enhancement solutions, but don’t know where to turn for help? Or, maybe you’ve already had a bad experience with a non-fiduciary business consultant, or management guru, more interested in his bottom line than your success?

www.CertifiedMedicalPlanner.com

Federal Government Report

Read this Federal Government report to learn what can happen when your advisor is not an informed Certified Medical Planner© designated medical management practitioner.

Link: http://oig.hhs.gov/fraud/docs/alertsandbulletins/consultants.pdf

Assessment

This caution was released in June 2001, a decade ago. It is as true today, as it was then … perhaps even more so.

Link: www.MedicalBusinessAdvisors.com

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

Healthcare Organizations: www.HealthcareFinancials.com

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On Employer Based Health Insurance Premium Costs

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One Client’s Comparative Expense Analysis Experience

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

Hospital Costs

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

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

The Survey

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

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

Case Report Model

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

My Client’s Story

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

My Numbers

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

Her Situation

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

Her Reaction

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

My Intervention

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

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

Where Did the Money Go?

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

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

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

The Road Ahead – More Expensive

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

Assessment

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

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

Conclusion

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

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

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