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  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    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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The “WOOZLE EFFECT” is Not a GOOZLE!

Evidence by Citation

By Dr. David E. Marcinko MBA

Courtesy: www.CertifiedMedicalPlanner.org

“A reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth.”Daniel Kahneman

As I was watching with interest more [fake] news such as stories surrounding evidence by citations of Russian involvement in US elections and fake prices leading to some violent market gyrations as in Bitcoin and the Corona Virus Pandemic, and societal musings around the thematic of hoaxes … we decided to offer this theme.

Enter the WOOZLE

And so, the Woozle effect, also known as evidence by citation, or a woozle, occurs when frequent citation of previous publications that lack evidence misleads individuals, groups and the public into thinking or believing there is evidence, and non-facts become urban myths and factoids.

Not a GOOZLE: https://www.daredictionary.com/view/dare/ID_00024696

H INDEX: https://medicalexecutivepost.com/2014/11/07/understanding-the-scientific-publication-h-index/

GOOGLE SCHOLAR INDEX: Google Scholar Search

LINK: https://en.wikipedia.org/wiki/Woozle_effect

PODCAST: https://www.bing.com/videos/search?q=WOOZLE+EFFECT&&view=detail&mid=D6C0C48EEE042D26E64ED6C0C48EEE042D26E64E&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3DWOOZLE%2BEFFECT%26FORM%3DHDRSC3

Assessment: Your thoughts are appreciated.

***

BUSINESS, FINANCE AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

***

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Should You Invite Dr. Marcinko to Speak at your Next Seminar or Event?

Invite Dr. Marcinko

The Choice is Up to You

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Colleagues know that I enjoy personal coaching and public speaking and give as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.

These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.

 Topics Link: imba-inc-firm-services

My Fond Farewell to Tuskegee University

And so, we appreciate your consideration.

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THANK YOU!

***

Five Ways to Protect Your Vehicle’s Exterior from Dings, Scrapes and Grime

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But, Don’t be Obsessive

By Dr. David Edward Marcinko MBA with Nalley Collision Center, GA.

DEM with JAGSome automobile owners, like me and other medical professionals, take pride in their cars. Regardless of whether you bought a new car from the showroom or bought your car used, you want to keep your vehicle looking like new for a long time.

Unfortunately, modern life is the enemy of a great-looking car. Tar and stones from roadways can wreak havoc on beautiful finishes. Other drivers can carelessly dent your car in hospital or mall parking lots, and refuse to accept responsibility for the damage. Debris flying out of trucks, birds, and other problems add to the long list of threats to your car.

The Steps

Rather than accepting dings, scrapes and grime on your car as a fact of life, follow these five steps to keep the exterior of your car looking fabulous.

1. Get Covered

Rain, snow, and sunshine can all adversely affect the exterior of your car. You can do little about the weather while driving your car, but when you get home, you can cover your car to protect its beautiful finish. Although garages offer the best protection against outside forces for your car, you might find out that you can get similar results by using a car port or a portable garage. A portable garage is a flexible cover that you can put over your vehicle to protect its exterior while not in use.

2. Paint Protection Film 

Special products exist that help protect the finish of your car at all times, even while you drive. Paint protection film creates a layer of protection between the exterior surfaces of your car and the environment, so your car can withstand an array of road hazards. This type of product eliminates expensive trips to your dealer’s body shop for touchup work and preserves the resale value of your car.

3. Wash Your Car

Although a carwash can put the exterior of your car in jeopardy, it can help prevent harmful grime build up. If you care a lot for your car, you will give it a loving hand-wash, detail and wax periodically to keep its finish looking great. While you wash, you can look for new scrapes and dents that either you or your dealer can quickly repair before they become ugly and embarrassing.

4. Cautious Parking

Parking lots pose some of the most severe threats to auto exteriors. It is my pet peeve. Regardless of how carefully you park, someone else will come along and park too close to your car, giving your car a free dent. Although often minor, parking-lot damage can cost a lot to repair. Motorists these days live with the fear that a claim will cause their insurance premiums to rise, so they might not take responsibility for denting or scraping your car.

It’s time to take parking into your own hands. You can try taking up two spots when you park, making it impossible for other car doors to reach your vehicle. Also, you can park far away from other cars where most people will never park. The long walk will give you valuable health benefits, and the remote parking spot can help prevent damage to your car.

5. Common Sense

Your best defense against scrapes, dents, and grime might reside under your own hat. Common sense should tell you to avoid roads while they undergo paving line-painting work. Avoid attempting to enter narrow alleys and resist the temptation to drive up to your mailbox when you get home at the end of the day. Never drive your car near trees and bushes. Always avoid dirt or gravel roads. Also, keep your garage and carport clear of tools and other objects that can easily fall and damage your car.

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Classic XJ-V8-WB Jaguar

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DE's Jaguar Touring Sedan

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Jaguar front seat

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My Jaguar's engine after a steam

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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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Understanding the Art of Selling Your Medical Practice

Part Two of Medical Practice Valuation

By Dr. David Edward Marcinko, MBA, CMP

By Prof. Hope Rachel Hetico, RN, MHA, CMP

www.CertifiedMedicalPlanner.org

In Part 1, we discussed how to establish fair market value (FMV) for a medical practice in the article, “Establish Your Practice’s Fair Market Value.” This time, we’ll review important terms and conditions for the sale transaction.

Valuation Types

Unfortunately, as a general rule, medical practice worth is presently deteriorating. A good medical practice is no longer a good business necessarily, and selling doctors can no longer automatically expect to extract a premium sale price. Nevertheless, appraising your medical practice on a periodic basis can play a key role in obtaining maximum value for it.

Competent practice valuation specialists typically charge a retainer to cover out-of-pocket expenses. Fees should not be based on a percentage of practice value, and may take 30-45 days to complete. Flat fees should be the norm because a sliding scale or percentage fee may be biased toward over-valuation in a declining marketplace. Fees range from $7,500-$50,000 for the small to large medical practice or clinic.

Expect to pay a retainer and sign a formal, professional engagement letter. Seek an unbiased and independent viewpoint. Buyer and sellers should each have their own independent appraisal done, using similar statistics, accounting measures, and economic assumptions.

At the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com we use three engagement levels that vary in intensity, purpose, and cost:

1. A comprehensive valuation provides an unambiguous value range. It is supported by most all procedures that valuators deem relevant, with mandatory onsite review. This gold standard is suitable for contentious situations. A written “opinion of value” is applicable for litigation support activities like depositions and trial. It is also useful for external reporting to bankers, investors, the public, Internal Revenue Service (IRS), etc.

2. A limited valuation lacks additional suggested Uniform Standards of Professional Appraisal Practice (USPAP) procedures. It is considered to be an “agreed upon engagement,” when the client is the only user. For example, it may be used when updating a buy/sell agreement, or when putting together a practice buy-in for a valued associate. This limited valuation would not be for external purposes, so no onsite visit is necessary and a formal opinion of value is not rendered.

3. An ad-hoc valuation is a low level engagement that provides a gross non-specific approximation of value based on limited parameters or concerns involved parties. Neither a written report nor an opinion of value is rendered. It is often used periodically as an internal organic growth/decline gauge.

Structure Sales Transactions

When the practice price has been determined and agreed on, the actual sales deal can be structured in a couple of ways:

(1) Stock Purchase v. Asset Purchase

In an asset transaction, the buyer will receive a tax amortization benefit associated with the intangible value of the business. This tax amortization represents a non-cash expense benefiting the buyer. In this case, the present value of those future tax benefits is added to the business enterprise value.

(2) Corporate Transactions

Typical private deals in the past involved some multiple (ratio) of earning before income taxes (EBIT)—usually a combination of cash, restricted stock, notes receivable, and possibly assumption of liabilities. For some physician hospital organizations, and public deals, the receipt of common stock can increase the practice price by as much as 40-50 percent (to accept the corresponding business risk, in lieu of cash).

Complete the Deal

The deal structure will vary depending on whether the likely buyer is a private practitioner, health system or a corporate partner. Some key issues to consider in the “art of the deal” include:

  • Working capital (in or out?): Including working capital in the transaction will increase the sale price.
  • Stock vs. asset transaction: Structuring the deal as an asset purchase will increase practice value due to the tax amortization benefits received by the buyer for intangible assets of the practice.
  • Common stock premium: The total sale price can be significantly higher than a cash equivalent price for accepting the risk and relative illiquidity of common stock as part of the payment.
  • Physician compensation: If your goal is to maximize practice value, take home a lower salary to increase practice sale price. The reverse is also true.

Understand Private Deal Structure

Assuming a practice sale is a private transaction, deal negotiations are based on the following pricing methodologies:

Seller financing: Many transactions involve an earn-out arrangement where the buyer puts money down and pays the balance under a formula based on future revenues, or gives the seller a promissory note under similar terms. Seller financing decreases a buyer’s risks (the longer the terms, the lower the risk). Longer terms demand premiums, while shorter terms demand discounts. Premiums that buyers pay for a typical seller-financed practice are usually more than what you would expect from a simple time value of money calculation, as a result of buyer risk reduction from paying over time, rather than up front with a bank loan or all cash. Remember to obtain a life insurance policy on the buyer.

Down payment: The greater the down payment for acquisition of a medical practice, the greater the risk is to the buyer. Consequently, sellers who will take less money up front can command a higher than average price for their practice, while sellers who want more down usually receive less in the end.

Taxation: Tax consequences can have a major impact on the price of a medical practice. For instance, a seller who obtains the majority of the sales price as capital gains can often afford to sell for a much lower price and still pocket as much or more than if the sales price were paid as ordinary income. Value attributed to the seller’s patient list, medical records, name brand, good will, and files qualifies for capital gains treatment. Value paid for the selling doctor’s continuing assistance after the sale and value attributed to a non-compete agreement are taxed at ordinary income. A buyer willing to allocate more for items with capital gains treatment, or a seller willing to take more in ordinary income, can frequently negotiate a better price. This is the essence of economically prudent practice transition planning.

Sidestep Common Buyer Blunders

Here are 10 blunders to avoid, as a buyer:

1. Believing the selling doctor’s attestations. Always verify data through an independent appraisal.

2. Wanting to change the culture of the practice. Be careful: Patients may not adjust quickly to change.

3. Using all available cash without keeping a reserve for potential contingencies.

4. Creating a conflict with the seller by recognizing a weakness and continually focusing on it for a bargain price.

5. Failing to realize that managed care plan contracts can be lost quickly or may not be always transferable.

6. Suffering from analysis paralysis. Money cannot be made by continually checking out a medical practice, only by actually running one.

7. Not appreciating the uniqueness of each practice, and using inaccurate “rules of thumb” from the golden age of medicine.

8. Not realizing that practice worth and goodwill value have plummeted lately and continue to decline in most parts of the country.

9. Not understanding that practice brokers may play both sides of the buy/sell equation for profit. Brokers usually are not obligated to disclose conflicts of interest, are not fiduciaries, and do not provide testimony as a court-approved expert witness.

10. Not hiring an appraisal professional who will testify in court, if need be, using the IRS-approved USPAP methods of valuation. Always assume that the appraisal will be contested (many times, it is).

After pricing and contracting due diligence has been performed, the next step in the medical practice sale process—as Donald Trump might say—is just good, old-fashioned negotiation.

Electronic Downloads

Part I: Part I

Part II: Part II

Additional Reading:

Cimasi, R.J., A.P. Sharamitaro, T.A. Zigrang, L.A.Haynes. Valuation of Hospitals in a Changing Reimbursement and Regulatory Environment. Edited by David E. Marcinko. Healthcare Organizations: Financial Management Strategies. Specialty Technical Publishers, 2008.

Marcinko, D.E. “Getting it Right: How much is a plastic surgery practice really worth?” Plastic Surgery Practice, August 2006.

Marcinko, D.E., H.R. Hetico. The Business of Medical Practice (3rd ed). Springer Publishing,New York,N.Y., 2011.

Marcinko, D.E. and H.R. Hetico. Risk Management and Insurance Planning for Physicians and Advisors. Jones and Bartlett Publishers, Sudbury, Mass., 2007.

Marcinko, D.E. and H.R. Hetico. Financial Planning for Physicians and Advisors. Jones and Bartlett Publishers, Sudbury, Mass., 2007.

Marcinko, D.E. and H.R. Hetico. Dictionary of Health Insurance and Managed Care. Springer Publishers, New York, N.Y., 2007.

Marcinko, D.E. and H.R. Hetico. Dictionary of Health Economics and Finance. Springer Publishers,New York,N.Y., 2007.

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Dr. Marcinko Appointed to “Medblob” Advisory Board

Professor Marcinko Appointed to Medblob Advisory Board

By Richard S. Tannenbaum; MS

[Co-Founder and Chief Financial Officer]

www.Medblob.com

At Medblob, we manage healthcare data for patients, providers, and research organizations. Our leadership team is from multi-disciplinary back grounds, including medicine, software and research. And, our advisors have broad experience and training in clinical medicine, insurance and healthcare information technology companies.

So, we are pleased to announce that Dr. David Edward Marcinko MBA CMP® has just been appointed to the Advisory Board of our company.

About Medblob™ 

The Challenge:

One of the biggest challenges for providers is having all of the patient’s medical information, at the point of care.

The Solution:

Medblob™ is an emerging and secure military encrypted and HIPAA compliant health information exchange and data warehouse, known as HealthFile™, that aims to have medical information available at the point-of-care so clinicians are able to make better decisions to improve their patients’ health.

The Outcome:

MedBlob™ solves a major cause of medical errors and preventable death: inaccurate or missing health information.

Assessment

Member of Medblob’s Advisory Board composed of medical, legal, and financial experts assisting the management team in the company’s mission of improving public health and outcomes for patients. Medblob Advisory Board was chartered to provide advice to the executive team regarding the company’s strategy, development, market positioning, and growth trajectory. LifeBook is Medblob’s military-grade secure patient electronic health record that acts as a single source of truth health record, medical data platform, and Network as a Service (NaaS).

Board of Advisors Link: http://www.medblob.com/board-of-advisors/

More: Please contact us to get involved in the future of healthcare information technology!

***

 DAVID EDWARD MARCINKO

Two Different Personal IRA Investing Strategies?

Based on Tax Considerations?

 

 

 

 

 

By Dr. David Edward Marcinko MBA

LINK: https://medicalexecutivepost.com/schedule-a-consultation/

One personal investing strategy is to place more conservative investments (those with lower expected returns) in a tax-deferred traditional IRA, 401-k, 403-b or similar, and more aggressive (higher-earning) assets in a taxable brokerage account or Roth IRA.

WHY? Each account is thus working hard but in very different ways.

HOW? The conservative funds in the traditional IRA or retirement accounts would fill any needs for safety as they grow more slowly – and the higher tax rate won’t take out as big of a bite.

Meanwhile, the more aggressive funds in a taxable brokerage accounts would grow more quickly, but be taxed at a lower rate.

Assessment: Any thoughts?

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MORE FOR 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

***

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

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

 

 

Off Road Christmas Touring with Dr. Marcinko

City Lights in Baltimore, Maryland

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

I stopped off in Baltimore, Maryland during the recent holidays to visit current clients, prospect for new ones, do a little public speaking and promote our book [Business of Medical Practice, third edition].

Link: www.BusinessofMedicalPractice.wordpress.com

Of course, we stopped by Johns Hopkins University where my sister worked, and promoted the Medical Executive-Post, as well.

Enter Christmas Street

And so, it was with great anticipation that we agreed with our host to visit Baltimore’s Christmas Street, in a section of the city known as Hampden. For 62 years, the residents of Baltimore’s 34th Street have drawn crowds from all over the world to view their display of Christmas lights.

Assessment

Crowd favorites are the motorized robot, the hubcap “Christmas tree”, and “snowmen” made from bicycle tires. The eaves of houses drip with strings of lights that illuminate Nativity scenes, while glowing candy canes light the sidewalks.

And, the hot chocolate and pizza, down the street at Angelo’s Restaurant, was especially delicious on any cold wintry night.

Video link: https://www.youtube.com/watch?v=hwk5N6qBx8Q

Channel Surfing

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

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

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

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

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

Sponsors Welcomed

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

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

***

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Popular Pre-Halloween Content for 2019

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Aggregating Content – Disseminating Knowledge

By Dr. David Edward Marcinko MBA [Editor-in-Chief]

Nathaniel Potter MD

Halloween (also spelled Hallowe’en) is an annual holiday celebrated on October 31st.  It has roots in the Celtic festival of Samhain and the Christian holy day of All Saints.

Today, it is largely a secular celebration but some have expressed strong feelings about perceived religious overtones.

Here are two interesting and popular ME-P articles for this Halloween season.

Poe: https://healthcarefinancials.wordpress.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

Potter: https://medicalexecutivepost.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

***

thumbnail_IMG_0487_edit2

“DANCE OF DEATH”

[Copyright 2018 iMBA Inc., All rights reserved. USA]

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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

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

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

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Understanding the Prisoner’s Dilemma in Health Economics

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DEM white shirt

By Dr. David Edward Marcinko MBA

Understanding the Prisoner’s Dilemma

[From Wikipedia, the free encyclopedia]

As all economists and psychologists know, the prisoner’s dilemma is a standard example of a game analyzed in game theory that shows why two completely “rational” individuals might not cooperate, even if it appears that it is in their best interests to do so. It was originally framed by Merrill Flood and Melvin Dresher working at RAND in 1950. Albert W. Tucker formalized the game with prison sentence rewards and named it, “prisoner’s dilemma” (Poundstone, 1992), presenting it as follows:

Two members of a criminal gang are arrested and imprisoned. Each prisoner is in solitary confinement with no means of communicating with the other. The prosecutors lack sufficient evidence to convict the pair on the principal charge. They hope to get both sentenced to a year in prison on a lesser charge.

Simultaneously, the prosecutors offer each prisoner a bargain. Each prisoner is given the opportunity either to: betray the other by testifying that the other committed the crime, or to cooperate with the other by remaining silent.

The offer is:

  • If A and B each betray the other, each of them serves 2 years in prison
  • If A betrays B but B remains silent, A will be set free and B will serve 3 years in prison (and vice versa)
  • If A and B both remain silent, both of them will only serve 1 year in prison (on the lesser charge)

It is implied that the prisoners will have no opportunity to reward or punish their partner other than the prison sentences they get, and that their decision will not affect their reputation in the future. Because betraying a partner offers a greater reward than cooperating with him, all purely rational self-interested prisoners would betray the other, and so the only possible outcome for two purely rational prisoners is for them to betray each other.

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thats-outrageous-prisoners-rights-to-free-medical-care-af

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The interesting part of this result is that pursuing individual reward logically leads both of the prisoners to betray, when they would get a better reward if they both kept silent.

In reality, humans display a systemic bias towards cooperative behavior in this and similar games, much more so than predicted by simple models of “rational” self-interested action. A model based on a different kind of rationality, where people forecast how the game would be played if they formed coalitions and then they maximize their forecasts, has been shown to make better predictions of the rate of cooperation in this and similar games given only the payoffs of the game.

An extended “iterated” version of the game also exists, where the classic game is played repeatedly between the same prisoners, and consequently, both prisoners continuously have an opportunity to penalize the other for previous decisions. If the number of times the game will be played is known to the players, then (by backward induction) two classically rational players will betray each other repeatedly, for the same reasons as the single shot variant. In an infinite or unknown length game there is no fixed optimum strategy, and Prisoner’s Dilemma tournaments have been held to compete and test algorithms.

In Health Economics

Advertising is sometimes cited as a real-example of the prisoner’s dilemma.

When cigarette advertising was legal in the United States, competing cigarette manufacturers had to decide how much money to spend on advertising. The effectiveness of Firm A’s advertising was partially determined by the advertising conducted by Firm B. Likewise, the profit derived from advertising for Firm B is affected by the advertising conducted by Firm A. If both Firm A and Firm B chose to advertise during a given period, then the advertising cancels out, receipts remain constant, and expenses increase due to the cost of advertising. Both firms would benefit from a reduction in advertising.

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cigarette+smoke

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However, should Firm B choose not to advertise, Firm A could benefit greatly by advertising. Nevertheless, the optimal amount of advertising by one firm depends on how much advertising the other undertakes. As the best strategy is dependent on what the other firm chooses there is no dominant strategy, which makes it slightly different from a prisoner’s dilemma. The outcome is similar, though, in that both firms would be better off were they to advertise less than in the equilibrium. Sometimes cooperative behaviors do emerge in business situations.

For instance, cigarette manufacturers endorsed the making of laws banning cigarette advertising, understanding that this would reduce costs and increase profits across the industry. This analysis is likely to be pertinent in many other business situations involving advertising

Without enforceable agreements, members of a cartel are also involved in a (multi-player) prisoners’ dilemma. ‘Cooperating’ typically means keeping prices at a pre-agreed minimum level. ‘Defecting’ means selling under this minimum level, instantly taking business (and profits) from other cartel members. Anti-trust authorities want potential cartel members to mutually defect, ensuring the lowest possible prices for consumers.

More Healthcare Examples:

Assessment

The prisoner’s dilemma game can be used as a model for many real world situations involving cooperative behaviour. In casual usage, the label “prisoner’s dilemma” may be applied to situations not strictly matching the formal criteria of the classic or iterative games: for instance, those in which two entities could gain important benefits from cooperating or suffer from the failure to do so, but find it merely difficult or expensive, not necessarily impossible, to coordinate their activities to achieve cooperation.

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

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Why 75 Years of American Finance Should Matter to Physician Investors

A Graphic Presentation [1861-1935] with Commentary from the Publisher

By Dr. David Edward Marcinko FACFAS MBA CPHQ CMP™

http://www.CertifiedMedicalPlanner.org

As our private iMBA Inc clients, ME-P subscribers, textbook and dictionary purchasers, seminar attendees and most ME-P readers know, Ken Arrow is my favorite economist. Why?

About Kenneth J. Arrow, PhD

Well, in 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked Academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, asset allocation, econometric, statistical and portfolio management principles that he studied have been transparent to most financial professionals and wealth management advisors for years; at least until now.

Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory era. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views. And, we envisioned the ME-P at that time to present these increasingly integrated topics to our audience.

Healthcare Economics Today

Today – as 2019 nears – savvy medical professionals, management consultants and financial advisors are realizing that the healthcare industrial complex is in flux; and this dynamic may be reflected in the overall economy.

Like many laymen seeking employment, for example, physicians are frantically searching for new ways to improve office revenues and grow personal assets, because of the economic dislocation that is Managed Care, Medi Care and Obama Care [ACA], the depressed business cycle, etc.

Moreover, the largest transfer of wealth in US history is – or was – taking place as our lay elders and mature doctors sell their practices or inherit parents’ estates. Increasingly, the artificial academic boundary between the traditional domestic economy, financial planning and contemporaneous medical practice management is blurring.

I’m Not a Cassandra

Yet, I am no gloom and doom Cassandra like I have been accused, of late. I am not cut from the same cloth as a Jason Zweig, Jeremy Grantham or Nouriel Roubini PhD, for example.

However, I do subscribe to the philosophy of Hope for the Best – Plan for the Worst.

And so dear colleagues, I ask you, “Are the latest swings in the economic, healthcare and financial headlines making you wonder when it will ever stop?”

The short answer is: “It will never stop” because what’s been happening isn’t any “new normal”; it’s just the old normal playing out before a new audience.

What audience?

The next-generation of investors, FAs, management consultants and the medical professionals of Health 2.0.

How do I know all this?

History tells me so! Just read this work, and opine otherwise, or reach a different conclusion.

Evidence from the American Financial Scene, circa 1861-1935

The work was created by L. Merle Hostetler in 1936, while he was at Cleveland College of Western Reserve University (now known as Case Western Reserve University). I learned of him while in B-School, back in the day.

At some point after it was printed, he added the years 1936-1938. Mr. Hostetler became a Financial Economist at the Federal Reserve Bank of Cleveland in 1943. In 1953 he was made Director of Research. He resigned from the Bank in 1962 to work for Union Commerce Bank in Cleveland. He died in 1990.

The volume appears to be self published and consists of a chart, approximately 85′ long, fan-folded into 40 pages with additional years attached to the last page. It also includes a “topical index” to the chart and some questions of technical interest which can be answered by the chart.

Link: http://fraser.stlouisfed.org/75years

Assessment

And so, as with Sir John Templeton’s [whose son is an MD] four most dangerous words in investing (It’s different this time), Hostetler effectively illustrates that it wasn’t so different in his era, and maybe—just maybe—it isn’t so different today for all these conjoined fields.

Conclusion      

Your thoughts and comments on this ME-P are appreciated. While not exactly a “sacred cow,” there is a current theory that investors will experience higher volatility and lower global returns for the foreseeable future.

In fact, it has gained widespread acceptance, from the above noted Cassandra’s and others, as problems in Europe persist and threats of a double-dip recession loom. But, how true is this notion; really?

Is Hostetler correct, or not; and why?

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:

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

HOSPITALS:

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

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

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Dr. Marcinko Interviewed on the Physician Credit Crunch

Financial Experts Share Tips on Obtaining Loans to Start or Expand a Medical Practice

By Michael Gibbons

Editor: ADVANCE Newsmagazines

Maybe you’re a young dermatologist or plastic surgeon who dreams of starting your own practice. Or maybe you’re an established professional but want to expand your palette of anti-aging services. Either way, you’ve probably made an unpleasant discovery: Banks are leery about lending today. Global recessions with seemingly no end in sight tend to give loan officers sticky fingers.HO-JFMS-CD-ROM

Dermatologists and Plastic Surgeons

We have it on good authority that dermatologists and plastic surgeons as a group are less affected by this problem than physicians in some other branches of medicine. Still, there’s no better time than now to absorb some sound advice on how to approach banks for loans—whether you’re a fresh-faced newcomer to the fresh-face business or a wrinkled veteran at eliminating wrinkles.

Start Small

There’s no soft-soaping it: Starting a healthy aging practice is much harder than expanding an existing practice, even in the flushest of times.

“For young dermatologists starting out, I recommend you start small,” advises Jerome Potozkin, MD, who offers facial rejuvenation, liposuction, body contouring and dermatological care through his practice in Walnut Creek, CA. “You can always expand. Keep your overhead low. Know what your credit score is and do everything you can to improve it. Pay your bills on time.”

Lasers aren’t cheap. Besides the initial acquisition costs, a service contract can cost $7,000 to $12,000 a year, according to Dr. Potozkin. “Don’t feel you have to buy every new laser under the sun,” he says. “In fact, renting rather than purchasing is an option many companies offer. When your volume is low you can rent and schedule laser days—although the pitfall there is you don’t have lasers available whenever patients come in.”

Also, young dermatologists “will probably have an easier time getting a loan if they go to a relatively underserved area, as opposed to an area that has a large number of dermatologists per capita,” says Dr. Potozkin, who began practicing 10 years ago. “There are two schools of thought on this: Go where you want to live to start a practice or go to where there’s a need and be instantly successful. I chose the former. It took me longer to get started but I’m very happy where I am.”

Patience, Prudence and Passiondem2

Be patient, prudent, passionate—and start with a spare office and as little debt as possible, advises Dr. David E. Marcinko MBA, a financial advisor and Certified Medical Planner™. Marcinko, a health economist,  is CEO of the Institute of Medical Business Advisors Inc., a national physician and medical practice consulting firm based in Norcross, GA www.MedicalBusinessAdvisors.com

“Patients are looking for passion from you, not lavish trappings,” Dr. Marcinko says. “When a banker or a loan officer sees $175,000 or more of debt they are loath to give a loan—and it’s hard to blame them. Purchase a home after you become a private practitioner. You need to be as close to debt-free as you can be.

Exit Strategy

“Another thing bankers want to know is, ‘If we give you a loan and you start a practice and it fails, how will we be paid back?’ They want an exit strategy.”

The good news is dermatology “remains a very lucrative specialty, and in most parts of the country they are in a shortage position, particularly with the aging population,” says Sandra McGraw, JD, MBA, principal and CEO of the Health Care Group, a financial and legal consulting firm based in Plymouth Meeting, PA., that advises the American Academy of Dermatology, among other groups.

“I would start with a realistic business plan for why you think this practice can succeed, in the specific location,” McGraw says. “How many patients do you expect to see? How will they know you are there and available? Remember that banks lend to all kinds of people, so keep your numbers realistic. Overestimating expenses is as bad as underestimating them. Then determine how you want the money—usually a fixed loan for a period of time and then a line of credit as you get your practice going and sometimes need the cash flow.”biz-book

Expanding a Practice

Established dermatologists should have an easier time getting loans to expand their practices. They have, one hopes, a track record of success and assets to put up as collateral.

Mid-career physicians “have cash flow, physician assets and equity to some degree in a house and personal assets,” Dr. Marcinko observes. “Banks can attach loans to personal assets and savings accounts. Ninety-nine percent of times you must sign a personal asset guarantee. Mid-lifers have assets young ones don’t, so mid-lifers aren’t quite the risk. They have businesses that have value and cash flow. Banks like cash flow.”

However, even veterans must do some homework before approaching a bank. “You still want to establish why you want the money and how the expansion will increase your income,” McGraw says.

Another tip: If the bank has loans out with reputable vendors, you might ask the loan officer to recommend them to you as potential contractors. “Sometimes keeping it local and supporting others with loans at the bank can be helpful,” she says.

Assessment

Dr. Marcinko adds, “Bankers today want you to come in with a well-reasoned, well-thought-out and well-written business plan. Give bankers a 30-second elevator speech on why you are different. It’s really important to ask yourself, ‘What can I offer the community as a doctor in my specialty that nobody else can?’ If you bill yourself as the first dermatologist to do laser surgery, that’s a perceived advantage. You purchased the equipment and learned to use it. But anyone can do that. If you can come up with something that nobody else has or can do, that’s how you’re successful in anything.”

Link: Dr. Marcinko Interview

Link: https://healthcarefinancials.files.wordpress.com/2009/08/dr-marcinko-interview.pdf

Conclusion

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

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

Sponsors Welcomed

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

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

2018 HSA Contribution Limits

Inflation Adjustments for the Tax Cuts and Jobs Act

By Dr. David Edward Marcinko MBA

http://www.CertifiedMedicalPlanner.org

On March 5, 2018, the IRS released Revenue Procedure 2018-18 (as part of Bulletin 2018-10). Due to changes made in the Tax Cuts and Jobs Act, certain adjustments needed to be made to inflation amounts.

The includes a reduction in the maximum family HSA contribution for those with family coverage under an HDHP from $6,900 to a new limit of $6,850 for calendar year 2018. The single contribution limit remains unchanged at $3,450 per year.

This reduction affects employees participating in an HSA Plan who have elected to contribute more than $6,850 for family coverage in 2018.

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

Leave FACEBOOK and Join the MEDICAL EXECUTIVE POST.com

AN “OPEN LETTER” FROM THE PUBLISHER-IN-CHIEF

Join Our Mailing List

Niche Specificity is the Key to Future Social Media Action

By Dr. David Edward Marcinko MBA [Publisher-in-Chief]

My solution to Facebook dilution.

It was a no good, very bad week for Facebook.

WHY: It came to light that up to 50 million users had their data improperly accessed by data firm Cambridge Analytica. Ever since, the company has been under incredible scrutiny as its’ stock price is in free fall. In fact, CEO Mark Z. lost about ten billion dollars; at least on paper…Ouch! But, he is still worth about 65 billion dollars, so don’t worry —  be happy for him!

The Critics

  • Did you know that Elon Musk is joining a growing group of people in the tech industry who have taken aim at social media companies and Facebook in particular?
  • Aaron Levie, CEO of cloud computing company Box, recently tweeted: “The days of arguing that (and acting like) tech companies are merely platforms and pipes are behind us.”
  • Marc Benioff, CEO of business software company Salesforce, recently started equating social media to smoking cigarettes.

And now, this Medical Executive-Post is jumping on the alternate social media site bandwagon. Leave Facebook now!

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Here’s How to manipulate Facebook instead of it Manipulating You

Social media platforms know a lot about us—but that doesn’t mean we can’t have our own ways of fighting back.

So, try these six tricks to take back control of your digital life. https://tinyurl.com/y888s8m5

Intellectual Riches … thru Niches

As Facebook became ever-more generalized, it also became less powerful, less informed, less important and therefore less credible; writ large. All opinions are not informed opinions

“When you try to be all things to every one – you became nothing to no one”

But smaller, niche alternatives like this Medical Executive-Post can provide new ways for us to interact with other smart, like-minded and informed people online.

Re-Enter the Medical Executive-Post of iMBA, Inc. 

imba inc

This Medical Executive-Post is sponsored by the Institute of Medical Business Advisors Inc., of Atlanta, Georgia; which was founded in 2006 as a leading national scope provider of healthcare administration education and medical practice management reports, books, dictionaries, journals, white-papers, fair-market valuations [FMV] and economic advisory opinions using multi-platform and traditional seminars and channels of knowledge distribution.

iMBA helps the nation’s medical, healthcare and education professionals make decisive improvements in their direction and performance by empowering them through unbiased information, consultants and proprietary tools, books, templates and B-school styled case models. 

We serve universities, medical, business, graduate and nursing schools; physicians, dentists and legal societies; accountants, financial service providers, wealth and hedge fund managers; emerging entities, hospitals, clinics, outpatient centers, CXOs and their BODs – the press, media and related organizations.

My Idea

Join Our Mailing List

For the solution to Facebook dilution, my idea is not new or radical; but it is simple. Join the Medical Executive Post. It is time.

To achieve a better and more niche focused professional social site, we need to be much more concentrated and serious about all vital topics in the healthcare industrial complex – which is an ecosystem projected to become 20% of domestic GDP; very soon.

Thus, this academic niche is not so small; but we are indeed highly educated, powerful and can become very influential and very actionable; more so than the general Facebook populace hoi polloi.

Remember, Pareto’s 80/20 Law and the trivial many versus vital few. Show us your vitality.

More Reasons to Join Us – Today!

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. 

Join Our Mailing List

Contact: MarcinkoAdvisors@msn.com

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Join Our Mailing List

 

Seeking University Faculty Appointment in 2018

Join Our Mailing List

Endowed Scholar-on-Sabbatical

dem

By David Edward Marcinko MBBS DPM MBA MEd CMP™ 

Any New Year typically brings to mind the passage of Father Time. And, it’s hard to believe I will be finishing up my current endowed R&D sabbatical after the Spring semester.

It means searching for a new faculty appointment to continue my passion for: [1] classroom teaching and junior faculty mentorship [2], university PR, outreach, promotion and grant-funding; and of course [3] more research, development, books and publications.

This competitive scholarship ethos is AKA the triad of success: “being a guide on the side – not a sage on the stage” AND “no margin – no mission” AND “publish or perish.

Employment and Subject Matter Expertise

Now, as a consummate team player, I’ve served as adjunct, to visiting, to full distinguished professor – and as department chair, to endowed chairman, online MOOC Dean and professor-of-the-practice.  Areas of specialization include: public and population health policy, management and administration; health economics, finance and insurance; and medical capitalism, innovation and free-enterprise at the graduate or doctoral levels.

And, as a former surgeon and clinician who also trained in Europe, and devotee of Nobel Laureate Ken Arrow PhD, I’m a global inter-disciplinarian within the health care industrial complex that may soon comprise 20% of domestic GDP.

Location – Location – Location

I’m pretty much private or public [mid-size] school agnostic, but prefer the Southeast, Northeast and Midwest in a livable city; with a 9-10 month faculty appointment.

But, I wouldn’t rule out a 12-month business school, or public health sciences type Dean position, as long as it is not totally administrative. A founding department chair, or inaugural deanship, would be near perfect; 24/7/365.

Crowd-Sourcing a Job?

So, I am crowd-sourcing this new job search as an emerging trend. Moreover, crowd-funding health insurance, and crowd-sourcing medical and diagnostic care is an emerging HIT trend. In fact, it’s the R&D equivalent of my current Health Dictionary Series™ WIKI project. It’s an experiment!

Regardless of the job search, check it out and tell me what you think!

http://www.HealthDictionarySeries.org

Assessment

Finally, please know that I am not looking for a mere job or to climb the ladder of academia. Rather, I am seeking a university home to continue my passionate career by paying it forward as servant-leader for the next generation of business and/or public health care executives.

More Info:

If you think I might be a good fit for your university, or would just like to brainstorm ideas; give me a holler: phone: 770-448-0769; or mail: MarcinkoAdvisors@msn.com; or arrange a virtual Skype interview to “chat”. Grab yourself a cup of coffee, because I am verbose.

Serious inquirers might also want to check me out, in far-too-much-detail, here!

http://www.DavidEdwardMarcinko.com

professor-dem

Thank you for the opportunity

Understanding the Physician-Entrepreneur’s Personality

13 Vital Questions for all Doctors to Consider

By Dr. David Edward Marcinko MBA, CMP™

[Editor-in-Chief]

www.BusinessofMedicalPractice.com

There is no way to eliminate all the risks associated with starting a medical practice, or launching any innovative concept in the health 2.0 ecosystem. However, entrepreneurial focused doctors can improve their chance of success with good planning and preparation. So, prior to starting your practice, merging, franchising or purchasing an existing one, ask yourself the following sobering questions. Hopefully, such reflection will enhance success, or at least prevent an unmitigated catastrophe. (www.sba.gov)

The Questions to Consider

1. Is medical practice ownership and physician entrepreneurship right for you?

It will be up to you, and your consultants; not someone else telling you to develop projects, organize your time or follow through on details. Your must be self motivated.

2. Do you like people and get along with different personality types?

Practice owners need to develop working relationships with a variety of people including patients, customers, vendors, staff, other physicians, and professionals like lawyers, accountants, consultants and bankers. Can you deal with a demanding patient, an unreliable vendor or cranky staff person in the best interest of your practice?

3. Can you make decisions and leave with ambiguity?

Practice owners are required to make independent decisions constantly; often quickly, under pressure and without all the facts. Ambiguity is a constant.

4. Do you have the physical and emotional stamina?

Practice ownership can be challenging, fun and exciting. But it’s also a lot of work. As a physician-owner, can you face twelve hour work days? As a doctor, can you offer advice, service, care and moral support 24/7?

5. How long can you live on your current savings?

Most small medical practice startups induce a declining bank balance in the early going. So, it’s wise to look at your expenses and determine how long you can live on your savings, and what personal costs you can temporarily eliminate. Emotionally, it’s easier to tighten expenses when you’re contemplating a new practice, than it is to cut back after you’ve started.  Financial consultants and accountants that perform consolidated financial statement preparation and analysis are vital in this regard. A two to five year margin of safety is not unusual and may be needed

6. How deeply in debt can you go?

Medical practice business debt can be good. It can fund expansion, improve profit ratios and cash flow. For physician entrepreneurs, business debt is often personal debt. Many start a practice by deferring payments for their own labor. Although lenders may make loans to a practice, the physician-owner will often be required to personally guarantee the loan. So, although the debt is on the business’s books, is ultimately the doctors’ debt should the practice fail.

7. What about health insurance?

If your current residency, fellowship or job offers health insurance, and is subject to the Consolidated Omnibus Budget Reconciliation Act (COBRA), you might be able to keep your coverage by paying the premiums, plus another 2% for administrative costs. You may keep your coverage under COBRA for up to 18 months and is a useful stopgap. For example, pay the premiums for six months or until another health insurance plan is obtained. Others suggestions are working spouse coverage with family benefits, or an HMO; or Medical or Health Savings Account (HSA/MSA).

8. Can you line up credit in advance?

Some new practice owners may set up a home equity line of credit that will let them borrow money at 1-2 percentage points over the prime rate or less. Lenders are more willing to make loans to someone who has a steady paycheck than to a new practice entrepreneur. If you have an excellent credit rating, you can probably get a home equity or other secured loan, but with more paperwork than in the recent past. Once you’re a self-employed practice owner, you’ll probably have to provide your most recent tax returns before getting approval. But, today, the biggest obstacle to a practice loan is a home mortgage. Domestic credit has been very tight since 2007, even for physicians.

9. What if you can’t manage the practice?

Disability insurance, unlike health insurance, usually cannot be transferred to an individual policy when you leave your job to start a new venture. So, get your own disability policy while you are still employed. Once you have the policy established and are paying the premiums, you should be able to keep the policy when you go out on your own. Remember, benefits received on a policy paid by you are free of federal income tax. Benefits on a policy paid for by a previous employer were taxable.

10. How well do you plan and organize?

Research indicates that many medical practice failures could have been avoided through better planning. Good organization of financials, inventory, schedules, information technology, medical services and human resources can help avoid many pitfalls.

11. Is your determination and drive strong enough to maintain your motivation?

Running a practice can wear you down. Some doctor-owners feel burned out by having to carry all the responsibility on their shoulders. Strong motivation can make the practice succeed and will help you survive slowdowns as well as periods of burnout.

12. How will the practice affect your family?

The first few years of practice startup can be hard on family life. The strain of an unsupportive spouse may be hard to balance against the demands of starting a medical business. There also may be financial difficulties until the business becomes profitable, which could take years. You may have to adjust to a lower standard of living or put family assets at risk.

13. How do you feel about the Patient Protection and Affordable Care Act of 2010?

Most provisions of the PPACA take effect over the next four to eight years, including expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage/claims based on pre-existing conditions, establishing health insurance exchanges, and support for medical research. The expense of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for high-income brackets, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies. There is also a tax penalty for citizens who do not obtain health insurance. Decreased physician reimbursement is a component, as well.

Assessment

More info: www.BusinessofMedicalPractice.com

Are you a medical innovator or healthcare entrepreneur? I am available for queries – thanks again for your interest.

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Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

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   Product Details 

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™

***

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WEBINAR on Medical Office Sexual Harassment Issues

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About MentorHealth

MentorHealth, the sponsor of this webinar, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

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Romantic Patient Advances

DEM white shirt

 ***
Presented By
Professor David Edward Marcinko 
March 13, 2017
***

Overview: Within the medical practice, clinic, hospital or university setting, faculty and supervisors exercise significant power and authority over others. Therefore, primary responsibility for maintaining high standards of conduct resides especially with those in faculty and supervisor positions. Members of the medical faculty and staff, including graduate assistants, are prohibited from having “Amorous Relationships” with students over whom they have “Supervisory Responsibilities.” “Supervisory Responsibilities” are defined as teaching, evaluating, tutoring, advocating, counseling and/or advising duties performed currently and directly, whether within or outside the office, clinic or hospital setting by a faculty, staff member or graduate assistant, with respect to a medical, nursing or healthcare professional student. Such responsibilities include the administration, provision or supervision of all academic, co-curricular or extra- curricular services and activities, opportunities, awards or benefits offered by or through the health entity or its personnel in their official capacity.

Employees are prohibited from having “Amorous Relationships” with employees whom they supervise, evaluate or in any other way directly affect the terms and conditions of the others’ employment, even in cases where there is, or appears to be, mutual consent.

Date : Monday, March 13, 2017 10:00 AM PST | 01:00 PM EST

Duration : 60 Minutes

Price : $139.00

Romantic Patient Advances

Areas Covered in the Session:

  • Consensual Amorous Relationships Defined
  • Handling Patient Advances
  • Signs of Flirtatious Behavior and Discouragement
  • Sexual Harassment Defined
  • Preferential Treatment
  • Un Reasonable Interference with Performance
  • Two-Pronged Test Approach
  • Offensive Behavior
  • Gender Based Animosity
  • Same Sex Harassment
  • Employer Liability
  • Disciplinary Actions
  • Tangible Employment Actions
  • Punitive Damages
  • Financial and Economic Costs

Who Will Benefit:

  • Physicians
  • Dentists
  • Podiatrists
  • Osteopaths
  • Pharmacists
  • Nurse Practitioners
  • Physician Assistants
  • All Clinical and Allied Healthcare Providers
  • Attorneys
  • Risk and Medical Compliance Managers
  • Health Insurance Agents

SIGN-UP HERE

Romantic Patient Advances

REGISTRATION

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WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans ). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

***

The Emerging Role of Chief Diversity Officer [CDO] 2.0

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dem-2

By Dr. David Edward Marcinko MBA MEd

http://www.CertifiedMedicalPlanner.org

My history

I came of age on the mean inner city streets of Baltimore, Maryland and developed a special interest in diversity, inclusion and urban renewal at a young age.

Today, I resonate with the identity of human capital educational leadership; small classes or teams; engaged students and stakeholders; parents and teachers; research and development; and a motivated staff inculcating life-long learning initiatives and critical thinking skills.

Career

Yet, I am not a career opportunist seeking incremental advancement through the halls of academia. Rather, I am a culturally sensitive and bi-racial physician-executive who senses there are deep, but often untapped, human resources embedded within many universities. If true; they are best released by an externally recruited champion of diversity and inclusion.

A Chief Diversity Officer [CDO]; if you will.

This includes a respect for values that celebrate the unique attributes, characteristics and perspectives that make each person who they are; ethnicity; gender; gender identity; language differences; nationality; parental status; physical, mental and developmental abilities; race; religion; sexual orientation; skin color; socio-economic status; work and behavioral styles; the perspectives of each individual DNA shaped by their nation, experiences and culture—and more.

Even when people appear the same on the outside, they are different.

Importantly, such inclusion includes a strategy to leverage diversity.

  • Diversity always exists in social systems.
  • Inclusion, on the other hand, must be created.

In order to leverage diversity, an environment must be created where people feel supported, listened to and able to do their personal best; for example:

The BAKKE DECISION

Historically, and for me, an important ruling on affirmative action by the Supreme Court in 1978 was the BAKKE Case. Allan Bakke, a white man, was denied admission to a medical school that had admitted black candidates with weaker academic credentials. Bakke contended that he was a victim of racial discrimination. The Court ruled Bakke had been illegally denied admission to the medical school, but also that medical schools were entitled to consider race as an admission factor.

***

92bd7cff-d571-4a20-9c4d-fd339ead550d

***

My story

As Department Chair and Residency Director at a local hospital, I was credited with accepting the first women residents and African Americans into our post-graduate education and surgical training program.

So, at this level of blended pedagogy, andragogy and heutagogy, my mission is to be a modern guide on the side; not bombastic sage on the stage. Moreover, this CDO 2.0 position holds special gravitas in order to set the tone for the future growth of inclusion and diversity thru example; in words and deeds.

Assessment

Frankly, I don’t see the CDO role as a mere “job”. It is a calling that requires a “hands-on” ambassador — helping to advise and lead in all related matters. As the sage once opined:

There is no limit to what you can accomplish if you don’t care who gets the credit!

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™8

***

WEBINAR on Medical Workplace Violence Issues

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About MentorHealth

MentorHealth, the sponsor of this webinar, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

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Medical Workplace Violence Issues

[Its Growing Recognition and Impact]

*** DEM white shirt

 ***
Presented By
Professor David Edward Marcinko 
 February 22, 2017
***
Overview: Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients, long waits for service, inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. A lack of staff training and the absence of violence prevention programming are also associated with the elevated risk of assault in hospitals. Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk.

Date : Wednesday, February 22, 2017 10:00 AM PST | 01:00 PM EST

Duration : 60 Minutes

Price : $139.00

Areas Covered in the Session:

  • Definition and Types of WPV
  • Contributing Factors and Risk Analysis
  • Effects and Outcomes
  • Financial and Economic Costs
  • Dealing with WPV
  • Prevention Plan Creation
  • The Haddon Matrix
  • Establishing WPV Prevention Guidelines

Who Will Benefit:

  • Physicians
  • Dentists
  • Podiatrists
  • Osteopaths
  • Pharmacists
  • Nurses
  • Nurses Aids
  • Nurse Practitioners
  • Physician Assistants
  • All Clinical Mental and Allied Healthcare Providers
  • Attorneys
  • Risk and Medical Compliance Managers
  • Health Insurance Agents

SIGN-UP HERE

Medical Workplace Violence Issues

REGISTRATION

***

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WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans ). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

***

WEBINAR on a Medical Malpractice Trial for Doctors

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About MentorHealth

MentorHealth, the sponsor of this webinar, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

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THE MEDICAL MALPRACTICE TRIAL FROM THE DOCTOR’s POV

[From First Service – to Final Verdict and Emotional Relief]

*** DEM white shirt

***
Presented By
Professor David Edward Marcinko 
February 6, 2017
***

“Even among the sciences, medicine occupies a special position. Its practitioners come into direct and intimate contact with people in their daily lives; they are present at the critical transitional moments of existence.

For many people, they are the only contact with a world that otherwise stands at a forbidding distance.  Often in pain, fearful of death, the sick have a special thirst for reassurance and vulnerability to belief.”

[Source: Paul Starr – The Social Transformation of American Medicine, Basic Books].

***

When this trust is violated, whether rooted in factual substance or merely a conclusion lacking in reality, American jurisprudence offers several remedies with the core being civil litigation.

For example, we have personally witnessed a spectrum of reasons that prompts a patient to seek the counsel of an attorney. Whether it be an untoward result of treatment or surgery, an outstanding invoice being mailed to a less than happy patient who decides that the doctor did not measure up to expectations, a physician’s wife employed as the office manager charging a patient $50 to complete a medical leave authorization form, or simply a perceived lack of concern on the part of the doctor or personnel, patients can be motivated to seek redress outside the realm of the doctor’s office.

Compound any of the above scenarios with well-meaning friends and family and the proverbial prescription for litigation has been certified. Woven throughout this discourse will be suggestions that might obviate the foregoing. While it is not a panacea, nor a cure-all for medical negligence cases, we believe it to be an effective methodology for resolving those differences that see the growth of a medical malpractice lawsuit …. honest communications.

Date : Monday, February 6, 2017 10:00 AM PST | 01:00 PM EST

Duration : 60 Minutes

Price : $139.00

MORE: Malpractice Trial

Webinar Covered Topics [60-75 minutes]

  • Understanding What’s at Stake in Litigation · What every Doctor must Know
  • Steps to Take after Summon and Service Receipt · Trail Players. Burden of Proof · Types of Trials · The Discovery Process · Depositions · Motions In-Limine
  • Jury Selection · Opening Statements · Presentation of Evidence ·  Summation and Final Instructions · Jury Deliberations · The Verdict and … Relief!

Who Should Attend

Physicians, Dentists, Podiatrists, Osteopaths, Pharmacists, Nurse Practitioners, Physician Assistants, and all Clinical and Allied Healthcare Providers. Attorneys, Risk and Medical Compliance Managers, and Health Insurance Agents; etc.

Malpractice Insurance Companies, Law firms, Risk Management Consultants, Hospitals, Medical Practices, Offices and Clinics, Out Patient Treatment and representative from Ambulatory Surgical facilities; etc.

Financial advisors [FAs], Certified Financial Planners® [CFPs], Certified Medical Planners™ [CMP™], Chartered Life Underwriters [CLUs], bankers, health attorneys, and all other risk managers, insurance agents, actuaries and financial intermediaries and consultants of all stripes, degrees and general designations.

Fraternal financial services organizations like the American College of Financial Services in Bryn Mawr, PA; Certified Financial Planner Board of Standards [CFP-BOD] in Washington, DC; the College for Financial Planning [CFP] in Centennial, CO; the Financial Planning Association [FPS] and the National Association of Personal Financial Advisors as well as all US state insurance commissioner offices, etc.

***

Sign-Up Here

A Medical Malpractice Trial From The Doctor’s Pov

REGISTRATION

***

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

***

WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans ). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

***

MARCINKO’s Upcoming WEBINARS from MentorHealth

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Sponsored Advertisement

MentorHealth

MentorHealth, the sponsor of these ME-P webinars, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

So, it is no wonder why they partnered up with the ME-P to produce these three exciting and timely Webinars, delivered by our own Publisher-in-Chief and Distinguished Professor David Edward Marcinko.

***

A Medical Malpractice Trial From The Doctor’s POV

Even among the sciences, medicine occupies a special position. Its practitioners come into direct and intimate contact with people in their daily lives they are present at the critical transitional moments of existence.

For many people, they are the only contact with a world that otherwise stands at a forbidding distance. Often in pain, fearful of death, the sick have a special thirst for reassurance and vulnerability to belief. When this trust is violated, whether rooted in factual substance or merely a conclusion lacking in reality, American jurisprudence offers several remedies with the core being civil litigation.

We have personally witnessed a spectrum of reasons that prompts a patient to seek the counsel of an attorney.

Monday, February 6, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Medical Workplace Violence Issues

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control.

Transporting patients,long waits for service,inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. A lack of staff training and the absence of violence prevention programming are also associated with the elevated risk of assault in hospitals.

Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk.

 Wednesday, February 22, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Romantic Patient Advances

Within the medical practice, clinic, hospital or university setting, faculty and supervisors exercise significant power and authority over others. Therefore, primary responsibility for maintaining high standards of conduct resides especially with those in faculty and supervisor positions. Members of the medical faculty and staff, including graduate assistants, are prohibited from having “Amorous Relationships”with students over whom they have “Supervisory Responsibilities.”

“Supervisory Responsibilities”are defined as teaching, evaluating, tutoring, advocating, counseling and/or advising duties performed currently and directly, whether within or outside the office, clinic or hospital setting by a faculty, staff member or graduate assistant, with respect to a medical, nursing or healthcare professional student.

Such responsibilities include the administration, provision or supervision of all academic, co-curricular or extra- curricular services and activities, opportunities, awards or benefits offered by or through the health entity or its personnel in their official capacity.

Monday, March 13, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

rm-photo

***

WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

***

MARCINKO’s Upcoming WEBINARS from MentorHealth

Join Our Mailing List

Sponsored Advertisement

MentorHealth

MentorHealth, the sponsor of these ME-P webinars, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

So, it is no wonder why they partnered up with the ME-P to produce these three exciting and timely Webinars, delivered by our own Publisher-in-Chief and Distinguished Professor David Edward Marcinko.

***

A Medical Malpractice Trial From The Doctor’s POV

Even among the sciences, medicine occupies a special position. Its practitioners come into direct and intimate contact with people in their daily lives they are present at the critical transitional moments of existence.

For many people, they are the only contact with a world that otherwise stands at a forbidding distance. Often in pain, fearful of death, the sick have a special thirst for reassurance and vulnerability to belief.

When this trust is violated, whether rooted in factual substance or merely a conclusion lacking in reality, American jurisprudence offers several remedies with the core being civil litigation. We have personally witnessed a spectrum of reasons that prompts a patient to seek the counsel of an attorney.

Monday, February 6, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Medical Workplace Violence Issues

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients,long waits for service,inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well.

A lack of staff training and the absence of violence prevention programming are also associated with the elevated risk of assault in hospitals.

Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk.

Wednesday, February 22, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Romantic Patient Advances

Within the medical practice, clinic, hospital or university setting, faculty and supervisors exercise significant power and authority over others. Therefore, primary responsibility for maintaining high standards of conduct resides especially with those in faculty and supervisor positions.

Members of the medical faculty and staff, including graduate assistants, are prohibited from having “Amorous Relationships”with students over whom they have “Supervisory Responsibilities.” “Supervisory Responsibilities”are defined as teaching, evaluating, tutoring, advocating, counseling and/or advising duties performed currently and directly, whether within or outside the office, clinic or hospital setting by a faculty, staff member or graduate assistant, with respect to a medical, nursing or healthcare professional student.

Such responsibilities include the administration, provision or supervision of all academic, co-curricular or extra- curricular services and activities, opportunities, awards or benefits offered by or through the health entity or its personnel in their official capacity.

Monday, March 13, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

***

MORE:

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WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans ). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

***

Vital Financial Texts for Doctors

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PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET

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

***

On Personal Financial Planning Ratios

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Rocking Financial Planning … Old School Advice!

DEM tieBy Dr. David E. Marcinko MBBS MBA CMP®

The economic platitude of the past, such as don’t spend more than 15-20 percent of your net salary on food, or 5-10 percent on medical care, among others, have given rise to the more individualized personal financial ratio concept. Personal ratios, like business ratios, represent benchmarks to compare such parameters as debt, income growth and net worth.

According to Edward McCarthy MIB CFP® – a personal financial expert from Warwick, Rhode Island whom I interviewed about a decade ago – the following represented useful ratios for the lay as well as medical professional [personal communication].

The Ratios: 

  • Basic Liquidity Ratio = liquid assets / average monthly expenses. Should be 4-6 months, or even longer, in the case of a medical professional employed by a financially insecure HMO. In a low interest rate environment, iMBA Inc offers 12-24 months for consideration.
  • Debt to Assets Ratio = total debt / total assets. A percentage which is high initially, and should decrease with age as the medical professional approaches a debt free existence
  • Debt to Gross Income Ratio = annual debt repayments / annual gross income. A percentage representing the adequacy of current income for existing debt repayments. Medial professionals should try to keep this below 25-30%.
  • Debt Service Ratio = annual debt re-payment / annual take-home pay. Medical professionals should try to keep this ratio below about 40%, or have difficulty paying down debt.
  • Investment Assets to Net Worth-Ratio = investment assets / net worth. This ratio should increase over time, as retirement for the medical professional approaches.
  • Savings to Income Ratio = savings / annual income. This ratio should also increase over time, especially as major obligations are retired.
  • Real Growth Ratio = (income this year – income last year) / (income last year – inflation rate). It is desirable for the medical professional to keep this ratio growing faster than the core rate f inflation.
  • Growth of Net-Worth Ratio = (net worth this year – net worth last year) / net worth last year – inflation rate. Again, this ratio should stay ahead of inflation.By calculating these ratios, perhaps on an annual basis, the medical professional can spot problems, correct them, and continue progressing toward stated financial goals.

Assessment

Now, after ten years, are these traditional ratios and advice still valid today: why or why not?

***

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***

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™

***

TEAM BASED MEDICAL CARE RISKS

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More on Why I Still Don’t Like It

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[By David Edward Marcinko MBBS MBA CMP™]

Redundancy occurs when more than one person (or committee) has the responsibility to make a decision or assume a task. Redundancy in a team based care model becomes a problem when it allows tasks to be overlooked or decisions to be avoided. This happens when a person or committee assumes that someone else with responsibility for the same task will make the necessary decisions. This can be due to a misunderstanding, or it can be due to an intentional dodging of the task or decision.

***

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***

Redundancy is best avoided by having only one person, lead physician or committee responsible for each task or decision. Since this is almost impossible in a hospital or large organization, there must be an unambiguous protocol for allocating tasks and decisions among the responsible personnel. The protocol must also establish a system for handling problems that the assigned personnel cannot solve.

Assessment

It is important that such problems be brought to the attention of a supervisor for reassignment to new personnel. Reassignment should not be done by first level personnel; reassignment at that level will make it impossible to prevent the dodging of unpleasant tasks.

More: Why I Rue the Hospital “Team-Based Medicine” Approach to In-Patient Care

Conclusion

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

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:

 Our New Textbook – “Take a Sneek Peek InsideNow Available!

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors

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

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™
Foreword by: J. WESLEY BOYD MD PhD MA

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

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ME-P Health Economics, Financial Planning & Investing, Medical Practice, Risk Management and Insurance Textbooksfor Doctors and Advisors

ME-P At Your Service!

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[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™

[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

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http://www.BusinessofMedicalPractice.com

***

Dr. David Edward Marcinko, editor-in-chief, is a next-generation apostle of Nobel Laureate Kenneth Joseph Arrow, PhD, as a health-care economist, insurance advisor, financial advisor, risk manager, and board-certified surgeon from Temple University in Philadelphia. In the past, he edited eight practice-management books, three medical textbooks and manuals in four languages, five financial planning yearbooks, dozens of interactive CD-ROMs, and three comprehensive health-care administration dictionaries. Internationally recognized for his clinical work, he is a distinguished visiting professor of surgery and a recipient of an honorary Bachelor of Medicine–Bachelor of Surgery (MBBS) degree from Marien Hospital in Aachen, Germany. He provides litigation support and expert witness testimony in state and federal court, with medical publications archived in the Library of Congress and the Library of Medicine at the National Institutes of Health.

***

Medical School Ethics versus Business School Ethics

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Is Business Finally Embracing Medical Values?

[By Render S. Davis MHA CHE]

[By David Edward Marcinko MBA]

dr-david-marcinko

In the evolutionary shifts in models for medical care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.

While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other business parties to the health care delivery system to raise their ethical bar.

Tit-for-Tat

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.”

***

face-off

[Medicine versus Business]

***

Assessment

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.

Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

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The True Cost of Car Ownership

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HINT … It’s More Than You Think!

[By insurancequotes.org]

[By Dr. David Edward Marcinko MBA]

Dr David E Marcinko MBA

Anyone looking to buy a car should be well aware that the cost of a car doesn’t end at the purchase price.

You must consider additional concerns such as: depreciation, fuel costs, insurance, maintenance and repair, and sales tax.

This is especially important for doctors and new medical practitioners who may have many other financial responsibilities.

***

Dave's Jaguar Sedan

Jaguar Sedan

Classic Jaguar

***

True Costs

To help potential buyers with their purchases, we’ve put together an infographic that outlines the real cost of ownership for various types of cars. So, buyers beware!

***

Cost-Car-Ownership-800-550x2206

***

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Conclusion

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

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(TM) 

On Medical Provider Network Referral Leakage

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Understanding the Referral Relationship

[By Dr. David Edward Marcinko MBA]

[By http://www.MCOL.com]

DEM blueDeveloping and cultivating a steady stream of referrals involves good planning, an investment of time and energy in the referral relationship, and a keen understanding of referring physicians’ needs and priorities.

Enhancing the referral relationship is a step-by-step process, not unlike the clinical process, that begins by identifying target physicians and their needs, prioritizing the list of referral contacts and then determining the best way to reach them.

A physician may routinely refer patients to a particular specialist because he or she has an out­standing reputation for medical expertise and competence, is more accessible than comparable practitioners or has a convenient location for the referring physician’s patients. The physician may have a relationship with the specialist because of marketing by a local hospital or the specialist’s own practice. And, in some cases the two physicians have a social relationship. Once again, there are many ways to create and maintain the relationship. Physicians should choose the approach that works best for them, put together a plan and stay consistent. Look for ways to make the relationship a win-win for both practices or for the referring hospital or outpatient facility.

If you are not comfortable with developing referral relationships for your practice, seek out partners, office staff or hospital partners who can appropriately assist, train or support you in this effort. Many hospitals have staff focused on physician sales and service.

The Society for Healthcare Strategy and Market Development (SHSMD) recently reported that 41% of hospitals had dedicated sales staff support, with more than half of those using their sales staff to support cardiology and radiology.[i] Often, hospitals are seeking physician speakers for community seminars, wellness programs and other outreach efforts. Ask about participating in these venues. Offer to write articles for newsletters, the Web site or local media outlets. All of these expose the physician and the practice to referral sources as well as the public.

Six Root Causes of Leakage

***

ImageProxy

***

Communication is Key

It really comes down to the age-old golden rule of doing unto others as you would want them to do unto you. Not surprisingly, referral relationships are built on mutual respect, trust and courtesy. Focusing on the needs of the referring physician is the best way for both relationships to thrive.

Communication is especially important in not only nurturing the referral relationship, but also improving the quality of care.

A recent study that examines the attitudes primary care physicians have regarding communication with hospitalists found that 3% of primary care physicians reported being involved in discussions about discharge and 17% to 20% reported always being notified about discharges.[ii]

The study suggests that delayed or inaccurate communication at discharge may negatively effect continuity of care and contribute to adverse events. Communication tools such as computer-generated summaries and standardized formats may result in a more timely transfer of information, making discharge summaries more consistently available during follow-up care.

Many physicians indicate a preference for quick voice mail updates on patients they’ve referred supported by the electronic or faxed record. This type of proactive communication is the basis of a strong and lasting referral relationship. In fact, the relationship can be further strengthened by tailoring communication to individual primary care doctors, according to their preferences.

Indeed, the most responsive specialists ask the referring physician how best to stay in touch because one size does not fit all. Some physicians prefer face-to-face contact, others phone or facsimile and still others e-mail.  The use of electronic medical records and other electronic communication devices can help the physician enhance the consistency, speed and real time level of their physician-to-physician communication.

Primary care doctors want to work with specialists who recognize their role in treating the patient on an ongoing basis. Many want frequent communication about the plan of care and status. At the very least, tertiary specialists should always pay the courtesy of discharge communication—a phone call, e-mail, timely letter or fax when they return the patient to the community physician. The specialist should include the diagnosis, any issues that he or she may have identified; any changes in treatment and medication, follow-up recommendations and a phone or pager number if the referring physician has questions or concerns.

Both sides should keep each other informed of changes within their respective practice including new partnerships, expanded services, staff changes and insurance plan participation. Paying close attention to these relationship and communication basics builds trust and respect among colleagues and improves care to patients.

***

Healthcare Center

***

Systems Can Help With Communication

A cardiac surgeon in the Northeast with a very busy practice dictates immediately following each case, and then at the end of the day calls to update the referring physician even if he just leaves a voice mail with his pager number. The referring physician has 24/7 access to the cardiac surgeon, who, two weeks later, has his practice administrator send a thank-you note for the referral. At a conference of specialists who were questioning their own ability to commit to this level of time, he simply stated “how can you not afford to pay attention to this part of your practice?”

Another example involves a large specialty practice that was challenged with communication back to the referring physician. They hired a clinician to support them as patient/practice case manager, with a primary job focus on communicating about the patient, ensuring discharge information was forwarded and conducting a personal office call with the referring physician. This ensured it was received, understood and if not, helping the referring physician to gain quick access to the specialist.

Citations:

[i] “By the Numbers, 2008.”  Society for Healthcare Strategy and Market Development of the American Hospital Association.

[ii] Sunil Kripalani, M.D., et al., “Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians,” The Journal of the American Medical Association, Feb. 28 2007, 297; 831-841.

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Conclusion

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Seeking Authors by “Crowd-Sourcing” our Proposed Medical Marketing TextBook

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MEDICAL PRACTICE MARKETING MANAGEMENT, ADVERTISING, SALES, COMMUNICATION AND SOCIAL MEDIA SKILLS

[New-Wave Success Strategies for Savvy Doctors]

***

[By Dr. David Edward Marcinko MBA CMP]

[By Prof Hope Rachel Hetico RN MHA CMP]

dave-and-hope10

Dear ME-P Readers and Subscribers,

No – We’ve not been in blog-silence mode lately.

Instead, we’ve been hard at work on our soon-to-be-released and major new 800 page print text book:

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

A Recent Project

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

***

And now, we are just working on our newest book proposal: MEDICAL PRACTICE MARKETING MANAGEMENT, ADVERTISING, SALES, COMMUNICATION AND SOCIAL MEDIA SKILLS – [New-Wave Success Strategies for Savvy Doctors]. © IMBA, Inc. All rights reserved.

Format and Style

This is the most journalistic styled book we’ve ever attempted. We’ve already completed about 10 chapters that need updating. 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 and subscribers.

Crowd-Sourcing the Book

Therefore, for the next few 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 marketing ideas.

We are Hoping you Can Help Us

If you have deep knowledge, experience or education in medical marketing; or an amazing story about how new sales, PR or modern channels of advertising distribution [electronic age] are transforming and changing your medical practice, clinic or hospital for the better; 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. To give you a sense of the range of topics we’ll be covering, as well as the book’s tone, we’ve pasted below a tentative draft of the Table of Contents. If all goes well, the print hardcover textbook it will be published in about a year.

Table of Contents: © IMBA, Inc. All rights reserved.

TOC(1)

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

Author SPECS(1)

Recent ME-P Works: © IMBA, Inc. All rights reserved.

ME-P Text Books

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

More on the ME-P Publishing Service

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:

Ann Miller RN MHA [Project Manager]

Institute of Medical Business Advisors, Inc.

MarcinkoAdvisors@msn.com

Conclusion

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

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(TM)

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

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

On Physicians and Automobile Leases

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Advantages, Disadvantages and Types

[By Dr. David Edward Marcinko MBA CMP™]

Dr. Marcinko 1972 VetteThe Rites of Spring!

As a former licensed state insurance agent, and financial advisor, I know that leasing a car may have advantages to a physician – and others – such as convenient maintenance, low down and monthly payments, no resale responsibility, and tax savings since you pay sales tax on the lease portion rather than the purchase price of the car.

It might also be worthwhile if the after tax borrowing cost of a home equity loan is less than the lease financing rate.

***

Spring 2011 - NIH

[First Days of Spring 2017]

May Day Weekend 2011 [Dr. David E. Marcinko MBA]

***

Types of Leases

There are two major types of leases: open and closed ended. In the former type, if the car is worth more than the set price upon expiration of the lease, you are responsible for the underage or coverage. In the more advantages later type, the responsibility of the value of the car is shifted to the leasing company. Other tips on care leasing include:

  • Inform the lessor how you want the auto equipped; do not accept unwanted options.
  • Obtain all delivery, and other, charges in advance, including down payment, security.
  • Deposit, registration fees, interest rates, residual value, rebates and all taxes (sales, personal property, use and gross receipt).
  • Know the capitalized cost (selling price) of the car
  • Know annual mileage limits, usually 15-18,000 miles, and all excess use charges.
  • Avoid maintenance and service contracts, and arrange for your own insurance.
  • Understand that terms, such as money factor, or interest factor, may be used instead of the term interest rate. In this case, simply multiple the rate by 24 for an estimate of the true interest rate involved.
  • Read the contract and understand all penalties, especially for premature or late termination, purchase or return terms, and consequences of theft.
  • Check the lease terms through an independent company, such as First National Lease Systems.

Rough Rules of Thumb

A rough rule of thumb to determine whether to buy or lease involves multiplying all the payments required by the number of months you will have to pay, and add the down payment to yield the total amount of the purchase. Then, multiply the lease payment by the number of months, and add required up-front costs, as well as residual value (end of lease buyout cost), to determine the total amount to lease. Compare the two figures to determine the most economical deal.

Typically, a cash deal is less expensive in the long run, providing a higher after tax rate of return is not available, as an alternate investment, for the funds.

***

Jaguar Touring sedan XJ-V8-LWB***

Dis-Advantages

But, there are dis-advantages to auto leasing, too!

Perhaps the worse reason to lease a car is to drive one that you could not otherwise afford to drive. This is because most low monthly payments are only composed of two portions: interest on the note and the prorated cost of auto depreciation. No money is applied to ownership of the vehicle.

Assessment

Finally, beware Spring-Fever and do not likely buy “gap” insurance to cover the difference between what your auto insurer would pay if your car was totaled, and what you would owe the leasing firm. It’s usually too expensive and the risk is minimal.

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Conclusion

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

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(TM)

***

A Brief Historical Review of Behavioral Finance and Economics

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And Related Influential Thought-Leaders

  • Dr. Brad Klontz CSAC CFP®
  • Dr. Ted Klontz PsyD
  • Dr. Eugene Schmuckler MBA MEd CTS
  • Dr. Kenneth Shubin-Stein FACP CFA
  • Dr. David Edward Marcinko MEd MBA CMP™

***

doctor

***

James O. Prochaska PhD, Professor of Psychology and Director of the Cancer Prevention Research Center at the University of Rhode Island, developed the Trans-Theoretic Model of Behavior Change [TTM] which has been evolving since in 1977. Nominated as one of the five most influential authors in Psychology, by the Institute for Scientific Information and the American Psychological Society, Dr. Prochaska is author of more than 300 papers on behavior change for health promotion and disease prevention.

TTM Stages of Change

In his Trans-Theoretical Model, behavior change is a “process involving progress through a series of these stages:

  • Pre-Contemplation (Not Ready) – “People are not intending to take action in the foreseeable future, and can be unaware that their behavior is problematic”
  • Contemplation (Getting Ready) – “People are beginning to recognize that their behavior is problematic, and start to look at the pros and cons of their continued actions”
  • Preparation (Ready) – “People are intending to take action in the immediate future, and may begin taking small steps toward behavior change”
  • Action – “People have made specific overt modifications in changing their problem behavior or in acquiring new healthy behaviors”
  • Maintenance – “People have been able to sustain action for a while and are working to prevent relapse”
  • Termination – “Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”

Relapse

In addition, researchers conceptualized “relapse” (recycling) which is not a stage in itself but rather the “return from Action or Maintenance to an earlier stage.” In medical care, these stages of behavior change have applicability to anti-hypertension and lipid lowering medication use, as well as depression prevention, weight control and smoking cessation.

***

Psychology

***

Uniting Psychology and Financial Behavior

More recently, validating the emerging alliance between psychology (human behavior) and finance (economics) are two Americans who won the Royal Swedish Academy of Science’s 2002 Nobel Memorial Prize in Economic Science. Their research was nothing short of an explanation for the idiosyncrasies incumbent in human financial decision-making outcomes.

Enter Kahneman and Smith

Daniel Kahneman, PhD, professor of psychology at Princeton University, and Vernon L. Smith, PhD, professor of economics at George Mason University in Fairfax, Va., shared the prize for work that provided insight on everything from stock market bubbles, to regulating utilities, and countless other economic activities. In several cases, the winners tried to explain apparent financial paradoxes.

For example, Professor Kahneman made the economically puzzling discovery that most of his subjects would make a 20-minute trip to buy a calculator for $10 instead of $15, but would not make the same trip to buy a jacket for $120 instead of $125, saving the same $5.

in vitro and in-vivo Economics

Initially, in the 1960’s, Smith set out to demonstrate how economic theory worked in the laboratory (in vitro), while Kahneman was more interested in the ways economic theory mis-predicted people in real-life (in-vivo). He tested the limits of standard economic choice theory in predicting the actions of real people, and his work formalized laboratory techniques for studying economic decision making, with a focus on trading and bargaining.

Later, Smith and Kahneman together were among the first economists to make experimental data a cornerstone of academic output. Their studies included people playing games of cooperation and trust, and simulating different types of markets in a laboratory setting. Their theories assumed that individuals make decisions systematically, based on preferences and available information, in a way that changes little over time, or in different contexts.

University of Chicago

By the late 1970’s, Richard H. Thaler, PhD, an economist at the University of Chicago also began to perform behavioral experiments further suggesting irrational wrinkles in standard financial theory and behavior, enhancing the still embryonic but increasingly popular theories of Kahneman and Smith.

Laboratory

Other economists’ laboratory experiments used ideas about competitive interactions pioneered by game theorists like John Forbes Nash Jr., PhD, who shared the Nobel in 1994, as points of reference.

Assessment

But, Kahneman and Smith often concentrated on cases where people’s actions departed from the systematic, rational strategies that Nash envisioned. Psychologically, this was all a precursor to the informal concept of life or holistic financial planning. Kahneman was awarded the Medal of Freedom, by President Barack Obama, on November 20, 2013.

READ: Behavioral Economics and Psychology DEM

e513455b-e924-451f-9132-d4bbbeb8e033-original

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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(TM)

***

Invite Dr. Marcinko

***

Reviewing Physician Disability Insurance Policies

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Including Policy Checklist

By Dr. David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org

Dr. DEM

The Basic Premise 101

Could you continue to support your family and pay your bills if you were unable to work for any length of time because of illness or injury? If you were to become disabled, do you know how much money would be coming in each month and from what sources?

The Checklist

As a doctor I covered the ER, and was an insurance agent, for almost a decade. But, I reformed and am now a Certified Medical Planner™ and B-school professor. And, I know that every disability insurance policy has different features.

The following checklist will help you compare policies you may be considering:

  1. How is disability defined? Is it defined as the inability to perform your own job, or inability to do any job? We recommend all our clients, as physicians, to obtain a policy that protects them in their own specialty. This kind of policy is defined as an own-occupation policy, which protects the income you earn in your own specialty and continues to pay benefits if your disability requires that you choose a new specialty or occupation.
  2. Are benefits available for partial or residual disability, as well as for full disability? The most comprehensive policies will pay you a benefit even if you are not completely disabled. If you can only earn up to 20% of your income you are deemed totally disabled; if you can earn 80% or more you are deemed totally well. Partial or residual policies pay benefits when you fall in the category between 20-80%.
  3. Are full benefits paid, whether or not you are able to work, for loss of sight, loss of hearing, or loss of limbs? This is called presumptive disability. Some policies do not cover presumptive disability, some cover you for a specified amount of time, and some protect you for life.
  4. What is the maximum benefit I am eligible for? The amount is based on your income to a maximum of $15,000 per month for one company, and $20,000 total.
  5. Is the policy non-cancelable, guaranteed renewable, or conditionally renewable? The most comprehensive policies are non-cancelable and guaranteed renewable; these put you in total control, not the insurance company, practice or association. The insurance company cannot raise rates, cannot reduce benefits, add exclusions, or cancel your policy at anytime. You are in control, and the policy is portable and goes wherever you go.
  6. How long must you be disabled before premiums are waived? Premiums are waived at the end of the waiting period and refunded for the amount paid during the waiting period.
  7. Is there an option to buy additional coverage, without undergoing additional medical tests or examinations, at a later date? This kind of coverage is called guaranteed issue disability insurance and is available to those who qualify.
  8. Does the policy offer an inflation adjustment feature? If so, what is the rate of inflation? Is there a maximum? This feature is available by an added rider. Ask a licensed DI4MDs.com agent if inflation protection fits your needs at this time.

***

Ankle-Leg Trauma

[Back When I Covered the ER]

[Copyright David Edward Marcinko and iMBA Inc., All rights reserved. USA]

***

Other Items

  • What is an adequate level of benefits in relation to your present and future obligations?
  • How long a waiting period (until benefits begin) should you select to fit your situation?
  • How long do you want to receive disability income should it become necessary? How much coverage can you get at your current salary?

More: More on Disability Insurance for Physicians

Conclusion

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

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:

Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

Enter “Population Health” Management

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Understanding the Costs and Risks

Dr. DEM

[By Dr. David Edward Marcinko MBA]

By http://www.MOL.com

Gratefully, our book, Financial Management Strategies of Hospitals and Healthcare Organizations [Tools, Techniques, Case Studies and Checklists] has become an academic best seller.

It contains a chapter on Wellness and Population Health 2.0; included here for your review [By Jennifer Tomasik, Carey Huntington, and Fabian Poliak].                 .

Population Health

I am especially proud of this work for 2016.  This managerial book mimics the popular style of colleague Atul Gawande MD in his acclaimed work The Checklist Manifesto.

Why? All hospitals are still subject to the imperative: No Margin – No Mission.

***

Pop Health

 ***

Assessment

In an example of population health management and policy leadership, another colleague, David B. Nash MD MBA of the Wharton School, and Endowed Dean of Jefferson University Medical School [father of population health], even wrote the “Foreword”.

Click on this link to read it entirely.

Link: Foreword.Nash

More:

Conclusion

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

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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Product DetailsProduct Details

***

Invite Dr. Marcinko

***

Why Medical Professionals Need a Financial Plan?

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We don’t plan to fail – We fail to plan

[By Dr. David Edward Marcinko MBA CMP™]

http://www.CertifiedMedicalPlanner.org

Dr. DEM

Our newest textbook COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will shape the physician-focused financial planning landscape for the next-generation of Health 2.0 medical professionals and their financial advisors.

Why Now?

We created this innovative textbook because the healthcare industry is rapidly changing and the financial planning ecosystem has not kept pace. Traditional insurance-commission and sales-driven generic advice is yielding to a new breed of deeply informed fiduciary advisor, and educated consultant, or Certified Medical Planner (CMP™). Internet and social media of the last decade demonstrates that medical providers are becoming accustomed to the need for knowledgeable advice. And so, financial planning is set to be transformed by “market disruptors” that will soon make an impact on the $2.8 trillion healthcare marketplace for those financial advisers serving this sector.

We are at the leading edge of this positive disruption — also known as niche based Financial Planning 2.0 — that over time will see today’s command-controlled financial services industry becomes a wide open academic marketplace. And, a growing cadre of specialty entrants is poised to shake up the industry drawing billions of dollars in revenue from traditional broker-dealer organizations while building lucrative new markets.

For example, an iMBA Inc survey points to the growing need for financial advisors to serve current and future medical professionals thanks to their eagerness to seek premium financial planning solutions from non-traditional sources and providers; like the online Certified Medical Planner™ charter designation program. The industry is ripe for a shakeup and physician focused financial planning will soon have its own new brands. We aim to be among the first-movers and top tier names in the industry.

Doctors and Computers

How We Are Different?

COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will change this niche industry sector by following eight important principles.

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and reviewers and asked them to draw on their experiences in contemporaneous healthcare focused financial planning. Like many of their physician and nurse clients, each struggles mightily with the decreasing revenues, increasing costs, automation, SEC scrutiny and higher physician-client expectations in today’s competitive financial advisory and technological landscape. Yet, their practical experience and physician focused education, knowledge and vision is a source of objective information, informed opinion and crucial information to all consultants working with doctors and medical professionals in the financial services field.

2. Second, our writing style allows us to condense a great deal of information into one volume. We integrate bullet points and tables; pithy language, prose and specialty perspectives with real world examples and case models. The result is an oeuvre of integrated financial planning principles vital to all modern physicians and allied healthcare professionals.

3. Third, to the best of our knowledge, this is the first peer-reviewed book of its type, as we seek to follow traditional medical research and journal publishing guidelines for best practices. We present differing viewpoints, divergent and opposing stake-holder perspectives, and informed personal and professional opinions. Each chapter has been reviewed by one to three outside independent reviewers and critical thinkers. We include references and citations, and although we cannot rule out all biases, we do strive to make them transparent to the extent possible.

4. Fourth, our perspective is decidedly from the physician-client side of the equation. More specifically, as consultants to medical professionals, we champion the physician-investor over the financial advisor. And, to the extent that both sides ethically succeed; we hope all concerned “do well – by doing good”. This is unique in the fee and commission driven financial services industry. Much like the emerging patient-centered care initiative in medicine, we call it client-centered advice.

5. Fifth, it is important to note that deep specificity and niche knowledge is needed when advising physicians and healthcare providers. And so, we present information directly from that space, and not by indirect example from other industries, as is the unfortunate norm. Medical case models, healthcare industry examples, and anecdotal insights from the Over Heard in the Doctor’s Lounge, and Over Heard in the Advisor’s Lounge features, are also included. Finally, personalized financial planning for all medical professionals is our core, and only focus.

6. Sixth, this textbook represents an academic template for about 25 percent [125/500 credit hours] of the Certified Medical Planner™ chartered professional online certification program curriculum. It is useful for those studying, auditing, or considering matriculation for this prestigious designation mark.

7. Seventh, we include a glossary-of-terms specific to the text, a list of comprehensive advice sources, and three illustrative physician-specific financial plan examples additionally available by separate order.

8. Finally, as editor, we prefer engaged readers who demand compelling content.  According to conventional wisdom, printed texts like this one should be a relic of the past; from an era before instant messaging and high-speed connectivity.  Our experience shows just the opposite. Applied physician focused personal financial planning literature, from informed fiduciary sources, is woefully sparse; just as a plethora of generalized internet information makes that material less valuable to doctor clients.

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plan

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A Seminal Work

And so, rest assured that COMPREHENSIVE FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will become a seminal book for the advancement of personal financial planning and related personal micro-economic principles in this niche ecosystem.

In the years ahead, we trust these principles will enhance utility and add value to your book. Most importantly, we hope to increase your return on investment by some small increment.

If you have any comments or would like to contribute material or suggest topics for future editions please contact me.

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

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Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

COMPREHENSIVE FINANCIAL PLANNING STRATEGIES for DOCTORS and ADVISORS

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UPCOMING: Our Newest Major Textbook Release

[By Ann Miller RN MHA]

Release: February 19th, 2015 by Productivity Press, Inc

744 Pages | 43 Illustrations

Editor(s): Dr. David Edward Marcinko MBA CMP™ and Professor Hope Rachel Hetico RN MHA CMP™

***

 COMPREHENSIVE FINANCIAL PLANNING 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™

 Features: 

  • Engaging content with case models, templates and examples for all medical professionals and their consulting advisors.
  • Combines holistic financial planning with new topics like hedge funds, investment banking, Wall Street practices and shenanigans; securities markets and margin accounts; alternative asset classes and investment policy creation – all integrated with emerging health industry concerns like the PP-ACA, ACOs, new tax laws and reimbursement models; practice sales, contracting and valuations; social media, hospital employee fringe benefits and PHO stock options.
  • Presents disruptive theories on industry suitability rules, fiduciary accountability and stewardship principles, and how to select the most knowledgeable and cost-efficient advisor for every life-cycle need.

Summary

Drawing on the expertise of multi-degreed doctors, and multi-certified financial advisors, COMPREHENSIVE  FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS[Best Practices from Leading Consultants and Certified Medical Planners™]will shape the industry landscape for the next-generation as the current ecosystem strives to keep pace. Traditional generic products and sales-driven advice will yield to a new breed of deeply informed financial advisor, or Certified Medical Planner™.

The profession is set to be transformed by “cognitive-disruptors” that will significantly impact the $2.8 trillion healthcare marketplace for those financial consultants serving this challenging sector. There will be winners and losers. The text which contains 24 chapters, and champions healthcare providers while informing financial advisors, is divided into four sections compete with glossary of terms, CMP™ curriculum content, and related information sources:

  1. For ALL medical providers and financial industry practitioners
  2. For NEW medical providers and financial industry practitioners
  3. For MID-CAREER medical providers and financial industry practitioners
  4. For MATURE medical providers and financial industry practitioners.

Using an engaging style, the book is filled with authoritative guidance and health care–centered discussions, to provide tools and techniques to create a personalized financial plan using professional advice. Comprehensive coverage includes topics likes behavioral finance, medical risk management, Modern Portfolio Theory (MPF), the Capital Asset Pricing Model (CAP-M) and Arbitrage Pricing Theory (APT); as well as insider insights on commercial real estate; High Frequency Trading platforms and robo-advisors; the Patriot and Sarbanes–Oxley Acts; hospital endowment fund management, ethical wills, divorce and other special situations.

The result is a codified “must-have” book, for all health industry participants, and those seeking advice from the growing cadre of financial consultants and Certified Medical Planners™ who seek to “do well – by doing good”, dispensing granular physician-centric financial advice: Omnia pro medicus-clientis.

Financial Planning 2015

 RAISING THE BAR

CERTIFIED MEDICAL PLANNER

“The informed voice of a new generation of fiduciary advisors for healthcare”

[Omnia pro medicus-clientis]  

More:

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

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FINANCIAL AND HEALTH ECONOMICS BENCHMARKING

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Understanding the operational and financial status of your organization or practice

[By Dr. David Edward Marcinko MBA CMP™]

Dr. DEMFinancial benchmarking can assist healthcare managers and professional financial advisors in understanding the operational and financial status of their organization or practice.

The general process of financial benchmarking analysis may include three elements: (1) Historical subject benchmarking; (2) Benchmarking to industry norms; and, (3) Financial ratio analysis.

History

Historical subject benchmarking compares a healthcare organization’s most recent performance with its reported performance in the past in order to: examine performance over time; identify changes in performance within the organization (e.g., extraordinary and non-recurring events); and, to predict future performance.

As a form of internal benchmarking, historical subject benchmarking avoids issues such as: differences in data collection and use of measurement tools; and, benchmarking metrics that often cause problems in comparing two different organizations.

However, it is necessary to common size data in order to account for company differences over time that may skew results.

Benchmarking

Benchmarking to industry norms, analogous to Fong and colleagues’ concept of industry benchmarking,   involves comparing internal company-specific data to survey data from other organizations within the same industry. This method of benchmarking provides the basis for comparing the subject entity to similar entities, with the purpose of identifying its relative strengths, weaknesses, and related measures of risk.

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Residents

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Financial Ratio Analysis

The process of benchmarking against industry averages or norms will typically involve the following steps:

  1. Identification and selection of appropriate surveys to use as a benchmark, i.e., to compare with data from the organization of interest. This involves answering the question, “In which survey would this organization most likely be included?”;
  2. If appropriate, re-categorization and adjustment of the organization’s revenue and expense accounts to optimize data compatibility with the selected survey’s structure and definitions (e.g., common sizing); and,
  3. Calculation and articulation of observed differences of organization from the industry averages and norms, expressed either in terms of variance in ratio, dollar unit amounts, or percentages of variation.

Trends

Financial ratio analysis typically involves the calculation of ratios that are financial and operational measures representative of the financial status of an enterprise.  These ratios are evaluated in terms of their relative comparison to generally established industry norms, which may be expressed as positive or negative trends for that industry sector. The ratios selected may function as several different measures of operating performance or financial condition of the subject entity.

The Selected Ratios

Common types of financial indicators that are measured by ratio analysis include:

  1. Liquidity. Liquidity ratios measure the ability of an organization to meet cash obligations as they become due, i.e., to support operational goals. Ratios above the industry mean generally indicate that the organization is in an advantageous position to better support immediate goals. The current ratio, which quantifies the relationship between assets and liabilities, is an indicator of an organization’s ability to meet short-term obligations. Managers use this measure to determine how quickly assets are converted into cash.
  2. Activity. Activity ratios, also called efficiency ratios, indicate how efficiently the organization utilizes its resources or assets, including cash, accounts receivable, salaries, inventory, property, plant, and equipment. Lower ratios may indicate an inefficient use of those assets.
  3. Leverage. Leverage ratios, measured as the ratio of long-term debt to net fixed assets, are used to illustrate the proportion of funds, or capital, provided by shareholders (owners) and creditors to aid analysts in assessing the appropriateness of an organization’s current level of debt. When this ratio falls equal to or below the industry norm, the organization is typically not considered to be at significant risk.
  4. Profitability. Indicates the overall net effect of managerial efficiency of the enterprise. To determine the profitability of the enterprise for benchmarking purposes, the analyst should first review and make adjustments to the owner(s) compensation, if appropriate. Adjustments for the market value of the “replacement cost” of the professional services provided by the owner are particularly important in the valuation of professional medical practices for the purpose of arriving at an ”economic level” of profit.

Data Homogeneity

The selection of financial ratios for analysis and comparison to the organization’s performance requires careful attention to the homogeneity of data. Benchmarking of intra-organizational data (i.e., internal benchmarking) typically proves to be less variable across several different measurement periods.

However, the use of data from external facilities for comparison may introduce variation in measurement methodology and procedure. In the latter case, use of a standard chart of accounts for the organization or recasting the organization’s data to a standard format can effectively facilitate an appropriate comparison of the organization’s operating performance and financial status data to survey results.

***Financial Planning MDs 2015

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

***

Operational Performance Benchmarking

Operational benchmarking is used to target non-central work or business processes for improvement.  It is conceptually similar to both process and performance benchmarking, but is generally classified by the application of the results, as opposed to what is being compared.  Operational benchmarking studies tend to be smaller in scope than other types of benchmarking, but, like many other types of benchmarking, are limited by the degree to which the definitions and performance measures used by comparing entities differ.  Common sizing is a technique used to reduce the variations in measures caused by differences (e.g., definition issues) between the organizations or processes being compared.

Common Sizing

Common sizing is a technique used to alter financial operating data prior to certain types of benchmarking analysis and may be useful for any type of benchmarking that requires the comparison of entities that differ on some level (e.g., scope of respective benchmarking measurements, definitions, business processes).  This is done by expressing the data for differing entities in relative (i.e., comparable) terms.[vii]

Example:

For example, common sizing is often used to compare financial statements of the same company over different periods of time (e.g., historical subject benchmarking), or of several companies of differing sizes (e.g., benchmarking to industry norms). The latter type may be used for benchmarking an organization to another in its industry, to industry averages, or to the best performing agency in its industry.[viii]  Some examples of common size measures utilized in healthcare include:

  1. Percent of revenue or per unit produced, e.g., relative value unit (RVU);
  2. Per provider, e.g., physician;
  3. Per capacity measurement, e.g., per square foot; or,
  4. Other standard units of comparison.

Assessment

As with any data, differences in how data is collected, stored, and analyzed over time or between different organizations may complicate the use of it at a later time.  Accordingly, appropriate adjustments must be made to account for such differences and provide an accurate and reliable dataset for benchmarking.

Conclusion

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

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References:

[i]             “Common Size Financial Statements”, by NetMBA.com (2007), http://www.netmba.com/finance/statements/common-size/ (Accessed 8/13/2009), p. 3.

[ii]             See “Benchmarking: A General Reading for Management Practitioners”, by  Sik Wah Fong, Eddie W.L. Cheng, and Danny C.K. Ho, Management Decision, Vol. 36, No. 6 (1998), p. 410.

[iii]            “A Perspective on Benchmarking”, Gregory H. Watson in conversation with the Editor, Benchmarking for Quality Management & Technology, Vol. 1, No. 1 (1994), p. 6.

[iv]            “A Perspective on Benchmarking”, Gregory H. Watson in conversation with the Editor, Benchmarking for Quality Management & Technology, Vol. 1, No. 1 (1994), p. 6.

[v]             “A Perspective on Benchmarking”, Gregory H. Watson in conversation with the Editor, Benchmarking for Quality Management & Technology, Vol. 1, No. 1 (1994), p. 6.

[vi]            ”Principles of Financial & Managerial Accounting”, Carl S. Warren, Philip E. Fess, 3rd edition, South-Western Publishing Co., Cincinnati, Ohio, 1992, p. 1169.

[vii]           ”Principles of Financial & Managerial Accounting”, Carl S. Warren, Philip E. Fess, 3rd edition, South-Western Publishing Co., Cincinnati, Ohio, 1992, p. 1169.

[viii]           ”Principles of Financial & Managerial Accounting”, Carl S. Warren, Philip E. Fess, 3rd edition, South-Western Publishing Co., Cincinnati, Ohio, 1992, p. 1169.

 

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Selecting a Healthcare Focused Financial Advisory Team

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Providing Physician Centric – Not Advisor Centric – Holistic Financial Planning

[By Dr. David Edward Marcinko MBA CMP™]

[By Professor Hope Rachel Hetico RN MHA CMP™]

David and HopeMost retail financial services products are designed to enhance the well-being of the Financial Advisor and/or vendor at the expense of clients.

The clients get only the leftovers. Of course, no one tells them that secret. They have to figure it out for themselves. As the old line goes, “Where are the customers’ boats?”*

*Rowland, M: Planning Periscope [Where Advisors are the Clients]. Financial Advisors Magazine; page 36, April 2014

Anyone following emerging health care trends and delivery models over the last few years has heard various permutations of the notion “team based medical care”, the “continuum of care” or “patient centered care.” All concerned hope that such high-performing holistic teams, with granular patient input, will improve health delivery and become essential to the advancement of coordinated, successful and cost-effective health care. So too; the informed financial planning team process for physicians and medical professionals!

Introduction

Now, we introduce the related concept of team-based and client-centered, financial planning advice for physicians and medical professionals. But, the concept must be more than a tag line, marketing gimmick or metaphor. And, there are several catches to this new team approach.

The first is doctor involvement to lead the team. Gone are the days of abrogating financial planning to some anointed, “quarter-back”, uber-advisor or planner coordinating inputs, team members, plans, advice and financial products! Today, it is better to Do-It-Yourself [DIY]; or pay the price; literally and figuratively. In other words, a philosophy of ME Inc; not Financial Advisor, Inc

The second is to ensure teams are indeed well educated, high-performing using best practices, that demand the sort of whole-person and psychological attention discussed in the first chapter of this book and extending well beyond financial planning software for the general populace.

The third catch is full integration. In theory, everyone loves team-based medical care.  But, it is seldom used successfully and all must ensure the concept does not re-disintegrate into the disparate parts of traditional care; or the compartmentalized financial planning of the past. This is akin to the individual pieces of a scramble puzzle, which is never fully assembled, as a picture in-toto. Complete – but not completed!

And, we must be absolutely sure of the team leader and of who is accountable; ME Inc or with a tour guide [FA pro re nata]. Most importantly; who has responsibility with the needed authority. Team based financial planning advice must not be a collective risk reduction mechanism for the involved consultants; as is often the case in medicine. And, it must not be an invoice generating machine or revenue enhancing mechanism like some electronic medical records. There must be fiduciary responsibility, of all team members, collectively and individually; and at all times.

Finally, the team must be more than an aspiration or theoretical model; it must be actual, executable and real.

The Real Notion of Teams

In financial planning, there seems to be a fixation … that a team is financial planner [certified; or not] and an attorney; nice-but a couple [and not really a team in the true sense of group development as first proposed by Bruce Tuckman, in 1965.

In his model, Tucker maintained that four phases are all necessary and inevitable in order for the team to grow, to face challenges, to tackle problems, to find solutions, to plan work, and to deliver results [Forming – Storming – Norming – Performing]. Later, headded Adjourning to successfully complete the task and break up the team. Timothy Biggs further added the Re-Norming stageto reflect a period where the team re-assembles, as needed. This put the emphasis back on the ME Inc or physician team leader – as too many ‘diplomats’ in a leadership role may prevent the team from reaching full potential.

Source: http://infed.org/mobi/bruce-w-tuckman-forming-storming-norming-and-performing-in-groups/

This is why “team” must be more than a metaphor. It deserves more than lip service. Delivering client-centered, coordinated financial planning services and products demands true collaboration–a fully integrated team engaged in practices that involve each member at the top, highest and best use of their licensure and education; optimizing their contributions and maximizing their impact on the well being of the client.

CMPs

In this context, board Certified Medical Planners™ may play a lead role going forward; along with other like-minded and educated professionals. Unfortunately, the ranks of CMPs™ while growing; are still painfully small. But, in addition to true expertise, they link physician clients with appropriate providers and resources throughout the holistic professional life/practice planning continuum. They focus on the doctor-client’s totality — emotional, financial, risk and business management and psyche. They advocate for the doctor client to connect him/her to the necessary resources, professional advisors and consultants who need to have their voices heard. Such successful, high-functioning financial planning teams give each member a voice.

The medical professional must be an active participant; not a passive bystander. This is not the norm in financial planning today where doctors are urged to hire a team quarterback. But, the NFL-QB is not a generalist at all; his arm is special and unlike all other teams players. He is unique, skilled and exceptional. A franchise player!

Fortunately, past is not prologue in the era of transparency, information at your fingertips, tablet PCs, Skype® and smart phones. To succeed in the hyper competitive new era of health reform requires education, involvement and active participation. In short, a new model of physician focused advisor. No longer is there a free lunch of passivity for medical professionals; either as doctors or advisory clients themselves. For financial planning in the new era of healthcare reform, successful doctors will assume the mantle of self-quarterback themselves.

ME Inc., or Going it Alone – but with a Team

The physician, nurse, or other medical professional should easily recognize that there are a vast array of opportunities, obstacles, and pitfalls when it comes to managing one’s finances.  Still, with some modicum of effort, the basic aspects of insurance, investments, taxes, accounting, portfolio management, retirement and estate planning, debt reduction, asset protection and practice management can be largely self-taught. Yet, it is realized that nuances and subtleties can make a well-intentioned plan fall short.  The devil truly is in the details.  Moreover, none of these areas can be addressed in isolation. It is common for a solution in one area to cause a new set of problems in another.

Accordingly, most health care practitioners would be well served to hire [independent, hourly compensated and prn] financial help. Unlike some medical problems, financial issues may not cause any “pain” or other obvious symptoms.  Medical professionals tend to have far more complex financial situations than most lay people. Despite the complexities of the new world of health reform, far too many either do nothing; or give up all control totally, to an external advisor. This either/or mistake can be costly in many ways, and should be avoided.

In reality, and at various time in their careers, the medical professional needs a team comprised of at least a financial analyst, lawyer, management consultant, risk manager [actuary, mathematician or insurance counselor] and accountant. At various points in time, each member of the team, or significant others, will properly assume a role of more or less importance, but the doctor must usually remain the “quarterback” or leader; in the absence of a truly informed other, or Certified Medical Planner™.

This is necessary because only the doctor has the personal self-mandate with skin in the game, to take a big picture view.  And, rightly or wrongly, investments dominate the information available regarding personal finance and the attention of most physicians.  One is much more likely to need or want to discuss the financial markets with their financial advisor than private letter rulings by the IRS, or with their estate planning attorney or tax accountant. While hiring for expertise is a good idea, there is sinister way advisors goad doctors into using all their retail services; all of the time. That artifice is – the value of time.

Assessment

True integrated physician focused and financial planning is at its core a service business, not a product or sales endeavor. And, increasingly money is more likely to be at the top of the list for providers as the healthcare environment is contracting. So, eschewing the quarterback model of advice, and choosing to self-educate thru this NEW book and elsewhere, may be one of the best efforts a smart physician can make.

Book Link: http://www.crcpress.com/product/isbn/9781482240283

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

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Help Select our Next Physician-Focused Financial Planning Textbook Cover

 Certified Medical Planner   

TRANSFORMATIONAL FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS

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

By Dr. David Edward Marcinko MBA CMP

By Hope Rachel Hetico RN MHA CPHQ, CMP

A Reader Opinion and Voting Poll

David and Hope

Drawing on the expertise of our readers, members and multi-degreed doctors, and multi-certified financial advisors, the text TRANSFORMATIONAL FINANCIAL PLANNING STRATEGIES FOR DOCTORS AND ADVISORS [Best Practices from Leading Consultants and Certified Medical Planners™] will help re-shape the industry landscape for the next-generation of MDs and FAs as the current ecosystem strives to keep pace.

Traditional generic products and sales-driven advice will yield to a new breed of deeply informed financial advisor, or Certified Medical Planner™.  The profession is set to be transformed by “cognitive-disruptors” that will significantly impact the $2.8 trillion healthcare marketplace for those financial consultants serving this challenging sector. There will be winners and losers.

The text which contains 24 chapters, and champions healthcare providers while informing financial advisors, is divided into four sections compete with glossary of terms, CMP™ curriculum content, and related information sources:

  1.  For ALL medical providers and financial industry practitioners
  2. For NEW medical providers and financial industry practitioners
  3. For MID-CAREER medical providers and financial industry practitioners
  4. For MATURE medical providers and financial industry practitioners

The result is a codified “must-have” book, for all health industry participants, and those seeking advice from the growing cadre of financial consultants and Certified Medical Planners™ who seek to “do well – by doing good”, dispensing granular physician-centric financial advice: Omnia pro medicus-clientis.

And so, we now ask our ME-P readers, contributors and subscribers to help us select the cover imprint for this ground-breaking major new textbook. Please select one from the following three options:

OPTION #1

K23315_v1OPTION #2K23315_v2

OPTION #3K23315_v3

 

Deeper Book Info:

For more information on the content, contributors, case models, format and style of this new book, which will advance the re-constructive innovation of the profession; please review this link:

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

THE VOTING POLL

RAISING THE BAR

The informed voice of a new generation of fiduciary advisors for healthcare

About Certified Medical Planners

Link: Enter the CMPs

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Are FAs a Wise Investment?

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Ask-the-Advisor

Dear Dr. David Edward Marcinko,

Dr. MarcinkoAre financial advisors a wise investment? Mine charges me 1% each year for all my assets under their management. Is it worth it?

—Allen

It is hard to know for sure. But the fact that many financial advisers have different hidden fees suggests to me that they themselves don’t think that people would pay if they charged for their services in a clear and upfront way.

Re-Frame

To help you think about this question in your own life, let’s contrast two cases: In case one, you are charged 1% of your assets under management, and this amount is taken directly from your brokerage account once a month. In case two, you pay the same overall amount, but you send a monthly check to your financial adviser.

Consider

The second case more directly and clearly depicts the cost of your financial adviser, providing a better frame for your question. So, put yourself in the mindset of the second case, and ask yourself if you would pay directly for these services.

I think the best answer, according to colleague and economist Dan Ariely PhD, can be expressed in this manner.

If the answer is yes, keep your financial adviser; if the answer is no, you have your first action plan for the New Year.

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Conclusion

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An ME-P Thanksgiving Day 2013 Tribute

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A Letter from the Publisher-in-Chief

By Dr. David E. Marcinko; MBA, CMP™

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

— Abraham Lincoln

Dear ME-P Readers & Subscribers

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

Thanksgiving Proclamation

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

October 3, 1863

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

Blessed to be Americans

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

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

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

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

Our Thanks to You

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On behalf of our ME-P staff, we want to thank all of you who have e-mailed and subscribed to us. We will continue to do our best to answer each letter and strive to make your subscription more worthwhile than ever before.

Assessment

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

Conclusion

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Will Future Doctors Need a Medical License?

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Licensing Doctors – Do Economists Agree?

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Dr. MarcinkoChallenging conventional wisdom is something I like to think … that I do.

After all, I am considered a healthcare ‘thought-leader”, and to the extent possible, we publish outside traditional box thinking on this Medical Executive-Post.

It’s all Relative

But, I am a piker compared to Shirley Svorny PhD.

Who is she?

Dr. Shirley Svorny is chair of the economics department at California State University, Northridge, and she holds a PhD in economics from UCLA

Medical Licensure Issues

Now, remember the old saying, “if everyone is thinking alike, then nobody is thinking”.

Well, a while back, Dr. Svorny wondered if a medical degree is a barrier – rather than enabler – of affordable healthcare. Enter the PP-ACA of 2010.

As an expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argued that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today. Malpractice attorneys, and monetary gain motives, too!

Her Published Abstract

“Despite the wide reach of medical licensing in health care production through its impact on the nature and cost of care, it has been all but ignored in debates over health care reform.

This paper pulls together statements made by economists whose expertise is in the area of health economics or, more specifically, medical licensure and discipline. Economists who have examined the market for physician services in the United States generally view state licensing as a means by which to enforce cartel-like restrictions on entry that benefit physicians at the expense of consumers. Medical licensing is seen as a constraint on the efficient combination of inputs, a drag on innovations in health care and medical education, and a significant barrier to effective, cost efficient health care.”

Full paper link:  2004-08-svorny-reach_concl

jester_hat

Am I Thought-Leader?

Am I a thought leader? Well, I don’t rightly know; that’s for others to decide. But, I do know that this essay was published a decade ago; in 2004, and at a time before the ME-P’s existence.

And so, based on this essay, Dr. Svorny is surely a “thought-leader” in my opinion

More about Dr. Svorny

In 1986-87, Dr. Svorny managed an industry risk group at Security Pacific Bank. She was a Milken Institute Affiliated Scholar and served as director of the San Fernando Valley Economic Research Center at Cal State Northridge. She has published articles in Economics of Education Review, Contemporary Economic Policy, Urban Affairs Review, Public Choice, Regional Science and Urban Economics, Cato Journal, Applied Economics, The Journal of Medical Licensure and Discipline, The Energy Journal, Economic Inquiry, and the Journal of Labor Research. Her opinion articles have appeared in the Los Angeles Times and the Los Angeles Daily News. Her research interests are in the areas of urban, labor, and health economics.

Assessment

Do traditionalists or collective healthcare reform advocates and health economists react rationally; or irrationally on this issue? What do you think?

Conclusion

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***

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

What Physician Investors Need to Know about Monte Carlo Simulation

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Probability Forecasting and Investing

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief] www.CertifiedMedicalPlanner.org

dr-david-marcinko1Recently, I had a physician-client ask me about Monte Carlo simulation. You know the routine: what it is and how it works, etc.

From Monaco

Named after Monte Carlo, Monaco, which is famous for its games of chance, MCS is a technique that randomly changes a variable over numerous iterations in order to simulate an outcome and develop a probability forecast of successfully achieving an outcome.

In endowment management, MCS is used to demonstrate the probability of “success” as defined by achieving the endowment’s asset growth and payout goals.  In other words, MCS can provide the endowment manager with a comfort level that a given payout policy and asset allocation success will not deplete the real value of the endowment.

Quantitative Tools Problematic

The problem with many quantitative tools is the divorce of judgment from their use. Although useful, MCS has limitations that should not supplant the endowment manager’s, FA or physician-investor’s, experience.

MCS generates an efficient frontier by relying upon several inputs: expected return, expected volatility, and correlation coefficients. These variables are commonly input using historical measures as proxies for estimated future performance. This poses a variety of problems.

  • First, the MCS will generally assume that returns are normally distributed and that this distribution is stationary.  As such, asset classes with high historical returns are assumed to have high future returns.
  • Second, MCS is not generally time sensitive. In other words, the MCS optimizer may ignore current environmental conditions that would cause a secular shift in a given asset class returns.
  • Third, MCS may use a mean variance optimizer [MVO] that may be subject to selection bias for certain asset classes. For example, private equity firms that fail will no longer report results and will be eliminated from the index used to provide the optimizer’s historical data.

Healthcare Investment Risks

A Tabular Data Example

This table compares the returns, standard deviations for large and small cap stocks for the 20-year periods ended in 1979 and 2010.

Twenty Year Risk & Return Small Cap vs. Large Cap (Ibbotson Data)

[IA Micro-Cap Value 14.66 17.44 24.69 0.44]

1979

2010

Risk

Return

Correlation

Risk

Return

Correlation

Small   Cap Stocks 30.8% 17.4% 78.0% 18.1% 26.85% 59.0%
Large   Cap Stocks 16.5% 8.1% 13.1% 15.06%

[Reproduced from “Asset Allocation Math, Methods and Mistakes.” Wealthcare Capital Management White Paper, David B. Loeper, CIMA, CIMC (June 2, 2001)]

The Problems

Professor David Nawrocki identified a number of problems with typical MCS in that their mean variance optimizers assume “normal distributions and correlation coefficients of zero, neither of which are typical in the world of financial markets.”

Dr. Nawrocki subsequently described a number of other issues with MCS including nonstationary distributions and nonlinear correlations.

Finally, Dr. Nawrocki quoted financial advisor, Harold Evensky MS CFP™ who eloquently notes that “[t]he problem is the confusion of risk with uncertainty.” Risk assumes knowledge of the distribution of future outcomes (i.e., the input to the Monte Carlo simulation). Uncertainty or ambiguity describes a world (our world) in which the shape and location of the distribution is open to question.

Assessment

Contrary to academic orthodoxy, the distribution of U.S. stock market returns is “far from normal.”[1] Other critics have noted that many MCS simulators do not run enough iterations to provide a meaningful probability analysis.

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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[1]   Nawrocki, D., Ph.D. “The Problems with Monte Carlo Simulation.” FPA Journal (November 2001).

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A Hospital Industry Outlook for 2013

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One Expert’s Opinion

By Ann Miller RN MHA

[Managing Editor]

The ME-P and nation recently celebrated National Hospital Week for 2013. And so, what better time than now to ask health economist and financial expert Robert James Cimasi MHA, ASA, AVA, CMP for his take on the industry outlook. www.HealthCapital.com

cimasiHistory Background and Overview

The U.S. Healthcare Delivery System is facing what is perhaps its greatest challenge in the expected demand for increased health services from the aging of the “baby-boom” generation, the fastest-growing segment of the population.

The enactment of healthcare reform in March 2010, requiring increased insurance coverage requirements for individuals and employers, will also increase patient demand for hospital inpatient and outpatient services in the coming years.

Hospital Industry 

The hospital industry continues to face many challenges in the changing healthcare environment, including workforce shortages, rising healthcare costs to provide care, and difficulty acquiring needed capital. With consistent financial stresses, hospitals in some areas appear to be struggling.

However, general acute-care hospitals recorded record high profits of $35.2 billion in 2006, an increase of over 20% from 2005.  Total net revenues for general acute-care hospitals were $587.1 billion, resulting in an average profit margin of 6% (the highest since 1997, when the average profit margin was 6.7%).

While the demand for healthcare continues to rise, the site of service also continues to evolve as more procedures are performed on an outpatient basis and by freestanding facilities rather than by inpatient acute care hospitals.  As evidence of this trend, the number of freestanding ambulatory care surgery centers increased from 2,864 in 2000 to 5,197 in 2006.

U.S. healthcare costs are again increasing after their rate of growth slowed in the mid-1990s.

In 2009, total national health expenditures (NHE) in the U.S. grew to $2.5 trillion, a 5.7% increase from 2008.  Meanwhile, the nation’s gross domestic product (GDP) shrank by 1.1%, and as a result, NHE increased from 16.2% to 17.3% of the GDP: the largest one-year increase-in history. Additionally, healthcare spending has been projected to grow to 19.6% by 2016. The potential impact of the 2010 healthcare reform legislation to reduce rising healthcare expenditures is yet uncertain.

According to a 2002 study conducted by the Blue Cross and Blue Shield Association (BCBSA), inpatient costs are responsive to hospital market organization.  Each 1% increase in for-profit hospital market share is associated with a 2% increase in inpatient expenditure per person.  Conversely, each 1% increase in network hospital market share corresponds to a 1% decrease in inpatient expenditures.

Risk Sharing

As healthcare costs again continue to rise faster than inflation in the overall economy in 2013, driven by advances in technology and treatment (as well as the growing baby-boomer population), pressures to reduce costs, such as those included in the ACA will result in a changed paradigm for healthcare delivery.

Reimbursement mechanisms are increasingly designed to control costs and access, and hospitals must continually adjust to deal with increasing pressure to contain reimbursement and utilization levels; ie., share financial risks.

The Marketplace

The healthcare marketplace continues to experience dramatic change as the business of healthcare becomes increasingly competitive, particularly in the outpatient ancillary services arena.  Providers and payors continue to seek to control costs and markets. Legal and regulatory issues also affect change as providers adapt to new opportunities and restrictions.

In particular, there are a wide variety of cost, operational, and regulatory pressures impacting the specialty and surgical hospital industry.

Of course, these pressures are offset by the stable and increasing demand for hospital services, particularly for those hospitals already in operation.

national-hospital-week

Assessment

Bob feels that hospitals that are operationally efficient will continue to be successful within this environment; others will not. How about you?

More: Financial Management Strategies for Hospitals and Healthcare Organizations : Tools, Techniques, Checklists and Case Studies

More: Arkansas Medical News Interviews Dr. Marcinko

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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

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

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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Purchase ME-P Textbooks, Handbooks and Dictionaries to Thrive

 Our Library is Growing … thanks to you

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By Ann Miller RN MHA

[ME-P Executive-Director]

We have been publishing the Medical Executive-Post for more than eight years now. And, with almost 3,000 formal posts, by the nation’s brightest experts, we have a treasure trove of information available to you.

So now, for the first time, all this information – and more – has been codified, updated, copy-righted and copy-protected in print form for your purchase and use. All have been edited by our Publisher – Dr. David Edward Marcinko and Professor Hope Rachel Hetico.

Just click on an image below to order.

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Assessment

Purchase our white papers, too: https://medicalexecutivepost.com/white-papers/

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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

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

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

Business%20Optimization

“Pound Foolish” [Book Review Video on Personal Finance]

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Exposing the Dark Side of the Personal Finance Industry

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

By Professor Hope Rachel Hetico RN, MHA, CPHQ, CMP™

www.CertifiedMedicalPlanner.org

David and HopeHere are the first four video segments of an interview with Helaine Olen, by Harold Pollack, regarding her new book, Pound Foolish.

This essay first appeared on the The Incidental Economist [TIE]; an electronic forum by colleague Austin Frakt PhD:

The VIDEOS:

Part IV: http://www.youtube.com/watch?v=0cSmrH6FUvU&feature=youtu.be

Part III: http://www.youtube.com/watch?v=QTEGaTg9pQE&feature=youtu.be

Part II: http://www.youtube.com/watch?v=xNPX7kft5oM&feature=youtu.be

Part I: http://www.youtube.com/watch?v=WPanXaLvTTI&feature=youtu.be

You can see a more extensive interview with Olen, with arguably better production values, on Frontline’s the retirement gamble last week.

About the Author

HELAINE OLEN is a free­lance journalist whose work has appeared in The New York Times, The Washington Post, Slate, Salon, Forbes, Business­Week, and elsewhere. She wrote and edited the popu­lar Money Makeover series in the Los Angeles Times. She lives in New York City with her family. Follow her on Twitter at @helaineolen.

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Assessment

This book reinforces the R&D efforts of our governing board of physician-directors, accountants, financial advisors, academics and health economists who [years ago] 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

 Certified Medical Planner

NOTEWORTHY:

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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

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

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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Health 2.0 Financial Planning for Medical Executive-Post Members

A By-Product of Health 2.0?

By Dr. David Edward Marcinko FACFAS MBA CMP*

[Founder and CEO]

www.MedicalBusinessAdvisors.com

Dr David E Marcinko MBAA decade ago, Editor Gregory J. Kelley of Physician’s MONEY DIGEST and I reported that a 47 year old-doctor with $184,000 annual income would need about $5.5 million dollars for retirement at age 65. Then came the “flash-crash’ of 2007-08, the home mortgage fiasco and the Patient Protection and Accountable Care Act [PP-ACA] of 2010; etc.

No wonder that medical provider career panic is palpable. Much like the new medical home concept, the idea of holistic life planning was born.

Life Planning

Life planning has many detractors and defenders. Formally, life planning has been defined in the following way. 

Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process.  For the client, their life becomes the axis around which financial planning develops and evolves.

But, for physicians, life planning’s quasi-professional and informal approach to the largely isolated disciplines of medically focused financial planning, was still largely inadequate.

Why? 

Today’s personal financial and practice environment is incredibly more complex than it was in 2007-08, as economic stress from HMOs, Wall Street, liability fears, criminal scrutiny from government agencies, IT mischief from hackers, economic benchmarking from hospitals and the lost confidence of patients all converged to inspire a robust new financial planning 2.0 approach for medical professionals.

Example of a financial planning mistake 

Recall the tale of Dr. Debasis Kanjilal, a pediatrician from New York who put more than $500,000 into the dot.com company, InfoSpace, upon the advice of Merrill Lynch’s star but non fiduciary analyst Henry Bloget.

Is it any wonder that when the company crashed, the analyst was sued, and Merrill settled out of court? Other analysts, such as Mary Meeker of Morgan Stanley, Dean Witter and Jack Grubman from Salomon Smith Barney, were involved in similar fiascos.

Although sad, this story is a matter of public record. Hopefully, doctors now understand that the big brokerage houses that underwrite and recommend stocks may have credibility problems, and that physicians got burned with the adrenalin rush of “self-directed” investment portfolios.

Example of a medical practice management mistake 

Just reflect a moment on colleagues willing to securitize their medical practices a few years ago, and cash out to Wall Street for perceived riches that were not rightly deserved

Where are firms such as MedPartners, Phycor, FPA and Coastal now? A recent survey of the Cain Brothers Physician Practice Management Corporation Index of publicly traded PPMCs revealed a market capital loss of more than 95%, since inception. 

Another Approach?

This disruptive narrative shift was formally noted by the Institute of Medical Business Advisors Inc [iMBA, Inc] and introduced to the medical and financial services industry. This research and corpus of work resulted in hundreds of publications in the Library of Medicine, National Institute of Health (NIH) and the Library of Congress, along with related publications, a dozen textbooks and white papers

http://www.ncbi.nlm.nih.gov/nlmcatalog?term=marcinko

The iMBA approach to financial planning, as championed by the www.CertifiedMedicalPlanner.org professional charter designation, integrates the traditional concepts of fiduciary focused financial planning, with the increasing complex business concepts of medical practice management.

The former ideas are presented in our textbook on financial planning for doctors: Financial Planning for Physicians and Advisors

The later in our companion book: Business of Medical Practice [Edition 3.0]

A textbook for hospital CXOs and physician-executives: Hospitals & Healthcare Organizations

While most issues of risk management, liability and insurance are found in Risk Management and Insurance Strategies for Physicians and Advisors

And, for the perplexed, all definitions are codified in the dictionary glossary Health Dictionary Series

Health 2.0 Paradigm Shift

And so, the ME-P community now realizes that a more integrated approach is needed.  The traditional vision of medical practice management, personal physician financial planning and how they may look in the future are rapidly changing as the retail mentality of medicine is replaced with a wholesale philosophy.

Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition.

Or, how Yale University economist Robert J Shiller warns in “The New Financial Order” [Risk in the 21st Century] that the risk for choosing the wrong healthcare profession or specialty might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. 

Physician-Executive

My Assessment

Yet, the opportunity to re-vise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the medicine, business and the meaning and purpose of life.

To allow this deeper and more realistic approach, the advisor and the doctor must build relationships based on fiduciary trust, greater self-knowledge and true medical business and financial enhancement acumen.

Are you up to the task?

Conclusion

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Informing Doctors about Automobile Motor Oil Changes

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What doctors need to know before their next service

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

DEM 2013Chances are you might have heard a thing or two about oil prices and all the work it takes to get it out of the ground. You may have even walked into an auto parts store and seen a wall filled with a plethora of different types, viscosities, and brands of oil. Luckily, there are choices to be had, and we’re here to walk you through them.

To Lubricate – Not Burn

Right off the bat, the point should be made clear that motor oil is not meant to be burnt. Sure, oils are used to make the gasoline and diesel fuels that power our vehicles, but motor oil is purely there to lubricate the internals of your engine, not to be burnt as an energy source. It’s that type of burning that causes some of the environmental issues. If you notice a blue smoke emitting from the tailpipe of your vehicle, and the need to add oil every so often, your engine might have a serious problem.

But, for normal motor oil usage, the lubrication of engine internals to keep metal from touching metal while the various bits and pieces move a couple thousand times a minute, there are basically two types – conventional and synthetic.

My Jaguar's engine after a steam

Conventional Oil

Conventional motor oil has done a great job for the past hundred years or so, and is still largely the norm when it comes to servicing your vehicle. Why is this? For the vast majority of drivers in normal vehicles, conventional motor oil meets the vehicle’s needs while being lower cost. In fact, a quart of conventional motor oil will only set you back half of what a quart of synthetic oil costs.

What are some of the benefits of conventional motor oil? First of all, there’s the cost proposition. And if you drive a normal vehicle, conventional oil might actually be a better choice, as it’s a thicker substance. Also, for that same reason, conventional oil is often the lubricant of choice in higher-mileage engines, where some worn components might not have the ability to seal that they once had.

Synthetic Oil

Synthetic motor oil, however, is the new wave of engine lubrication. First designed for aircraft applications in the 1970s, it has also found a home in the engines of many high-performance vehicles. With the requirement of maintaining lubricating abilities at high altitudes and temperatures in aircraft, it was a natural fit. Because of the higher tolerances of aircraft and high-performance engines, the thinner nature of synthetic oil is meant to squeeze into every nook and cranny available, exactly what is needed in these finely-crafted engines.

While synthetic oil might cost twice as much as conventional, it’s thermal properties that keep it from breaking down over time mean that oil changes can occur less often at higher mileage intervals, saving you headaches and recouping some of those costs. Also, due to its thinner nature, it flows easier in cold weather, meaning less warm-up time for your engine, decreasing, once again, headaches and harmful exhaust fumes.

My Kitty Oil

I’ve got a near showroom and mint conditioned 2000 Jaguar XJ-V8-LWB. It  is a full-size luxury sedan, offering sporting drive characteristics, mixed with a classic style and interior comfort. It was available in multiple trims which all came very well equipped with upscale amenities. And, this extended wheelbase version offers much more rear seat leg room for long and winding Georgia road trips. The standard steel engine [not nikasil] in this XJ is a 4.0L V8 which produces 290 hp. The upper and lower timing chain tensioners are original, second generation metal, not plastic.

There is also a supercharged version of this vehicle which bumps output to an impressive 370 hp. Even with all of its power and weight, my XJ-8-L is still rated at over 20 mpg on the highway. Ammenities and upgrades include a mobile phone, Magellan GPS, LoJack theft recovery system, CD and MP-3 players, with internal and external cable antenna for satellite radio.

As for oil, my owners manual calls for 10w30 as preferred, but 10w40 is acceptable for hotter climates like Atlanta. Since my XJ-8 has 90,000 miles on it, I tend to use something a little thicker 15w40 and might used 20-50 come summer if it starts consuming in the high heat.

What a Cat!She is my third favorite female after my intelligent and beautiful wife, and smart and lovely daughter.

Assessment

Now that we know the key differences in the available types of motor oil, which should you choose at your next service? For that, your mechanic will take into account your driving style, vehicle mileage, and other factors, and help you decide what is best for your vehicle.

XJ-V8-LWB Jaguar touring sedan

 

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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