BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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The Winter Solstice, or the December Solstice, is the point at which the path of the sun in the sky is farthest south. At the Winter Solstice, the sun travels the shortest path through the sky resulting in the day of the year with the least sunlight and therefore, the longest night.
Telehealth extension: Tucked in the new Congress’ spending bill is an extension of HHS rules that made telehealth more accessible during the pandemic. But the provision, which extends the flexibility through the end of 2024, falls far short of a push from some lawmakers who wanted to make that flexibility permanent.
Traditional guidance says not to spend more than 4% of your retirement savings in the first year to protect yourself from running out of money in your golden years. A new recommendation puts that figure at 3.8% with a 30-year time horizon, according to researchers at Morningstar Inc., a half-point higher than the 3.3% withdrawal they recommended in 2022 due to expectations for lower future investment returns. That means if you retire this year with a $640,000 portfolio invested 50% in stocks and 50% in bonds, you should take out no more than $24,320 in 2023.
U.S. equities finished higher in choppy action, posting the first gains in four sessions, as investors digested a host of monetary policy decisions from central banks in Asia. The Bank of Japan and People’s Bank of China kept their respective benchmark interest rates unchanged, but the former surprisingly tweaked its yield curve control policy.
Equity news was on the light side today, as General Mills beat earnings estimates and raised its full-year guidance, and shares of Steel Dynamics gained ground after it was announced that it would replace ABIOMED in the S&P 500.
On the economic front, housing starts declined less than anticipated, while building permits fell much more than expectations. Treasury yields rose, particularly on the long end of the curve, while the U.S. dollar fell, crude oil prices saw a modest increase, and gold prices rallied.
Asian stocks finished broadly lower and market in Europe diverged amid the host of monetary policy decisions.
• 62% of clinicians agreed the role of the clinician will change to be more of a partnership with the patient in 10 years’ timer. • 51% of clinicians agreed tele-health will negatively impact their ability to demonstrate empathy with patients. • 56% agreed patients will be more empowered to take care of their own health. • 77% of clinicians expect real-time patient analytics to be critical to personalized care in the future. • 43% expect every individual will have their genome sequenced to support illness prevention.
• 84% of respondents say their organizations require them to use digital health tools and most clinicians see the value in digital transformation. • 99% of leaders in U.S.-based health systems say it is important for their organizations to invest in digital transformation and 95% of international health system leaders agree. • 93% of international payer respondents and 74% of U.S. payers say their organizations have a team focused on digital transformation. • 80% of health system leader respondents in the U.S. think that a physician visit deserves to be reimbursed at the same or higher levels than an in-person visit.
NOTE: The Healthcare Information and Management Systems Society is an American not-for-profit organization dedicated to improving health care in quality, safety, cost-effectiveness and access through the best use of information technology and management systems.
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39% of Providers Conduct Covid-19 Screens Via Telehealth
In a recent survey providers were asked what types of patient care they deliver via telehealth. The survey found:
• Conduct primary care visits (75%) • Conduct chronic care visits (72%) • Order prescription refills (64%) • Conduct COVID-19 screenings (39%) • Conduct urgent care visits (38%) • Address mental health concerns (36%) • Conduct follow-up after a procedure or surgery care (28%)
What are you going to do 10-20 years from now? We toyed with the idea and came up with a list of healthcare jobs we think will be born in the coming decades. In case you want to become an organ designer or an end-of-life therapist. OR telesurgery VR planner.
And before you say I’m looking too far into the future, let me remind you that researchers are experimenting with a computer made of DNA-coated microbeads, with wireless charging of electronic implants, an Osaka hospital uses smart glasses to connect remote teams, while the FDA cleared an A.I. software automatically flagging cases of pneumothorax.
I hope you will find the newsletter useful!
Best regards, Bertalan Meskó, MD PhD The Medical Futurist
SYNOPSIS: The home office deductionallows qualified taxpayers to deduct certain home expenses when they file taxes. And, now that some doctors and many of us are working remotely, you may be wondering whether working from home will yield any tax breaks. If your small medical or healthcare consulting or other business qualifies you for a home office tax deduction, should you be concerned about triggering an audit? How does a business qualify in the first place; etc?
Well, to claim the home office deduction on their 2021 tax return, taxpayers generally must exclusively and regularly use part of their home or a separate structure on their property as their primary place of business.
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If I work from home, do I qualify for a home office tax deduction?
If you’re an employee working remotely rather than an employer or business owner, you unfortunately don’t qualify for the home office tax deduction (however, please note that it is still available to some as a state tax deduction). Prior to the Tax Cuts and Job Acts (TCJA) tax reform passed in 2017, employees could deduct unreimbursed employee business expenses, which included the home office deduction. However, for tax years 2018 through 2025, the itemized deduction for employee business expenses has been eliminated.
If I’m self-employed, should I take the home office tax deduction?
You may have heard that taking the home office deduction sends a red flag to the IRS and ups your chances of being audited. Although there may have been some merit to this advice in the past, changes in the tax rules in the late 1990s made it easier for people who work out of their homes to qualify for these write-offs. So if you qualify, by all means, take it.
Do I qualify for the home office tax deduction?
Generally speaking, to qualify for the home office deduction, you must meet one of these criteria:
Exclusive and regular use: You must use a portion of your house, apartment, condominium, mobile home, boat or similar structure for your business on a regular basis. This also includes structures on your property, such as an unattached studio, barn, greenhouse or garage. It doesn’t include any part of a taxpayer’s property used exclusively as a hotel, motel, inn, or similar business.
Principal place of business: Your home office must be either the principal location of your business or a place where you regularly meet with customers or clients. Some exceptions to this rule include day care and storage facilities.
What is “exclusive use”?
The biggest roadblock to qualifying for these deductions is that you must use a portion of your home exclusively and regularly for your business.
The law is clear and the IRS is serious about the exclusive-use requirement. Say you set aside a room in your home for a full-time business and you work in it ten hours a day, seven days a week. If you let your children use the office to do their homework, you violate the exclusive-use requirement and forfeit the chance for home office deductions.
The exclusive-use rule doesn’t mean:
You’re forbidden to make a personal phone call from the office.
You have to rush outside whenever a family member needs a moment of your time.
Although individual IRS auditors may be more or less strict on this point, some advisers say you meet the spirit of the exclusive-use test as long as personal activities invade the home office no more than they would be permitted to in an office building. The office can also be a section of a room if the division is clear — thanks to a partition, for example — and you can show that personal activities are excluded from the business section.
What is “regular use”?
There’s no specific definition of what constitutes regular use. Clearly, if you use an otherwise empty room only occasionally and its use is incidental to your business, you’d fail this test. If you work in the home office a few hours or so each day, however, you might pass. This test is applied to the facts and circumstances of each case the IRS challenges.
What does “principal place of business” mean?
In addition to passing the exclusive- and regular-use tests, your home office must be either the principal location of that business or a place for regular customer or client meetings.
If your home office is in a separate, unattached structure — a detached garage converted into an office, for example — you don’t have to meet the principal-place-of-business or the deal-with-clients test. As long as you pass the exclusive- and regular-use tests, you can qualify for home business write-offs.
What if your business has just one home office, but you do most of your work elsewhere?
Remember that the requirement is that your home office is your principal place of business, not your principal workplace. As long as you use the home office to conduct your administrative or management chores and you don’t make substantial use of any other fixed location to conduct those tasks, you can pass this test.
If you’re an employee of another company but also have your own part-time business based in your home, you can pass this test even if you spend much more time at the office where you work as an employee.
This rule makes it much easier to claim home office deductions for individuals who conduct most of their income-earning activities somewhere else (such as outside salespeople or tradespeople).
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What qualifies as a business?
As with the regular-use test, whether your endeavors qualify as a business depends on the facts and circumstances. The more substantial the activities, in terms of time and effort invested and income generated, the more likely you are to pass the test.
Making money from your efforts is a prerequisite, but for purposes of this tax break, profit alone isn’t necessarily enough. If you use your den solely to take care of your personal investment portfolio, for example, you can’t claim home office deductions because your activities as an investor don’t qualify as a business.
Taxpayers who use a home office exclusively to manage rental properties may qualify for home office tax status but as property managers rather than investors.
What if I operate a child care or storage facility?
The exclusive-use test doesn’t apply if you use part of your house to:
Provide day care services for children, older adults or individuals with disabilities. If you care for children in your home between 7 a.m. and 6 p.m. each day, for example, you can use that part of the house for personal activities the rest of the time and still claim business deductions. To qualify for the tax break, your home care business must meet any applicable state and local licensing requirements.
Store product samples or inventory you sell in your business. Assume your home-based business is the retail sale of home-cleaning products and that you regularly use half of your basement to store inventory. Occasionally using that part of the basement to store personal items wouldn’t cancel your home office deduction. To qualify for this exception, your home must be the principal location of your business.
How do I calculate the home office tax deduction?
Your home office business deductions are based on either the percentage of your home used for the business or a simplified square footage calculation.
The most exact way to calculate the business percentage of your house is to measure the square footage devoted to your home office as a percentage of the total area of your home. If the office measures 150 square feet, for example, and the total area of the house is 1,200 square feet, your business percentage would be 12.5%.
An easier calculation is acceptable if the rooms in your home are all about the same size. In that case, you can figure out the business percentage by dividing the number of rooms used in your business by the total number of rooms in the house.
Special rules apply if you qualify for home office deductions under the day care exception to the exclusive-use test.
Your business-use percentage must be reduced because the space is available for personal use part of the time.
To do that, you compare the number of hours the child care business is operated, including preparation and cleanup time, to the total number of hours in the year (8,760).
Assume you use 40% of your house for a nursing daycare business that operates 12 hours a day, five days a week for 50 weeks of the year.
12 hours x 5 days x 50 weeks = 3,000 hours per year.
3,000 hours ÷ 8,760 total hours in the year = 0.34 (34%) of available hours.
34% of available hours x 40% of the house used for business = 13.6% business write-off percentage.
Simplified square footage method
Beginning with 2013 tax returns, the IRS began offering a simplified option for claiming the deduction. This new method uses a prescribed rate multiplied by the allowable square footage used in the home.
For 2021, the prescribed rate is $5 per square foot with a maximum of 300 square feet.
If the office measures 150 square feet, for example, then the deduction would be $750 (150 x $5).
The space must still be dedicated to business activities.
With either method, the qualification for the home office deduction is determined each year. Your eligibility may change from one year to the next. Finally, please note that only certain expenses such as rent, mortgage interest and property taxes qualify for the deduction, and the deduction is limited to $10,000.
Guide to Telehealth – Then, Now, Tomorrow? By Rebecca Chi
Healthcare providers have employed various forms of telehealth since long before the start of the coronavirus pandemic. Telehealth delivers knowledge and expertise to people and places that need it. A movement that largely began as a way to improve access to healthcare in rural communities saw explosive growth in 2020. Today, telehealth is in wide use and here to stay.
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What is telehealth? The US Health Resources and Services Administration defines telehealth as any electronic information and telecommunications technology that is used to support and promote long-distance clinical healthcare, patient and professional health-related education, public health and health administration. Telehealth technologies benefit providers, healthcare organizations and patients.
The importance of telehealth The key to maintaining population health and lowering expenditures is delivering timely access to high-quality care.
The US is struggling to improve the quality of healthcare and make the needed shift to value-based models. Innovative telehealth solutions that addressed our country’s worsening healthcare access problem reached the point of widespread adoption in 2020, when the pandemic pushed the healthcare system to its limits.
Telehealth increases convenience of care and access while decreasing costs and maximizing physician time. Providers, payers and employers are increasingly adopting various and connected types of telehealth solutions to improve healthcare operations and patient outcomes. Patients embrace the convenience, safety, accessibility and flexibility of telehealth options.
On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2022.
In addition to numerous payment updates in the MPFS, such as significant updates to the Merit-based Incentive Payment System (MIPS), new policies may preserve expanded telemedicine services through 2023 and clinicians may incur more difficulty earning bonuses under the Quality Payment Program (QPP) eligibility threshold. CMS also includes in the proposed rule a request for information to address COVID-19 vaccine reimbursement proposals. (Read more...)
Executive Order Expands Tele-Medicine to Ease Burden
By Health Capital Consultants, LLC
On August 3, 2020, President Donald Trump signed an executive order aimed at expanding access to care through two avenues: telemedicine and eased financial burdens on rural providers.
And so, our colleagues for this Health Capital Topics article will discuss the executive rule and the subsequent agency actions on these fronts.
Walmart Health and MeMD, a multi-specialty telehealth provider, announced they have entered into an agreement for Walmart Health to acquire MeMD.
This reinforces Walmart’s commitment to integrated, omni-channel health delivery that leverages data and technology to improve engagement, health equity and outcomes.
The Journal of the American Medical Association not long ago published an online editorial by two physicians at NewYork-Presbyterian that called for the creation of a new medical specialty focused on virtual care.
Others expanded on this idea in a blog post last month on the Health Affairs website, calling for a “virtualist movement” that involves not just physician specialists but whole care teams devoted to virtual care. This virtual team would include nurses, pharmacists, medical social workers, psychologists, nutritionists and physical therapists.
Zebra Technologies recently released survey results from nurse managers and IT executives on clinical mobility. Here are some key findings from the report:
• 65% of hospitals had a mobile device policy in 2017.
• By 2022, 98% of hospitals will expect to have a mobile device policy.
• Half of hospitals have had a predictive data analytics policy for 3+ years.
• 42% of hospitals have had a predictive data analytics policy for < 1 year.
• 3 in 4 IT executives say clinical mobility investments will increase by 2022.
• 97% expect workflow notifications to be sent to mobile devices by 2022.
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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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