www.certifiedmedicalplanner.com | The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

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Life planning has many detractors and defenders. Formally, it has been defined by Mitch Anthony, Gene R. Lawrence and Roy T. Dilibertoof the Financial Life Institute, in the following trinitarian 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 financial advisor or planner, the life of the client becomes the axis around which financial planning develops and evolves.

Other definitions are:

Financial Life Planning is about coming to the right answers by asking the right questions. This involves broadening the conversation beyond investment selection and asset management to exploring life issues as they relate to money.
Financial Life Planning is a process that helps advisors move their practice from financial transaction thinking, to life transition thinking. The first step aiming to help clients “see” the connection between their financial lives and the challenges and opportunities inherent in each life transition.

But, for informed physicians, life planning’s quasi-professional and informal approach to the largely isolate disciplines of financial planning and medical practice management is inadequate. Today’s practice environment is incredibly complex, as compressed economic stress from HMOs, financial insecurity from Wall Street, liability fears from attorneys, criminal scrutiny from government agencies, IT mischief from malicious hackers, economic benchmarking from hospitals and lost confidence from patients all converge to inspire a robust new financial planning approach for medical professionals. Now, add politics and the ACA of 2010.

Our Approach

The iMBA approach to financial planning, as championed by the Certified Medical Planner, integrates the traditional concepts of financial life planning, with the increasing complex business concepts of medical practice management. The former are presented in our textbook on financial planning for doctors. And, the later is in our companion book: “The Business of Medical Practice” www.BusinessofMedicalPractice.com

Others on risk management and insurance; accounting, tax and investing; retirement, practice succession and estate planning, are planned in our future iMBA Handbook series for physicians and their advisors www.MedicalBusinessAdvisors.com

Example

For example, views of medical practice, personal lifestyle, investing and retirement, both what they are 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 the ultimate fear represented by Yale University economist Robert J Shiller, in “The New Financial Order”: Risk in the 21st Century, warns that the risk for choosing the wrong profession or specialty, might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics.

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

Conclusion

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 and http://www.springerpub.com/Search/marcinko

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: CMP Program, Financial Planning | Tagged: Financial Planning, holistic planning, life planning, www.BusinessofMedicalPractice.com, www.certifiedmedicalplanner.com, www.medicalbussinessadvisors.com | 3 Comments »

Meet Speaker Dr. David Edward Marcinko MBA

Posted on February 19, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Management Expert, Social Media Pioneer, Journalist and Financial Advisor

www.BusinessofMedicalPractice.com

I am available for a limited number of speaking engagements each year. As social media’s leading integrated voice for medical and financial service professionals, the ME-P voice was noted by the WSJ.com in 2009, which said that ”This website is packed with great information.” And, medical information technology and eMR guru Alberto Borges MD recently opined “You do have an exceptional website”.

The ME-P’s Reach

With over 250,000 visitors, the ME-P is among the web’s most influential and prominent platforms. I frequently discuss the precarious intersection among medical practice management, financial services, health economics and related social media in keynote speeches, panel discussions, and media interviews.

Journalist

I also use my two decade long medical, surgical, business management and financial advisory practice and journalistic experiences to engage the private practice community, culminating in the third edition of our book: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors].

Locale

I am based near Atlanta, GA, so travel for speaking opportunities is not problematic and very inexpensive.

Curriculum Vitae

Here is my CV: DEM Formal CV

Please contact me if you’re interested in having me engage your divese audience: MarcinkoAdvisors@msn.com

Sincerely,

Dr. David Edward Marcinko; MBA

Certified Medical Planner™
www.CertifiedMedicalPlanner.com

My Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Filed under: Book Reviews, CMP Program, Experts Invited, Financial Planning, Health Economics, Practice Management | Tagged: david marcinko, www.BusinessofMedicalPractice.com, www.certifiedmedicalplanner.com | 3 Comments »

The Uniform Prudent Investor Act versus Fiduciary Accountability

Posted on February 18, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

A Primer and Review for Financial Advisors

By Dr. David Edward Marcinko MBA, CMP™

http://www.amazon.com/Financial-Planning-Handbook-Physicians-Advisors/dp/0763745790/ref=sr_1_1?ie=UTF8&s=books&qid=1276795609&sr=1-1

More than a decade ago Charles L. Stanley, CFP™ gave an overview of the legislation and highlights areas of change for financial advisors and planners and to the financial services industry. To date, the Uniform Prudent Investor Act (UPIA) has been enacted in most states. Essentially, the act changed the legal criteria for “prudent investing” for trusts. All assets owned by a trust are considered “investments” for purposes of the Uniform Prudent Investor Act. Consequently, if a trust owns a life insurance policy or an annuity, it is considered an “investment” for purposes of the UPIA. Trustees and their advisors are subject to the act.

Background Review

The UPIA (California Probate Code Article 2.5) was adopted by the Uniform Conference of Commissioners on Uniform State Laws in 1994. When determining whether or not certain investing is “prudent,” the standard is applied to the whole portfolio rather than to individual investments.

The UPIA radically changes the analysis of risk. The UPIA considers that risk is unavoidable. For example, fixed income instruments carry the risk of loss of purchasing power, even though the principal may not be reduced in terms of real numbers. Risk is often desirable so long as it is sufficiently compensated. The UPIA seeks to compel the trustees to analyze the trade-offs between risks and returns, taking into consideration the needs and objectives of the trust.

Restrictions Reduced

The restrictions on what type of investments can be held in trust have been eliminated. The trustee can invest in anything that plays an appropriate role in achieving the risk/return objectives of the trust and that meets the other requirements of prudent investment. The trustee’s duty to diversify trust assets is codified in the UPIA. It is now recognized that proper effective diversification may enhance returns and/or reduce risk at the same time.

The UPIA rejected the traditional trust rule that generally prohibited “delegation of duty” by trustees, especially the duty of investment of trust assets. Delegation is now permitted, subject to safeguards. Agents are now made liable if they do not follow the new law.

What Must a Trustee Do to Comply with the Act?

According to Stanley, to comply with the UPIA, trustees must review trust assets and make and implement decisions to either keep or discard assets in order to bring the trust portfolio into compliance with the purposes, terms, distribution requirements, and other circumstances of the trust:

The trustee must diversify the assets of the trust unless it is prudent not to do so (16048). For example, it would not be acceptable for the trust to hold all municipal bonds.
The trustee must either comply with the Act in full or have the trust amended to restrict the requirements to diversify trust assets.
The trustee must delegate if he or she believes that he or she doesn’t the expertise to perform certain functions, this is particularly anticipated in the area of investment management. The trustee is expected to document all of the above to be available for review either by beneficiaries and/or courts should they become involved. This includes a written Investment Policy Statement. The act doesn’t specifically require this, but how would one prove they had been acting as a prudent trustee without documentation?
The trustee must periodically review the circumstances, assets and any professional delegates whom he or she has retained to assist him or her. The portfolio must be periodically rebalanced to maintain the established risk/reward characteristics identified in the Investment Policy Statement. This is not specifically stated, but is implied in ¤16047(b) and is a part of proper portfolio management under Modern Portfolio Theory. The act requires the costs of management to be “reasonable.”
The trustee must deal impartially with beneficiaries when there are two or more beneficiaries and must invest impartially, taking into account the differing interests of the beneficiaries.

Note: In most states, trust language can draft the trustee out of any and all requirements of the Uniform Prudent Investor Act. Many attorneys are doing this. So check trust language carefully.

Assessment

This essay is not a “final answer” in regard to compliance with the Uniform Prudent Investor Act. Financial advisors should consult with a competent attorney if you have any questions about a specific application with a specific physician investor or other client.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. How has the fiduciary standard altered the above Act; or the current Dodd-Frank Act [Wall Street Reform and Consumer Protection Act]? 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.

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Ethics, Financial Planning | Tagged: Charles L. Stanley, CMP, david marcinko, fiduciary, Investment Policy Statement, Prudent Investor Act, UPIA, www.certifiedmedicalplanner.com | 18 Comments »

Do Physician Investors and/or their Financial Advisors Use and Abuse Modern Portfolio Theory?

Posted on February 4, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

The Cultural Clash of Passivity versus Activity

By Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

Ninety-three year old Professor Harry Markowitz PhD, coined the phrase “modern portfolio theory” [MPT] and concluded that investors are rewarded for taking certain risks but may not get rewarded for taking others. He developed the notion of an “efficient frontier” for different groups of asset classes and the idea that the higher the expected return, the higher the risk.

The Brinson, Hood, Beebower Study

In their 1986 study, Brinson, Hood, and Beebower attempted to measure three investment activities: (1) asset class selection, (2) market timing, and (3) security selection. They concluded that asset class selection had, by far, the greatest effect on the risk/return characteristics of a portfolio (some 93.6% of performance). But the most startling conclusion was that, if left alone, investment policy would have produced a higher average return than when market timing and security selection were taken into account. These latter factors actually reduced the average return over a 10-year period.

The Fama & French Study

In 1982, Fama and French found that three factors—market exposure, company size, and “value”—were systematic risks that explained the vast majority of equity market returns. “U.S. small-cap value stocks” is therefore a discreet asset class possessing all three of these systematic risks.

Most physicians and financial advisors are aware of modern portfolio theory but some fail to apply the principles to actual investor situations. Three examples: (1) using erroneous asset-class definitions, (2) using actively managed funds, and (3) relying on market timing. The abuse of modern portfolio theory can create portfolios loaded with latent risks that, on the surface, appear benign.

Not all Agree

Not everyone is in agreement with modern portfolio theory. Some detractors agree in principle, recognizing, for example, that “value” stocks have had higher returns than “growth” issues but they cite the cause as “mispricing” rather than risk.

Assessment

Institutional investors have gradually increased their commitment to passive strategies from virtually zero 20 years ago to 30% or more in the last decade [Think: Vanguard].

Individual and physician investors, on the other hand, have less than a 5% commitment.

Note: “Modern Portfolio Theory: Fact or Fiction?,” Gerard F. Stellwagen and Robin P. LaCouture, NAPFA Advisor, July 1997, pp. 1–7, National Association of Personal Financial Advisors for Fee-Only Financial Advisors.

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.

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: CMP Program, Investing, Portfolio Management | Tagged: Brinson, david marcinko, Efficient Frontier, Fama & French, financial advisors, Harry Markowitz, Hood and Beebower, Modern Portfolio Theory, MPT, www.certifiedmedicalplanner.com | 9 Comments »

A Doctor-Financial Advisor Makes the Case for Stock-Market Timing

Posted on February 2, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Do a Growing Number of Stock-Market Timers Outperform?

By Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

Money management styles tend to fall in and out of favor in cycles. When the market goes through a sustained bull market, buy-and-hold becomes the proclaimed path to investing success as I have opined previously. But, when the market enters a bear phase, like the flash crash of 2008-09, there is renewed belief in market timing as I now try to explain.

The Studies

And yet, studies of actual results of professional money managers using market-timing techniques reveal that the average timer’s results, like the average mutual fund, slightly lag behind the market indexes. But a growing number of timers consistently outperform the market over a full market cycle. When risk-adjusted return is used as the standard to measure performance, even the average market timer outperforms the market by a notable margin. A study of 25 market timers by Wagner, Shellans, and Paul (1992) during the period 1985–1990 (both bull and bear) shows that the level of risk assumed by the average timer was 40–60% below the S&P 500, even after subtracting fees, and the returns were comparable to the S&P 500.

Marketplace Phases

History has shown that starting from the market’s last high water mark, the market typically goes through three phases: (1) a correction, (2) a recovery to breakeven, and (3) a move to new highs. A study of the 108-year period from 1885 to 1993 reveals that the average correction phase consumed 32% of the time period and the return to breakeven exhausted an additional 44%. The market spent only 24% of the time moving to new highs. This is the only time that typical buy-and-hold investors saw their investments appreciate. This makes the stock market an extremely inefficient money-making vehicle.

Since the market timer who sold at the top will have more money at the bear market bottom than the buy-and-hold investor, the study indicates that the timer may have between 26% and 54% more to invest on the upswing. The study also shows that a timer does not have to be perfect in discerning entry and exit points. In fact, he or she can miss 20% of the advance, participate in 20% of the decline, and lose money as much as 47% of the time and still have an average gain equal to the net average gain for the buy-and-hold investor.

Assessment

Of course, it is quite a feat to obtain all the returns attributable from the buy-and-hold strategy while being in the market about half the time.

Note: “Why Market Timing Works,” Jerry C. Wagner; The Journal of Investing; Summer of 1997, pp. 78–81, Institutional Investor, Inc.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Did I make my case? Are you a market timer or buy-hold strategist; and why? Did this strategy work until the market meltdown of 2008-09; how about since then? 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.

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

Filed under: CMP Program, Investing, Portfolio Management | Tagged: david marcinko, Investing, Shellans, Stock Market Timing, Wagner, www.certifiedmedicalplanner.com | 2 Comments »

Do SPDRs Yield Tax Advantages?

Posted on January 30, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

How about Trading Efficiency?

By Dr. David Edward Marcinko; MBA CMP™

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

[Publisher-in-Chief]

The bull market generated large mutual fund capital gains distributions at the end of 2007; and maybe again for 2011. Accordingly, tax efficient mutual funds are getting more attention as a result. Also growing in popularity is Standard & Poor’s Depository Receipts (SPDRs), sponsored by and traded on the American Stock Exchange (AMEX). SPDRs are trusts that own stock positions that match a particular index, like the S&P 500. Investors then buy shares of the trust.

The Facts about SPDRs

Investors sell their shares of SPDRs on the Exchange rather than redeeming shares through the mutual fund. The trust does not sell stock to make cash redemptions. This avoids most of the capital gain distributions that annoy long-term investors. As a prospectus from the American Stock Exchange notes:

In-Kind Redemptions

While no unequivocal statement can be made as to the net tax impact on a conventional mutual fund resulting from the purchases and sales of its portfolio stocks over a period of time, conventional funds that have accumulated substantial unrealized capital gains, if they experience net redemptions and do not have sufficient available cash, may be required to make taxable capital gains distributions that are generated by changes in such fund’s portfolio. In contrast, the ‘in kind’ redemption mechanism of SPDRs may make them more tax efficient investments under most circumstances than comparable conventional mutual fund shares.

Fund Trading and AMEX Insight

The AMEX prospectus not only provides a detailed look at the in-kind redemption mechanism of the SPDRs, which is important to their tax efficiency, it also offers analysis of the economics of intraday SPDRs fund trading. Unlike mutual funds, for which prices are determined at the end of each trading day, SPDRs can be bought or sold at anytime during the day at the spot price. SPDRs trade like a stock, so the account does not need futures approval and shares can be sold short or margined. The SPDRs shares track the futures closely.

Assessment

The reservation that physicians and all investors, as well as we financial advisors, have is simply “Are the SPDRs expensive to trade?” The AMEX prospectus does not answer that question in so many words, but it provides the data needed to make a cost calculation. In 1996, the bid/asked spread on the SPDRs was 1/16 or less more than 62% of the time and 1/8 or less about 95% of the time. Each investor can make his or her own commission assumptions, but the range on the S&P 500 exceeded 0.5% more than 75% of the time and was greater than 1% approximately 25% of the time. With such a narrow bid/asked spread relative to the average move in the shares and a reasonable level of commissions, it is often easy to get in or out of the fund at a price appreciably better than closing NAV.

Assessment

What are these spreads today? Copies of the prospectus and other information on SPDRs are available by calling 1-800 THE AMEX

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Do you use SPDRs; why or why not? 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.

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

Filed under: CMP Program, Investing, Portfolio Management | Tagged: American Stock Exchange, AMEX, david marcinko, SPDRs, Standard & Poor’s Depository Receipts, www.certifiedmedicalplanner.com | Leave a comment »

Why Classic Retirement Planning Often Fails Doctor Colleagues?

Posted on January 27, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Monitor the Money – Not the Returns

Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

While taking my certified financial planner courses to earn the CFP® designation, almost two decades ago at Oglethorpe University in Atlanta, I learned that in classic retirement planning engagements the financial planner or advisor determines the client’s retirement income needs, the assets already earmarked for the retirement portfolio, the desired retirement date, how distributions will need to be made, the assumed inflation rate, and life expectancy, etc.

Then, if a shortage develops, the advisor changes the asset allocation, increases the savings rate, proposes postponing retirement, or suggests reducing retirement income expectations, etc.

However, later in business school I learned that even when the inflation rate and investment returns prove to be accurate; this approach often fails doctors and all investors.

Geometry not Arithmetic

Why? Most planners focus on the wrong thing when monitoring portfolios. Possibly, there is confusion between compounding investment returns and compounding wealth. Planners tend to compound the arithmetical average return in projecting ending wealth over multi-period horizons. But, the accumulation of wealth is determined by the geometric compounding of actual returns.

Law of Large [Small] Numbers

Still later on in B-school, I learned of the LoLN [normal distributions, parametric equations and cohorts], as well as Poisson distributions [non-normal or asymmetric distributions, and non-parametric equations and cohorts] or Law of Small Numbers.

Planners and Advisors often believe in the former Law of Large Numbers, and eschew [or are unaware of] the later — that is, that over time, average annual returns will approach ever more closely the expected return. The longer the investment horizon, the further the portfolio can wander from its expected dollar value despite the fact that it is approaching its expected return. The future value of each portfolio is determined by the unique and unpredictable pattern of compounded returns and inflation it suffers.

IOW: The longer the period over which this pattern can exercise its effects, the greater the potential divergence from its required return. In fact, while the expected range for the annualized rate of return narrows over time, the expected range for the terminal value of the portfolio diverges over time.

Assessment

Today, forward thinking advisors use “portfolio sufficiency monitoring” to adjust nominal performance results for inflation by establishing benchmarks for performance objectives, setting triggers for reevaluation of the portfolio when it wanders too far from established benchmarks, and monitoring and adjusting portfolio risk to maximize the probability of meeting retirement portfolio objectives.

It answers the question: “Will I have sufficient assets to meet my retirement income needs?” while investment performance monitoring answers the question, “Is my retirement portfolio performing well relative to other portfolios?” My doctor clients retire; not others!

Note: Monitoring Retirement Portfolio Sufficiency,” by Patrick J.Collins, Kristor J. Lawson, and Jon C. Chambers, Journal of Financial Planning, February 1997, pp. 66–74, Institute of Certified Financial Planners.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. How do you monitor your portfolio? And, how do FAs perform same for their physician and other clients. 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.

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

***

Invite Dr. Marcinko

***

Filed under: CMP Program, Financial Planning, Investing, Portfolio Management, Retirement and Benefits | Tagged: CMP, Investing, Law of Large Numbers, normal distributions, Poisson distributions, Portfolio Management, retirement planning, www.certifiedmedicalplanner.com | 4 Comments »

On the Rise and Fall of Limited Partnerships

Posted on January 24, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Taking A Historical Look at this Investment Vehicle

By Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

Back in the 1980s – a time I am loathe admitting that I remember well – limited partnerships (LPs) were all the rage and often touted as the investment vehicle of the future; especially to tax-averse physicians and high income medical professionals and investors.

Oil and gas and real estate LPs dominated the market. But, there were also cattle feeding, master recording disks, equipment and aircraft leasing, and cable TV investments. The LP heyday was 1983 through 1989, and most early LPs were private or non-publicly traded.

Popularity Rising

Why were they so popular? LPs provided the benefits of direct ownership (income potential and tax benefits) without management responsibility and personal liability. Losses were limited to one’s original investment. Brokerage firms pushed them hard, paying their sales representatives [financial advisors?] the highest commissions and often characterizing these risky investments as “safe” and a “means of capital preservation.”

Early ’80s

In the early 80s, investors could use depreciation, interest, and investment tax credits to offset not only LP income but ordinary income from salary and other investments. This was a huge incentive for high income earning doctors. In 1981, the Tax Act allowed accelerated depreciation for real estate, and non-recourse debt was treated as depreciable cost (partners bore no risk of economic loss). Soon, the IRS began to attack LPs. Both real estate and oil and gas values declined. LPs soon became illiquid investments, producing little or no return.

’86 Tax Act

Then came the Tax Reform Act of 1986 (TRA), which brought with it “at risk” limitations to real estate tax shelters and the new passive loss provisions. LP sales then spiraled downward. The ’86 Tax Law provided that limited partners could not increase their basis in the LP for their share of partnership debt unless they were personally liable for repayment or if the lender had an interest other than as a creditor (unless “qualified non-recourse debt” was used).

1990s

In the ’90s, investors either hung on to – or sold – their LP investments in the secondary market. Investors were subject to substantial discounts upon sale and they had to recapture tax benefits previously received (including those from non-recourse financing).

Assessment

Simply abandoning these investments did not avoid unfavorable tax consequences, such as the decrease in a partner’s share of partnership liabilities being treated as a cash distribution. Capital gains were recognized to the extent that a partner’s share of partnership liabilities exceeds the adjusted basis of the partner’s interest.

Note: “What Happened to Limited Partnerships?” Lee Knight and Ray Knight Journal of Accountancy, July 1997, pp. 37–42, American Institute of Certified Public Accountants.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Were you burned by LPs back in the day, or have a LP story to tell us? Please opine. 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.

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

Filed under: CMP Program, Investing, Taxation | Tagged: CMP, david marcinko, limited partnerships, oil LPs, real estate LPs, Tax Reform Act of 1986, www.certifiedmedicalplanner.com | Leave a comment »

How Doctors Divvy Up the Estate Money [New Spouse v. Kids]

Posted on January 23, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

The Kids of a New Spouse

Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

Multiple marriages entail interesting estate planning moves. Why? In these days of multiple marriages, doctor clients and others often can get caught between wanting to provide for their children from a previous marriage and their spouse’s statutory inheritance rights. Depending on the state of residence, the surviving spouse may have a statutory right to a specific share of his or her spouse’s estate. But, states define what constitutes the “augmented estate” in different ways. Some fairly sophisticated estate planning may be appropriate.

States Right’s

Inasmuch as spousal rights of election were codified many decades ago when divorce was not a common occurrence, many states’ statutes do not fairly recognize the economics and family dynamics of married individuals who have children from a prior marriage. In some states, a spousal right of election is limited to those assets that pass through probate. In other states, the right of election is enforceable against not only probate assets but certain assets, such as jointly held property that would otherwise pass via title to the co-owner, gifts the decedent made within a certain time period prior to death, and life insurance benefits. This expanded pool of assets against which the right of election may be assessed is typically referred to as the “augmented estate.” Most states provide that the right of election is charged ratably against the beneficiaries under the decedent’s will and the beneficiaries of any testamentary substitutes.

The UPC

In many states, the same percentage would apply regardless of the length of the marriage. In 1990, the model Uniform Probate Code (UPC) was amended to provide a scaled right of election based on the length of the marriage. It ranges from a minimum of 12% up to a maximum of 50% for marriages of 15 years or more. Only a handful of states have adopted it. Even though the UPC includes pension and profit sharing plan benefits in the augmented estate, the sliding scale is subordinate to federal pension legislation which can result in an inequity in the case of a short-term marriage.

Assessment

While both pre- and post-nuptial agreements can help, life insurance is favored, particularly in the majority of states where it is excluded from the augmented estate. And, in states where life insurance is part of the augmented estate, it could be used to provide the surviving spouse with his or her share, particularly when a closely held business is passed on to children of a prior marriage. Financial planners, doctors and advisors need to be familiar with this area to effectively serve clients.

Note: “Providing for Children from a Prior Marriage: An Estate Planning Entry Point,” George B. Kozol, Journal of the American Society of CLU & ChFC, January 1997, pp. 52–57, American College.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Estate Planning, Financial Planning | Tagged: CMP, david marcinko, Estate Planning, Multiple marriages, physician divorce, Uniform Probate Code, UPC, www.certifiedmedicalplanner.com | 3 Comments »

On FAs Working with Terminal Clients

Posted on January 20, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Unique Challenges Financial Planners Face when Advising Dying Clients

By Dr. David Edward Marcinko MBBS DPM MBA MEd CMP™

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

[Publisher-in-Chief]

We doctors are comfortable – or at least familiar – in dealing with death; financial advisors and planners are not!

Although many financial planners attend conferences to keep current on sophisticated planning techniques, most are not emotionally equipped to service terminally-ill clients. Others claim that there’s intensity and an intimacy that comes with working with dying clients that can be deeply rewarding. Such clients are usually grateful for having their affairs put in order before death. The few FAs in the industry that are both physicians and advisors concur.

Myriad of Issues

The many issues that need to be addressed in these situations include:

1. How the client wants to spend their final months, what it will cost, and what impact it may have on the estate;

2. Whether to spend money [health insurance navigation] on expensive and also experimental medical treatments;

3. If there is an existing life insurance policy; the pros and cons of accelerated benefits or viatical settlements;

4. Spending down or gifting assets to reduce estate taxes;

5. How long to keep working;

6. Taking important actions while still competent to do so;

7. Deciding whether to transfer assets to the dying client (one year survival) in order to get a step-up in basis at death;

8. Helping clients decide what type of funeral or final arrangements are preferred;

9. Working with the surviving spouse to restructure final financial affairs.

Rules-of-Thumb

Financial rules of thumb are often reversed in these situations. Instead of maximizing gains, the goal is to minimize losses. Macro-planning gives way to micro-planning and crisis management. Surviving spouses may be torn between wanting to pay for treatments to save his or her spouse and to protect the funds available in the event of the spouse’s death.

Assessment

Emotional turmoil does not necessarily end with the client’s death. As the financial advisor, you may take long, tearful phone calls from a surviving spouse whose grief and anxiety has been transformed into fears about their finances. Sometimes their fear can result in irrational anger, which they may take out on you. This type of work is not for the weak-spirited.

Note: “Final Plans,” Anita J. Slomski, Dow Jones Investment Advisor, March 1997, pp. 76–82, Dow Jones Financial Publishing Corp.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. As a FA, do you work with the terminally ill? 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.

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

***

Filed under: "Advisors Only", Career Development, CMP Program, Financial Planning | Tagged: CMP, david marcinko, dying clients, terminal clients, www.certifiedmedicalplanner.com | 2 Comments »

The Living Legacy of Dr. Harry Markowitz

Posted on January 19, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Creating Diversified Portfolios of Uncorrelated Assets

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

More than a half century ago, a paper appeared in The Journal of Finance written by a 24-year-old doctoral candidate in economics at the University of Chicago—Harry Markowitz. It was called “Portfolio Selection” and suggested that investors take into account risk in pursuit of the highest return—a concept that we take for granted today [Modern Portfolio Theory].

Markowitz drew a trade-off curve between risk and reward and called it the “efficient frontier.” A rational physician executive or other investor who knew his or her risk tolerance could choose an appropriate portfolio from a point on this curve. Markowitz led investors to diversified portfolios of uncorrelated investments.

Dissertation Follow-up

Markowitz followed up his dissertation in 1959 with a book entitled Portfolio Selection [Efficient Diversification of Investment]. His many contributions to finance earned him the Nobel Prize in Economic Science in 1990 along with William Sharpe and Merton Miller. He reasoned that diversification is about avoiding the covariance.

If risks are uncorrelated, you can reduce the risk of a portfolio to practically zero by sufficient diversification. This doesn’t work if risks are correlated. If one invests in a very large number of securities that are correlated, risk does not approach zero but rather the average covariance, which is a very substantial amount of risk.

Where It All Started

It was at the RAND Corporation that Markowitz met William [Bill] Sharpe who was working on his PhD at UCLA. Markowitz takes issue with Sharpe’s Capital Asset Pricing Model (CAPM), which claims that the expected return of a security depends only on its beta—ignoring fundamental analysis.

CAPM also implies that the market portfolio is efficient, even though investors in the market may not act rationally. It says that the market portfolio is a mean-variance efficient portfolio. Markowitz disputes this conclusion. He points to Fama and French and others who have found that expected returns are more closely related to book-to-price or size—not to beta.

Assessment

The still living Markowitz fends off criticism of mean-variance analysis only being valid when probability distributions are normal by stating that he realizes that probability distributions are not normal in the real world.

But, if they are similar to a normal distribution, mean variance does a good job at approximating expected utility. He admits that when they are too dispersed, mean variance doesn’t work well.

Note: Travels along the Efficient Frontier,” an interview with Harry Markowitz by Jonathan Burton, Dow Jones Asset Management, May/June 1997, pp. 21–28, Dow Jones Financial Publishing Corp.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Do you use MPT when investing, or CAP-M? 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.

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: CMP Program, Investing, Portfolio Management | Tagged: Capital Asset Pricing Model, CAPM, CMP, david marcinko, Fama and French, Harry Markowitz, Merton Miller, Modern Portfolio Theory, MPT, William Sharpe, William [Bill] Sharpe, www.certifiedmedicalplanner.com | 1 Comment »

How Investors View Financial Advisors?

Posted on January 14, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

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A Public Opinion Survey

Dr. David Edward Marcinko MBA CMP™

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

Boston-based Dalbar company is a surveyor of financial information for the mutual fund industry. About a decade ago Dalbar released a nine-part survey on personal financial advice to measure the level of demand for advice that existed back then and to ascertain consumer preferences, expectations, beliefs, and sources for personal financial advice.

Now, please allow me to suggest that all FA colleagues use the results to evaluate your current practices and planed initiatives to determine how current thinking must change to meet today’s and tomorrow’s needs. And so, we now share some of the results of this survey.

Customer Expectations of Personal Financial Advisors

• Investors and prospective investors expect their personal financial advisors to educate them about investments and to minimize the taxes they pay.

• Unrealistic expectations present a major problem to personal financial advisors. The expectations for advisors to produce the highest returns, prevent investing mistakes, and avoid losses set the stage for disappointment in the future, thus undermining the public trust of advisors.

• Advertising, training, compensation, and industry practice is out of step with customer expectations. This survey indicates that emphasis in all these areas should be directed to vastly simplify education, increase use of tax saving strategies, and help investors to define financial goals.

Demand for Personal Financial Advisors

• Of the consumers surveyed, 89% report the need for a personal financial advisor for assets of $100,000 or more. This contradicts the notion that a growing number of people prefer to do-it-themselves. This finding presents the advisor with an opportunity: The demand for advice is higher than the market would suggest.

• The demand for advice, as measured by the Advice Demand Index (ADI) is highest among those who prefer to pay for advice through commissions. The ADI is highest for commission-payers at 93%, followed by those who prefer to pay a percentage of their assets (92.5%). Flat-fee payers have the lowest demand for advice, at just 88.7%.

Importance of Personal Financial Advice Functions

• Consumers unanimously agree that the ability of their advisor to provide clear explanations of investment alternatives, to be available when needed, and to keep them informed of their investment status are the most important financial advice functions.

• Consumers revealed that the delivery of a comprehensive written financial plan is the least important function that their advisor performs.

Assessment

This report was not physician specific so one wonders how applicable it is to medical providers; especially the “no-desire” for a financial plan part?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Are the results still valid today; or after the 2008-09 “flash crash”? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Filed under: "Advisors Only", CMP Program, Experts Invited, Financial Planning | Tagged: David Edward Marcinko, financial advisors, stock-brokers, www.certifiedmedicalplanner.com | 5 Comments »

Defining Health Level Seven [HL-7]

Posted on January 14, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – How it works?

By Dr. David Edward Marcinko MBA CMP™

http://www.springerpub.com/Search/marcinko

[Publisher-in-Chief]

HL7 is an international community of health care subject matter experts and information technology physicians and scientists collaborating to create standards for the exchange, management, and integration of protected electronic health care information. The Ann Arbor, Mich.-based Health Level Seven (HL7) standards developing organization has evolved Version 3 of its standard, which includes the Reference Information Model (RIM) and Data Type Specification (both ANSI standards).

HL7-3

The HL7 Version 3 is the only standard that specifically deals with creation of semantically interoperable health care information, essential to building the national infrastructure; HL7 promotes the use of standards within and among health care organizations to increase the effectiveness and efficiency of health care delivery for the benefit of all patients, payers, and third parties; uses an Open System Interconnection (OSI) and high level seven health care electronic communication protocol that is unique in the medical information management technology space and modeled after the International Standards Organization (ISO) and American National Standards Institute (ANSI); each has a particular health care domain such as pharmacy, medical devices, imaging, or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data.

The Goals

Goals include:

develop coherent, extendible standards that permit structured, encoded health care information of the type required to support patient care, to be exchanged between computer applications while preserving meaning;
develop a formal methodology to support the creation of HL7 standards from the HL7 Reference Information Model (RIM);
educate the health care industry, policymakers, and the general public concerning the benefits of health care information standardization generally and HL7 standards specifically;
promote the use of HL7 standards world-wide through the creation of HL7 International Affiliate organizations, which participate in developing HL7 standards and which localize HL7 standards as required;
stimulate, encourage, and facilitate domain experts from health care industry stakeholder organizations to participate in HL7 to develop health care information standards in their area of expertise;
collaborate with other standards development organizations and national and international sanctioning bodies (e.g., ANSI and ISO) in both the health care and information infrastructure domains to promote the use of supportive and compatible standards; and
- collaborate with health care information technology users to ensure that HL7 standards meet real-world requirements and that appropriate standards development efforts are initiated by HL7 to meet emergent requirements.

Assessment

HL7 focuses on addressing immediate needs but the group dedicates its efforts to ensuring concurrence with other U.S. and International standards development activities. Argentina, Australia, Canada, China, Czech Republic, Finland, Germany, India, Japan, Korea, Lithuania, The Netherlands, New Zealand, Southern Africa, Switzerland, Taiwan, Turkey, and the United Kingdom are part of HL7 initiatives.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Career Development, CMP Program, Glossary Terms, Information Technology | Tagged: CMP, david marcinko, Health Level Seven, Hl 7, www.certifiedmedicalplanner.com | 2 Comments »

Going ‘Bare’ Might be an Expensive Mistake

Posted on January 13, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

An Opinion on E & O Insurance for FAs

Dr. David Edward Marcinko MBA CMP™

http://www.amazon.com/Insurance-Management-Strategies-Physicians-Advisors/dp/0763733423/ref=sr_1_3?ie=UTF8&s=books&qid=1275315795&sr=1-3

[Publisher-in-Chief]

This post is not about medical malpractice liability insurance. As a doctor, financial advisor and insurance agent I have written and opined on this subject before; informally on this blog and more formally through our handbooks:

and, of course, pragmatically with clients: www.MedicalBusinessAdvisors.com

No, this post is about Errors and Omissions insurance for financial advisors.

About E & O Insurance for FAs

Like many physicians, most financial planners and advisors are confident that the way they practice minimizes the chance of being sued by a disgruntled [patient] client. And, perhaps that has been their experience so far. But just one arbitration case for a substantial claim can cost $10,000 or more, and a conventional lawsuit that goes to court with a jury trial will run about $50,000, even if it’s a totally bogus claim. With the cost of errors and omissions coverage for financial advisors now down to between $650 and $2,000 per year, it doesn’t make much sense to “go bare;” especially after the highly emotional 2008-09 debacle.

Historical Past

In years past, most financial planners opted to go without insurance because premiums on E&O policies ran about $7,500 -10,000 per year. Most of them should think again and take the same advice they give their clients—insure for catastrophic loss. We all know that when the stock market bubble finally bursts, there will be a lot of unhappy clients looking to recoup losses. What better time than now while things are good to put E&O coverage in place.

E & O Coverage

E&O policies cover errors, misstatements, negligence, breach of duty, and other wrongful acts, but fraudulent acts are usually not covered. Many major broker/dealers carry group coverage for the affiliated planners. Deductibles are typically $5,000 per planner and $20,000 for the firm. Policies are not standard—coverage can vary widely. Some cover insurance, some cover only securities, investment advisory and financial planning, and some cover other investment advice (e.g., real estate, franchises, etc.). Make sure the policy you buy covers what you actually do.

Claims-Made Policies

Be aware that these policies, like malpractice coverage, are on a “claims-made basis” rather than an “occurrence basis.” Therefore, prior acts are not usually covered unless the planner had continuous coverage with an insurer since the act was committed. As a result, it is essential to never permit a gap in coverage inasmuch as this could break the chain necessary for coverage of prior acts. So, this is where “tail coverage” comes into play; and it might be expensive!

Assessment

Experts point out that the biggest reason planners get sued is failure to diversify the client’s portfolio adequately. A fair [majority?] number of “financial advisors” are “one-product” sales people who always sell the product they know. This can be an expensive modus operandi. You only buy professional liability insurance because you cannot afford the consequences.

Note: “Minding Your Es & Os,” by Eric L.Reiner, Dow Jones Investment Advisor, February 1997, pp. 56–61, Dow Jones Financial Corp. [908] 389-8700)

Conclusion

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

Physician Advisors: www.CertifiedMedicalPlanner.org

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

Filed under: "Advisors Only", CMP Program, iMBA, Inc., Op-Editorials, Professional Liability | Tagged: broker/dealers, CMP, david marcinko, E & O Insurance for FAs, www.certifiedmedicalplanner.com, www.medicalbusinessadvisors.com | 5 Comments »

More on Disability Insurance for Physicians

Posted on January 12, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Some Advice from a Doctor, Insurance Agent and Financial Advisor

Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

Policies Are Harder to Get, More Expensive, and Offer Less Protection Than Before

Due principally to large claims from anesthesiologists, surgeons, emergency room physicians, and trial attorneys, disability insurance underwriting is becoming stricter. Among the effects on policyholders: revised definitions of disability; restriction of benefits to two years on so-called “soft tissue” disabilities and mental and nervous disorders; and downgrading of professionals to the general white-collar category. The result is higher premiums.

Buy a Good Individual Policy

Based upon the fact that disability is the only insurance product on the market that is non-cancelable (premiums and policy features are locked in until age 65), my advice is to buy a good quality individual policy as early as possible and hang on to it. Group benefits should be added later. Also, many group plans only include straight salary in compensation. Incentive compensation, which makes up a large portion of an executive’s compensation, is not considered. Under the Revenue Reconciliation Act of 1993, employee disability benefits can only cover up to $150,000 in compensation. Finally, don’t forget that if the employer pays the premiums, benefits are taxable. This can substantially reduce an executive’s disability income.

Pay More for Non-Cancelable Coverage

I also may recommend paying a 15–20% higher premium to obtain non-cancelable coverage, if available, as compared to guaranteed renewable coverage. In both cases, coverage cannot be canceled. However, in the latter case, premiums can be increased on a class basis. Also, investigate the partial-disability benefits as well as the residual benefits after returning to work.

Note: “Your Disability Is Your Opportunity,” by Jaberta C. Evans, Dow Jones Investment Advisor, December 1996, pp. 76–80, Dow Jones Financial Publishing Corp., [908] 389-8700.)

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Ask-an-Advisor", "Doctors Only", CMP Program, Insurance Matters, Op-Editorials | Tagged: CMP, david marcinko, Disability Insurance Physicians, www.certifiedmedicalplanner.com | 8 Comments »

On Stock Market [Mis]Timing Strategies

Posted on January 11, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Do They Come Up Short?

Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

Stock market investment rules are notorious for showing profit when tested on the same sample period from which they were developed, and then failing when applied to a new period. According to Professor Roger C. Vergin, it’s dangerous to use the same data to both discover and test the rules.

Of Marty Zweig

Using the “Zweig Strategies” developed by Martin Zweig and published back in 1986 in Winning on Wall Street (WOWS), Professor Vergin shoots some rather sizable holes in Zweig’s indicators by testing them against the 10-year period since WOWS was published. Zweig’s models are applied to various periods from 19 to 33 years, ending in 1985, and they claim to outperform a buy-and-hold strategy with annual rates of return as much as eight times as large, according to some measures. When the author ran these strategies for the 10-year period ending Dec. 5, 1995, not only did they not outperform a buy-and-hold strategy, but they trailed the market averages by a significant amount—9% vs. 14.4% for buy-and-hold.

The “Z” Indicators

Zweig’s indicators include a prime rate indicator, a Federal Reserve indicator, an installment debt indicator, a 4% indicator (market momentum), a monetary model, and a “super” model, which Zweig referred to as “the only investment model you will ever need.”

Vergin corrects for inconsistencies in the evaluation criteria from one strategy to the next in WOWS and runs the numbers for the original test period first. Zweig’s strategies still outperform buy-and-hold. But, when run against an independent time period, as the author has done, the wheels fall off. Vergin runs the Zweig Strategies against the S&P 500, the Value Line Index, and an index developed by Zweig called ZUPI (all NYSE stocks).

Assessment

Over the 10-year period, none of the six Zweig Strategies outperformed a simple buy-and-hold strategy when compared against any of the three indexes mentioned above. They produced an average return of 9% compared to 14.4% for buy-and-hold.

In fact, Dr. Burton Malkiel’s [personal communication] conclusion in his book A Random Walk Down Wall Street, was that: “market timing is likely, not only to not add value, but to be counterproductive” seems to have borne out again.”

Note: “Market-Timing Strategies: Can You Get Rich?” by Roger C. Vergin. The Journal of Investing, Winter 1996, pp. 79–85, Institutional Investor, Inc. [212] 224-3185)

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. By trying enough patterns against past events, one can always find simple rules that “would have” worked well in the past. But, do they hold up against differing periods of time; like say 2008-09? … At least not yet! What do you think?

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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Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

Filed under: CMP Program, Investing, Portfolio Management | Tagged: A Random Walk Down Wall Street, Burton Malkiel, CMP, David Edward Marcinko, Federal Reserve, Marty Zweig, Roger C. Vergin, Stock Market Timing, www.certifiedmedicalplanner.com, ZUPI | 2 Comments »

Are You Scared of Investment Losses?

Posted on January 10, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Well Doctors – You Should Be!

By Somnath Basu PhD, MBA
President: AgeBander
Thousand Oaks, CA

There is a very simple way for medical professionals, and us all, to approach investment decision making. To start with, begin by asking yourself some basic and preliminary questions such as what is the investment for (to buy a house, to fund a kid’s education, or is it to fund retirement and the like) and how long these investments will last (for example, up to 40 – 50 years sometimes when one starts planning for retirement early).

Basic Questions

Once these basic questions are answered then ask this $64 million dollar question of your-self. Over your planning time horizon, how much of this money are you willing to lose? For example if you are trying to accumulate $100,000 for a house, how much could you afford to lose and still not lose your bearings? What if it is a five-year plan and in the 4^th year you lose 50% of your accumulated funds with only one more year to go. How would you feel? This is the critical question in any investment decision. Typically you will not hear a financial planner [FP] or financial advisor [FA] talk in such terms; but perhaps they should!

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

Conservative Investing

When financial planners and financial advisors talk about conservative investing, they couch the same idea in terms of risk and return. In the language of these experts such measures are often quantitative and difficult to understand for the average investor. While return on investments seems like a fairly straightforward concept (8% or 11% for example), risk is mentioned usually in terms of standard deviation, a statistical terminology difficult both to explain and to understand. Hence, most physicians and investors are pretty much in the dark when it comes down to making the decision itself since it is their sole responsibility. Thus, the investor is left with no other choice but to decide on whether the suggested investment return sounds attractive or not. On this track, the higher the return, the more attractive the investment seems.

Furthermore, FAs may suggest that a return such as 8-10% is a conservative rate whereas 12-15% is aggressive. Hence if an 8-10% based investment is being suggested, the investor is likely to go with what she/he thinks is the most conservative decision, being the conservative investors they believe they are. (As an aside, there is a whole theory about physician investors being conservative and risk averse)

Unwinding the Mystery

To unwind this basic mystery, simply ask the FA the likelihood of various amounts of losses in any single year including the last year of the investment. Could half your funds be wiped out in any year including the last year? What is the likelihood of such an event? What is the likelihood that it could be 25% in any given year? Suppose your planner shows how your $100,000 will grow to $150,000 in five years if you were to earnings the average rate of 8% per year for five years. Under such a scenario, what is the likelihood that you could lose half your accumulated funds in the last year and come out with a negative investment return even though you still earned that 8% average rate over the five years? As we know now such possibilities not only exist but are not uncommon either. As an extreme case in point consider the 2008-09 financial debacle [flash-crash]! If your investment was maturing in 2009, the outcome would have been a lot worse.

The Driver of Concern

This concern of loss is what should drive us in our investment decisions. Most planners are unable to explain this concept of loss aversion to their clients because they themselves are not adequately educated to understand the concept themselves. However, as mentioned before, the solution is simple. Now reconsider the example above of earning an average annual rate of 8% over 5 years. While it sounds conservative on the surface, it is actually quite aggressive. Earning 8% a year for five consecutive years (or averaging out over the five years to an 8% rate) is a very tall order. To do so, especially under most circumstances, one would actually be exposed to a large amount of loss in any given year.

Without getting into the details of how the standard deviation measurement of risk converts into the loss propensity and using very rough estimates, another way to view the 8% investment opportunity is to understand that in any year, you may not even earn a dollar (0%) and this could happen in each and every year. The likelihood of such an outcome is astonishingly high – about 25%. Thus, the investment decision is about whether you are willing to bet where the odds of loss is one to four (25%) every year for each of the five years. Of course the reverse is also true that in each of the years you have a 75% chance to earn a positive return on your investment and the earning rate itself could be anywhere from zero to the highest rate imaginable. Further, there is a 12% chance that you could be actually losing 8% a year for each of the five years! In prolonged economic downturns, which are not so uncommon, such are the outcomes. Now ask yourself this question: If you were told about these odds of losses, would you still consider the 8% investment opportunity to be conservative? Hopefully not, especially when you feel unsettled about the existing economic state of affairs. Further, would you consider a 10% return to be attractive and conservative if you were rejecting a 15% investment and choosing the 10% one?

Assessment

As mentioned earlier, this idea of loss aversion is probably the most powerful tool in the investor’s bag. Once you understand the implications of loss from any investment decision, then the loss aversion approach to making this decision is a dimensional shift, something that can be easily understood and applied by all investors. Furthermore, if most physicians and investors behaved similarly, collectively we would make the investment market a much safer place. Unfortunately for now, there are no known ways of educating all investors about this critical aspect since the tools that currently exist are all based on statistical concepts of risk and return which make little sense to most lay investors.

Conclusion

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Filed under: CMP Program, Financial Planning, Investing, Portfolio Management | Tagged: CMP, Financial Planning, Investing, Somnath Basu, www.certifiedmedicalplanner.com | 1 Comment »

PhysAssist Scribes for eMRs [Necessity or Frivolity?]

Posted on January 5, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

On Human eHR Input Devices [aka Personal Secretaries]

By Dr. David Edward Marcinko MBA CMP™

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

What it Is – How it Works?

According to their website, PhysAssist Scribes provide turn-key solutions, recruits, interviews, trains and certifies staff, schedules and maintains highly-trained human eHR input scribes for their clients [$8-10/hour wages]. Emergency room departments and physicians were an initial target market.

Data Input Services

Scribes provide real-time charting for physicians by shadowing them throughout their shifts and performing a variety of tasks including recording patients’ history and chief complaints, transcribing the physical exam, ordering x-rays, recording diagnostic test results, and preparing plans for follow-up care, etc.

Typical Clients

Clients are mostly hospital based physicians, but one can imagine progressing down the food chain to large medical practices and even to solo practitioners as technology advances and HR costs are reduced. So, give em’ a click, and tell us what you think.

http://iamscribe.com

Reported Benefits

Increase physician performance
Increase physician job satisfaction
Increase overall patient satisfaction
Improve chart accuracy
Decrease patient length of stay
Increase communication among ED staff
Improve physician recruiting and [retension] retention.

Assessment

It seems implausible to me that in order to facilitate the widespread use of eMRs, one has to hire another layer of bureaucracy in order to input the patient encounter. Is this an indictment of the various speech recognition systems or physician keyboarding ability? I am not a technophobe but eHRs are not yet up to pragmatic-use snuff. This is reminiscent of jeweled encrusted “buggy-whips” of the 1850’s. They were expensive, cumbersome and added no utility; but were “nice-to-have” devices for the affluent until the internal combustion engine came along [i.e. non-solo or small group medical practitioner].
Of course, injecting another human resource [i.e. personal secretary] into the data input equation increases privacy breach possibilities for this protected health information [PHI]. And, it is not exactly the model of a contemporary and lean micro-medical office.
Does a secretary-scribe really have to be “certified”? Won’t a good typist do just as well? Is this an example of vertical integration in the PhysAssist business model? How long till the scribes join the labor-union movement and seek employment benefits?
What happens to the doctor, patient and data input chain when a scribe quits, or is a no-show for work?
What ever happened to Occam’s razor (or Ockham’s razor), often expressed in Latin as the lex parsimoniae (translating to the law of parsimony, law of economy or law of succinctness), which is a principle that generally recommends selecting a hypothesis that makes the fewest new assumptions. IOW: KISS
Of additional interest to note is the misspelling of the word retention, as “retension” on the www.IAmScribe.com website. Not a very good impression for a transcribing firm; or am I just an aging editorial curmudgeon?
Are e-MR scribes a necessity or mere frivolity?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Are such secretary scribes a “covered entity” or “business associate” under the HIPAA laws with the needed paperwork, etc? Or, is this an Obama administration job creation initiative?

And, 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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Filed under: CMP Program, Information Technology, Op-Editorials, Practice Management | Tagged: business associate, covered entity, Dr. David Edward Marcinko MBA, EHRs, EMRs, HIPAA, PHI, PhysAssist Scribes, www.certifiedmedicalplanner.com | 15 Comments »

Book Dr. Marcinko to Speak

Posted on January 5, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

At Your Next Medical Management, Pharma or Financial Services Seminar

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

Many Venues

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

Assessment

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

Speaker: And so, 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 and http://www.springerpub.com/Search/marcinko

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Filed under: Career Development, CMP Program, Financial Planning, Health Economics, Investing, Managed Care, Touring with Marcinko | Tagged: Dr. Marcinko, Financial Planning, medical management, Practice Management, speaker's, www.certifiedmedicalplanner.com, www.medicalbusinessadvisors.com, www.MedicalExecutivePost.com | 2 Comments »

Are Financial Services “Professional” Certifications Important? [A Poll]

Posted on December 29, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Often of Murky Respect – Usually Confusing to Clients

By Dr. David Edward Marcinko MBA, CMP™

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

[Editor-in-Chief]

There are more than 100 “certifications” which represent the often nebulous field of “financial advisory, or planning credentials” that presently exist in the market place today.

Some of these “professional” designations are awarded to individuals in the financial planning or financial “advisory” space after [some] diligent study, and [often not so] arduous testing; others not so.

And so, are such “credentials” more important to you, or your clients; pleas opine.

More:

Enter the CMPs

Disclaimer: I am a reformed Certified Financial Planner®, Series 7 [stock-broker], 63 and 65 license holder, and RIA representative who also held all applicable insurance and security licenses.

Filed under: "Advisors Only", CMP Program, Experts Invited, Financial Advisor Listings, Financial Planning | Tagged: certified financial planner, certified medical planner, CMP, financial advisors, financial planners, RIAs, stock-brokers, www.certifiedmedicalplanner.com | 9 Comments »

Join Our ME-P Partner Research Panel for 2011

Posted on December 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Invitation to Respond

By Prof. Hope Rachel Hetico; RN MHA CPHQ CMP™

[Managing Editor]

Dear ME-P Readers and Subscribers,

On behalf of the Medical Executive-Post, I would like to invite you to become a member of the ME-P Partner Research Panel (MPRP) for 2011. This panel presents a chance for a limited number of M-E-P participants to have their voices heard through ongoing research studies with the www.MedicalBusinessAdvisors.com [iMBA, Inc].

The insights and suggestions of this vital partner community help shape products and programs which are critical to our mutual success.

The MPRP Panel

The MPRP panel is composed of ME-P readers and subscribers who have agreed to participate in a research program which asks their opinions via surveys typically once or twice a month. Most of your feedback would be submitted online, although there may be opportunities to participate in more in-depth types of research throughout the year. In all cases, it is up to you whether you choose to participate in the research request. All responses remain confidential and are reported only in aggregate.

Building Out the Process

As we continue to build out this process we are seeing greater internal iMBA Inc management participation and interest. External ME-P product development groups and business teams are asking for MPRP insights, as well. Complete studies have been developed around some topics, while at other times MPRP members have been asked to help with focus group activities and in-depth interviews. The help provided by the MPRP is not only appreciated by iMBA Inc, but has become vital to our work here at the ME-P.

Registration Required

I hope you will become a part of this new, vital component of the MPRP network. The registration process requires only a click on the “Join Us” tab, or confirmation-reply email to: MarcinkoAdvisors@msn.com Your membership will be a powerful way to present your thoughts and opinions to the management and staff of the ME-P. Please call us [770-448-0769] with queries, and/or “click” or email register now.

Assessment

You’ve probably already noticed that we have asked two of our valued research partners and sponsors www.CertifiedMedicalPlanner.com to assist us in managing and maintaining the many details of the panel. The CMP™ program has been involved with partner research on an ongoing basis for more than five years. Over time, you will become familiar with both www.MedicalBusinessAdvisors.com and www.CertifiedMedicalPlanner.com as two of the primary contacts for the ME-P Partner Research Panel.

Conclusion

Thanks for your participation in the ME-P Partner Network. I look forward to hearing more from you in the future. And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Filed under: CMP Program, Research & Development, Sponsors | Tagged: CMP, hope hetico, institute of medical business advisors, medical executive post, research and development, www.certifiedmedicalplanner.com, www.medicalbusinessadvisors.com | Leave a comment »

How I KISS My IRA [A Prudent Checklist]

Posted on December 21, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Simplified Retirement Thoughts for Physicians in 2011

By Dr. David Edward Marcinko MBA CMP™

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

[Publisher-in-Chief]

As a reformed certified financial planner and stockbroker, and current CMP™ professional charter holder for more than a decade, I am always amazed at how complex and convoluted some medical colleages and other folks make IRAs and their retirement planning.

So, please allow me to offer this brief checklist of advice on how to KISS your IRA in 2011!

What to have in an IRA?

Assets that are expected to generate the greatest relative pretax returns, such as:

fixed-income investments expected to yield high returns
stocks with high dividend yields
stocks expected to be held short term
mutual funds that emphasize stocks paying high dividends
mutual funds that expect to hold stocks short term.

What not to have:

collectibles (e.g., art objects, antiques, and stamps)
tax-free, tax-deferred, or tax-sheltered vehicles (e.g., municipal bonds, Series EE U.S. savings bonds, or variable annuities)
investments in individual foreign securities or mutual funds that hold primarily foreign securities.

Activities to avoid:

borrowing from the account
creating unrelated business taxable income, which may result from ownership of an interest in a partnership or S corporation or from purchasing securities on margin or borrowing to acquire real estate.

Assessment

So, what’s in your IRA, doctor? Do you have a Keep It Simple and Sane [KISS] checklist?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Do you KISS your IRA like me? 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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Filed under: CMP Program, Op-Editorials, Portfolio Management, Retirement and Benefits | Tagged: CMP, david marcinko, IRA, www.certifiedmedicalplanner.com | 3 Comments »

Doctors – Are You Preparing for Retirement [A Voting Opinion Poll]?

Posted on December 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ME-P Voting Poll with Survey

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

[Publisher-in-Chief]

As a physician-focused financial advisor, I know that for those medical professionals between the ages of 45 to 54, the thought of retirement should be popping up a few times these days.

And, for doctors between ages 55 and 64, the thought may be taking on urgent tones about now!

In fact, many of us are reconciling to the idea that it may be a fact that we have to either postpone our retirements or live a much simpler life during retirement. Whatever the thoughts may be, what’s driving them is our preparedness to retire.

And so, we’d appreciate your vote and comments, too!

Disclaimer: I am a reformed Certified Financial Planner®, Series 7 [stock-broker], 63 and 65 license holder, and RIA representative who also held all applicable insurance and security licenses.

Filed under: "Doctors Only", CMP Program, Financial Planning, Retirement and Benefits, Voting Polls | Tagged: david marcinko, Financial Planning, retirement planning, www.certifiedmedicalplanner.com | 2 Comments »

Why You’re Better off with Variable Annuities than Mutual Funds?

Posted on December 3, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Investing Under the Umbrella

By Dr. David Edward Marcinko MBA, CMP™

[Editor-in-Chief]

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

While participation in savings programs such as 401(k), 403(b), IRAs, and SEPs were at record numbers before the “flash-crash” of 2008-09, each of these plans is subject to a contribution cap.

Consequently, investors are always looking for tax-efficient methods to save more for retirement; especially medical professionals as the economy improves as it has been doing of late. Many have turned, or continue to use, mutual funds. In fact approximately 47% of mutual fund assets are composed of nonqualified funds. And, investors tend to buy mutual funds on the basis of before-tax performance rankings.

Enter the VAs

But these folks might far better off with variable annuities [VAs] according to C. Michael Carty and Robert E. Skinner in the article “Variable Annuities vs. Mutual Funds” (Financial Planning, November 1996, pp. 75–84, Securities Data Publishing, Inc). In fact, they present a strong case for investing in variable annuities (said to operate under an umbrella that protects them from current taxation and inflation) as compared to mutual funds, which may continue today.

The Dickson-Shoven Study

Carty and Skinner refer to a 1993 study by Dickson and Shoven conducted at Stanford University in which mutual funds were ranked on an after-tax basis. The change in relative rankings was dramatic. Dickson and Shoven concluded that:

Investors should always use after-tax rankings to evaluate and select mutual funds.
Given two investments with similar pretax returns, an investor should select the one involving fewer taxes.
A variety of approaches to sheltering or deferring taxes should be considered.

And, in one of the first comparison of returns between variable annuities and mutual funds, Rodney Rhoda of Fidelity Investments demonstrated that the difference in expense charges between variable annuities and mutual funds are less than one would expect because of lower variable annuity trading costs and a more stable asset base, which is usually more fully invested.

Assessment

I am not a fan of VAs as several essays in this ME-P suggest. Fees, expenses, loads and commissions are just too darned high. And, most are sold, not bought.

However, the authors demonstrated that under either lump-sum or gradual withdrawal assumptions, variable annuities consistently beat mutual funds, particularly for medium to high tax-bracket investors who achieve only median investment performance. Low tax-bracket investors who achieve average or lower investment performance benefit least from variable annuities. Also, variable annuities have been shown to be more likely to withstand the ravages of inflation.

And so, the conundrum continues.

Conclusion

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How Equity-Based Securities Affect a Physician’s Total Financial Plan

Posted on December 1, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Equity Securities Provide a Portfolio Growth Engine

By Dr. David Edward Marcinko MBA, CMP™

[Editor-in-Chief]

Equity securities provide growth. Theoretically, the amount of growth potential in an equity security is infinite. A stock’s price appreciation possibilities have no limit. However, a stock’s price can also go to zero and an investor can lose the entire amount invested. Therefore, while stocks contribute long-term growth to a portfolio, they also add risk.

Stock Diversification is Key

Diversification is the best defense against risk, so only a portion of every portfolio should be in stocks. Other investments—fixed income securities; cash equivalents that can be used to take advantage of opportunities or for emergencies; real estate; and even commodities (precious metals, for instance, or securities of companies whose businesses are commodity-based)—should all be considered by the responsible physician-investor or financial advisor as components of a well-rounded, balanced portfolio.

And So is Portfolio Diversification

The stock portfolio itself should also be diversified. Diversify among all types of equity securities such as some large capitalization stocks, some small capitalization stocks, some utilities, some cyclical stocks, some value stocks, some growth stocks, and some defensive stocks. Because it is difficult to adequately diversify an equity portfolio with a small amount of money, consider mutual funds or ETFs for some doctors or financial advisory clients. At least this is the philosophy of our Certified Medical Planner™ [CMP] online educational program.

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Assessment

Always remember that, because the equity component of the portfolio can be expected to provide more than its proportionate share of the risk of a portfolio, it must be constantly monitored. Also remember that every physician-investor as a different level of risk tolerance, and some may be able to handle ownership of only the most solid and stable equity investments.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. But, what is “di-worsification?” 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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Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Filed under: CMP Program, Financial Planning, Investing, Portfolio Management | Tagged: asset allocation, CMP, david marcinko, Equity Securities, Investing, Portfolio Management, stock diversification, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 2 Comments »

About the Mortgage Electronic Registry System

Posted on November 29, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Loan Help or Hindrance?

By Dr. David Edward Marcinko MBA, CMP™

[Editor-in-Chief]

According to their website, Mortgage Electronic Registry System [MERS] is an innovative process that simplifies the way mortgage ownership and servicing rights are originated, sold and tracked. Created by the real estate finance industry, MERS eliminates the need to prepare and record assignments when trading residential and commercial mortgage loans www.MERSInc.org Sounds good, right?

State Laws

Unfortunately, property law is handled on a state-by-state basis and digital MERS may not be a legal replacement for paper. In fact, MERS use may devalue the physical paper trail and lead to lost or misplaced loan documents [aka: admissible evidence].

Assessment

As a financial advisor for more than 15 years, and a former certified financial planner for more than a decade, who resigned due to the industry’s lack of fiduciary accountability, I appreciated this issue deeply

www.MedicalBusinessAdvisors.com

Full Disclosure:

I am also the Founder and CEO of www.CertifiedMedicalPlanner.com; an online certification, licensure and educational program for financial advisors and medical management consultants working in the healthcare space; who are always fiduciary advisors.

Conclusion

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Filed under: CMP Program, Financial Planning, iMBA, Inc., Information Technology, Mortgage Electronic Registry System, Op-Editorials | Tagged: certified medical planner, CMP, commercial mortgage loans, david marcinko, home loans, MERS, Mortgage Electronic Registry System, mortgage ownership, real-estate, residential mortgage loans, www.certifiedmedicalplanner.com, www.medicalbusinessadvisors.com | 2 Comments »

What is the Role of a Physician-Focused Financial Advisor?

Posted on November 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Changing Times – Demand Changing Roles

By Dr. David Edward Marcinko MBA, CMP™

Editor-in-Chief

As a financial advisor for more than 15 years, it has been my experience that many doctors who require assistance in developing a comprehensive personal financial plan also need help with implementing any investment planning recommendations. While perhaps not so true before the “flash-crash” of 2008-09, the issue seems especially true today as retirement portfolios have been decimated, and the specter of healthcare reform is no longer just a threat but a political reality. The mindset of hubris has been replaced by a tone of fear in many medical colleagues.

The Financial Advisors

Physician investors who develop an investment plan may use a competent financial advisor [FA] or other specialist in the investment area. A financial advisor can help clients understand their current financial situations and develop strategies for achieving their goals. Other FAs are specialists that help clients design and implement plans for investing. Still others use a more comprehensive approach to the entire financial planning process with extreme degrees of healthcare specificity

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These Certified Medical Planners™ are fiduciaries at all times and put client needs first as registered investment advisors [RIAs], not commissioned sales agents or mere stock-brokers despite often confusing monikers.

Implementation

Implementation may be accomplished using professionally managed portfolios and mutual funds. The following shows how a plan may be implemented with an advisor assisting the physician-investor. The process may include:

• Developing investment policy and strategies

• Selecting and implementing managed portfolios and mutual funds

• Evaluating performance on a periodic basis

• Periodically reviewing and adjusting the investment plan as required

Note: The advisor may provide all of the investment services, or the physician investor may use other advisors in the process.

Example:

A financial planner has developed a number of financial planning recommendations for a client. One recommendation is to develop a written investment plan, review current investments, and implement changes. The planner has recommended an investment advisor experienced in selecting and monitoring managed portfolios and mutual funds. The financial planner will meet with the client and advisor initially and once each year to monitor the plan.

Example:

A financial planner has developed a financial plan for a client. The financial planner specializes in developing investment policy but not in implementing investments. The financial planner will use asset allocation software and develop a written long-term plan for the client. The doctor-client will work with a major brokerage firm to implement the plan using managed portfolios and mutual funds. The financial planner will monitor the brokerage firm and help the client evaluate performance.

Example:

A financial planner has developed a financial plan for a physician-client and will assist the client in developing asset allocation strategies. The planner has extensive knowledge in implementing the asset allocation strategies using managed portfolios and mutual funds. The planner will select and monitor the choices. The planner will provide the client with a quarterly performance report and meet with the client every six months to review the plan and strategies.

Assessment

Understanding the above is more critical than ever as physician-income continues to shrink going forward in the era of healthcare reform.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Do you seek professional assistance with your investing needs, or do you go-it-alone; why or why not? Then, subscribe to the ME-P. It is fast, free and secure.

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Filed under: CMP Program, Financial Advisor Listings, Investing, Op-Editorials, Portfolio Management | Tagged: certified medical planner, CMP, david marcinko, fiduciary, financial advisor, financial planner, Financial Planning, Investing, registered investment advisor, RIA, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 4 Comments »

A Brief History of the ME-P

Posted on November 20, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Enhancing Health 2.0 Connectivity for Physicians and their Financial Advisors

By Staff Reporters

The Medical Executive-Post [ME-P] was launched in 2006, and was a resounding success. We first went online in October 2006 with an overwhelmingly positive response. Readers and subscribers alike reported finding it a credible source of information with more than half saying the information was far new to them. Our parent company remains: www.MedicalBusinessAdvisors.com

Our Research

In additional, our internal research revealed:

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Physician and Financial Advisory Books Launched Since Inception

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Filed under: Accounting, Financial Planning, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Information Technology, Investing, Media Mentions and PR, Portfolio Management, Practice Management, Practice Worth, Professional Liability | Tagged: CMP, financial advisors, financial planners, Financial Planning, healthcare administration, medical management consulting, physicians, Practice Management, www.certifiedmedicalplanner.com, www.medicalbussinessadvisors.com, www.MedicalExecutivePost.com | Leave a comment »

Mental and Physical Well-Being for [Physician] Boomers and Their Retirement Plans

Posted on November 4, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

By Somnath Basu PhD MBA

President – AgeBander
Thousand Oaks, CA

A Pew Research Center study[1] on the effects of financial stress on health finds 42.4% of respondents in a survey on the subject indicated that their health had been affect by financial problems. The study also found that 1 in 8 baby boomers were raising children, planning for retirement and at the same time caring for their elderly parents. This is the unfortunate reality for many baby boomers who face the implications of being a sandwich generation.

The Boomer Spectrum

For boomers across the spectrum of age (1945-64) financial stress has also contributed significantly to relational strife and has exacerbated many medical conditions. It has been linked to depression and sleep disorders and has been known to negatively affect the autoimmune and digestive system. For retirees who find themselves on a limited income with few options for augmenting that income the additional stress of financial problems has certainly been detrimental to their mental, emotional and physical well being. For such retirees who had an improper perception of their retirement needs the realization of the truth is definitely overwhelming. For others, who had thought they had planned ahead and were diligent, are now wrestling with guilt and remorse over their failure to provide for their retirement years. These individuals too are likely also facing fairly severe mental health conditions related to retirement security. Additionally these retirees will likely look back on the sacrifices they did make and feel these were in vain further exacerbating the state of their mental health. This in turn leads them also to resist reasonable advice because their fears make them more suspecting of any advice including the reasonable ones.

The Emotional Culprits

Two of the chief culprits have been the tendency of boomers (as a solace, all other generations suffer from these same problems though boomers have been most affected) to overestimate and have overconfidence about their financial knowledge and understanding of key financial concepts. Their lack of knowledge about overestimating themselves and being overconfident about their understanding of key financial concepts has proved to be detrimental to many a boomer’s health and well being in retirement. This is mainly due to these weaknesses leading them to not having enough funds for their retirement expense needs. A national collaborative strategy initiative on this problem has identified five action areas needed to help alleviate this problem – the need to educate consumers on the areas of financial policy, education, practice, research, and coordination. The reality is that when retirees are affected mentally, physically and emotionally (leading to overconfidence and over optimism), their financial decisions become faulty due to acting on their perceptions of retirement risk. This makes them tend to drastically under-estimate their retirement expenses. In such cases they experience or will experience significant reductions in their quality of retirement life. To ensure that expectations of retired life are realistic and risk perceptions are aligned to realistic and achievable goals are the first steps for boomers to ascend in order to improve the quality of their overall mental and physical health in retirement.

Objective Retirement Planning

An objective of planning for retirement thus becomes the need to find some kinds of lifelong guaranteed pensions since it is well known and understood that retirees who have such luxuries are many times more satisfied in retirement than their peers. The more satisfied in retirement the better mental and financial well-being one has. The main thrust in achieving such a mental state is to understand the importance of a secure and assured income that arrives in the bank consistently every period (such as monthly or bi-weekly).

Perception too plays a big role in mental health as does the security of regular income. However, those receiving Social Security as their regular income are known to be less satisfied than others. Studies show that Social Security benefits carry a “hand-out stigma” for those who rely on them for their well being. From the boomers perspective, living a simpler life but funding retirement from a disciplined pension fund approach (using 401(k) funds, IRAs, personal financial portfolios, etc.) ensures the chances that their mental and physical well-being in retirement will not be reduced in any way by their financial well-being. Now is the time for boomers to exact such a lifestyle and bring in a certain semblance of stability in the vision for the rest of their lives.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What are your retirement plans and how does this essay impact on them; if at all? 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.

Notes: [1] http://personalfinancefoundation.org/research/efd/Negative-Health-Effects-of-Financial-Stress.pdf

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Filed under: Experts Invited, Retirement and Benefits | Tagged: retirement planning, Somnath Basu, www.certifiedmedicalplanner.com | 3 Comments »

Events Planner: November 2010

Posted on November 1, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

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Events-Planner: NOVEMBER 2010

By Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.

First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 175,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions. As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention.

So, enjoy the Medical Executive-Post and this monthly Events-Planner with our compliments.

A Look Ahead this Month: Now, the important dates:

November 07: World Congress Health Innovation Meeting. Alexandra, VA

November 08: Patient Centered Medical Homes and ACOs, Hartford, CT

November 08: Medical Compliance Meeting in a Post Reform World, Baltimore, MD

November 11: Conducting Effective internal Medical Investigations, HCCA, Orlando, FL

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Understanding Medical Practice Stock Sale vs. Assets Sale

Posted on October 18, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Insights for Physician-Focused Financial Advisors

By Dr. Charles F. Fenton III, FACFAS, JD

www.BusinessofMedicalPractice.com

In most cases, healthcare knowledgeable financial advisors [FAs] recommend that the physician buyer of a medical practice solely purchase the assets of the practice and not the stock of the practice itself http://www.CertifiedMedicalPlanner.org

A Risk Reduction Strategy

Why? By purchasing selected assets, the buyer is ensured that he will not become responsible for the known or unknown liabilities of the corporation; thus a risk reduction strategy. In prior days, avoiding purchasing the stock of the corporation was a wise recommendation www.MedicalBusinessAdvisors.com

Enter the Managed Care Era

However, with the advent of managed care, the purchase of the stock of the corporation can provide the new practitioner with certain competitive advantages.

For example, it may take a new practitioner three to nine months to get onto enough managed care panels to make the practice profitable. Purchase of the stock of the corporation ensures the new practitioner of acquiring the Federal tax identification number of the corporate entity.

Assessment

Since most managed care corporations identify providers by the Federal tax identification number, purchase of the stock of the corporation should allow the new practitioner to be enrolled on managed care panels in a shorter period of time. Instead of applying anew to the managed care entity, the new practitioner merely needs to be listed as a new member of a provider already on the managed care panel.

Conclusion

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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: CMP Program, Practice Management, Practice Worth, Professional Liability, Risk Management | Tagged: certified financial planner, Charles Fenton, medical practice sale, Stock Sale vs. Assets Sale, www.BusinessofMedicalPractice.com, www.certifiedmedicalplanner.com | Leave a comment »

ME-P Sponsor Appreciation Post

Posted on October 5, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Outstanding ME-P Support Provided By These Firms and Companies:

Interested in website sponsorship, speaking or exhibit opportunities?
Please contact Ann Miller RN MHA
770-448-0769 or email: MarcinkoAdvisors@msn.com

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Financial Planning for Physicians and Advisors

Posted on September 25, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Our Handbook

By Ann Miller RN, MHA

Managed care and government-led initiatives to control health care costs have decreased physician compensation. Physicians must now carefully plan their practices and seek financial security in a manner that is markedly different from other professionals. To do so, physicians and their advisors must be well informed about the growing range of financial planning options to choose the course that balances risk, cost, time horizon, outcome and their own personal economic style. This innovative guide confronts the reality that personal financial planning for physicians is decidedly more complex than it is in other professions.

Financial Planning for Physicians and Advisors

This handbook describes a personal financial planning program to help doctors avoid the perils of harsh economic sacrifice. It outlines how to select a knowledgeable financial advisor and develop a comprehensive personal financial plan, and includes important sections on: insurance and risk management, asset diversification and modern portfolio construction, income tax and retirement planning, and succession and estate planning. When fully implemented with a professional’s assistance, this book will help physicians and their financial advisors develop an effective long-term financial plan.

Assessment

http://www.jblearning.com/catalog/0763745790/

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Be the first to review this text. 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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Filed under: Book Reviews, CMP Program, Financial Planning, Recommended Books | Tagged: Certified Medical Planner™, david marcinko, Financial Planning, Financial Planning for Physicians and Advisors, hope hetico, www.certifiedmedicalplanner.com | 2 Comments »

Congratulations Somnath Basu PhD

Posted on July 17, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ME-P Thought-Leader and 2010 USDLA Award Winner

[Excellence in Distance Learning Teaching Award]

By Ann Miller RN, MHA [Executive-Director]

The United States Distance Learning Association, the nation’s premier distance learning association since 1987 recently presented its 2010 International Distance Learning Awards, the premier awards for the distance learning industry. And, ME-P thought-leader Somnath Basu PhD, MBA was a category winner.

These prestigious awards are presented annually to organizations and individuals, and recognize four categories of excellence: 1) 21st Century Best Practice Award; 2) Best Practice Awards for Distance Learning Programming; 3) Excellence in Distance Learning Teaching Awards; and 4) Outstanding Leadership by an Individual Award.

United States Distance Learning Association

The USDLA International Distance Learning Awards are created to acknowledge major accomplishments in distance learning and to highlight those distance learning instructors, programs, and professionals who have achieved and demonstrated extraordinary achievements through the use of online, videoconferencing, and satellite/video delivery technologies globally.

The USDLA Awards

USDLA International Distance Learning Awards honors organizations with its 21 Century Best Practice Awards. This award category recognizes outstanding leadership in the field of distance learning for an agency, institution, or company incorporating blended or individual distance learning technologies.

In addition, the Awards for Best Practice in Distance Learning Programming are presented to outstanding organizations, which have designed and delivered outstanding and comprehensive Best Practices for individual programs or a series of programs through online, videoconferencing, and satellite delivery technologies.

http://www.callutheran.edu/schools/business/graduate/cif/

Award levels include Platinum, Gold, Silver and Bronze categories. The Excellence in Distance Learning Teaching Awards honors outstanding instructors whose programs demonstrate extraordinary achievements in a distance learning environment for teachers or trainers. Award levels include Platinum, Gold, Silver and Bronze categories.

Finally, the Outstanding Leadership by an Individual awards recognize those who have demonstrated strong, innovative skills for the development and/or administration of programs or who are recognized scholars in the field of distance learning globally.

About Dr. Basu

Somnath Basu PhD is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu See his agebander at work at www.agebander.com

Assessment

The 2010 USDLA International Distance Learning Awards were presented to five major sectors of distance education and training and include the Pre-K – 12, Higher Education, Corporate, Government and Telehealth markets. The 2010 USDLA International Awards were presented at the USDLA International Awards Ceremony, on Tuesday, May 4, 2010 during the USDLA National Conference in St. Louis, Missouri, USA.

Conclusion

Feel free to congratulate Somnath directly by sending him an email: basu@callutheran.edu

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Filed under: Breaking News, Career Development, CMP Program, Experts Invited, Financial Planning, Media Mentions and PR | Tagged: California Institute of Finance, Excellence in Distance Learning Teaching Awards, School of Business at California Lutheran University, Somnath Basu, United States Distance Learning Association, USDLA, USDLA International Distance Learning Awards, www.certifiedmedicalplanner.com | Leave a comment »

Understanding the Premise of Appraisal Value and Investment Time Horizon

Posted on July 8, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Key Issues in Healthcare Entity Valuation and Appraisal

By Robert James Cimasi; MHA, ASA, AVA, CBA, CMP™

www.HealthCapital.com

The Premise of Value under which any healthcare entity fair market valuation is conducted is an assumption further defining the Standard of Value to be used.

The Premise of Value defines the hypothetical terms of the sale and answers the question, “Value under what further defining circumstances?” Two general concepts relate to the consideration and selection of the Premise of Value, i.e., “value in use” and “value in exchange.”

Value in Use

Value in use is that premise of value that assumes that the assets will continue to be used as part of an ongoing business enterprise, producing profits as a benefit of ownership.

For example, in valuing the assets of a surgical hospital, the valuator must determine whether it is appropriate to value simply the tangible assets, or if it is appropriate to consider the enterprise as a going concern and incorporate the potential value of intangible assets. Orderly liquidation value involves assuming that the equipment is sold, perhaps separately, over a reasonable period of time. Forced liquidation assumes that the equipment is sold as quickly as possible to the first bidder.

Value in Exchange

Value in exchange is often referred to as “liquidation value.” Liquidation value describes a sale of the assets of a business enterprise under conditions other than its continued operation as a going concern.

The liquidation can be on the basis of an orderly disposition of the assets where more extensive marketing efforts are made and sufficient time is permitted to achieve the best price for all assets, or on the basis of forced liquidation where assets are sold immediately and without concern for obtaining the best price.

Liquidation

Of course, costs of liquidation should be considered in the value estimate when using this premise of value. Shortening the investment time horizon may have a deleterious effect on the valuation of the subject entity as it presents a restriction on the available pool of buyers and investors and the level of physician ownership, as required under the standard of Fair Market Value.

Assessment

Do the dual issues of value premise and time horizon still seem logical in modernity; why or why not? How comfortable are you that a reasonable FMV can be determined for any healthcare entity after passage of The Patient Protection and Affordable Care Act in March of 2010? Please comment and opine.

Channel Surfing the ME-P

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Conclusion

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Health Economics, Practice Worth | Tagged: fair market value, FMV, healthcare appraisal, medical practice valuation, Robert Cimasi, Value in Exchange, Value in Use, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 4 Comments »

How the ME-P Views Client Engagements and Consultations

Posted on July 2, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

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An Expert Led – Future Focused Firm – Enhancing Doctor and Advisory Practices

By Ann Miller RN, MHA

[Executive Director]

ME-P consultants use advanced analytics, medical practice intelligence, education, deep experiential insight and publications to deliver measurable value across the full continuum of the independent health care administration and integrated economics and financial services space. Our team includes DOs, CPAs, MDs, DPMs, MBAs, PhDs, CFAs, MSFSs, CFPs®, RNs, CMPs™ and health care leaders, business leaders and CXOs. All have extensive strategic, operational, academic, technological, business and financial experience, certifications and licenses.

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Typical Clients

Our clients include medical practices, hospitals and health systems; financial advisory firms RIAs and BDs; pharmaceutical companies, academic medical centers and physician organizations; private equity and investment firms, health insurance providers and medical device manufacturers are included. We help build a foundation for improving care delivery, related financial services sector performance and overall matrix or organizational advancement through the systems we implement. And, we enable our clients to:

Evaluate current performance, identify improvement areas and drive progress over time
Uncover opportunities to capture market share and grow volumes
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Launch seminars, lectureships, collaborative workshops and speaking engagements.

The ME-P Difference

Along with the ME-P website, here is how we are different: www.CertifiedMedicalPlanner.com

ME-P is future-focused

We have a track record of predicting trends that keep you ahead of the competition. We continuously scan the horizon to anticipate changes that will transform practices, clinics, hospitals, the financial services industry, RIAs and medical practices.

ME-P is expert-led

Our experts collaborate with you to form powerful relationships, support critical decision making, address challenges and uncover opportunities. We bring a unique understanding of your challenges—many of our experts are former financial services colleagues, physicians, CXOs, insurance agents, executives and nurses, etc.

ME-P is data-driven and action-oriented

Our solutions are grounded in proprietary analytical tools and data. By combining expert insight and data intelligence, we develop recommendations that may empower you to grow top-line and bottom-line performance today and in the future.

ME-P is core to health entity and business process

Through value-added analysis and intelligence, our healthcare business solutions become key tools and drivers for your current and future plans www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What benchmarks do you use for consulting engagements? Are doctors and FAs more or less likely to retain a consulting firm in today’s competitive environment? Are these two consulting sectors more or less integrated today than yesterday?

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Filed under: Career Development, CMP Program, Experts Invited, iMBA, Inc., Media Mentions and PR | Tagged: david marcinko, financial services, healthcare consultants, ME-P, medical executive post, medical practice management, Practice Management, seminars, speaker's, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | Leave a comment »

On HIT Continuity Planning

Posted on June 28, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Setting Up Your HIT Security System

By Richard J. Mata, MD, CIS, CMP™ [Hon]

In order for a healthcare organization to thrive, it must be able to continue to function no matter what the circumstances are.

When disaster strikes, the organization must mobilize all the talent and resources needed to continue their operations and return to a normal state as soon as possible.

Time is money, and in today’s economy, an hour could be worth thousands of dollars. Every department in an organization has responsibilities during a disaster. Planning for a disaster and then dealing with it is a team effort by all parts of an organization.

Phases of Healthcare Business Continuity Planning

A system is required to realize this objective, and part of this system is healthcare entity business continuity planning (BCP).

Phase One: Set up a BCP Project

The first step is to set up a BCP project, which includes feedback from key members from all departments. Appoint a project manager who has a solid background in the clinical and financial systems and functions that the organization deploys or services it provides. The project manager can work with business and system analysts to document business flow and interactions with computerized systems that may go down, and how the organization will function on a manual system until service returns.

Phase Two: Review Emergencies and Assess Business Risk

The second phase involves reviewing the different types of emergencies that can arise and assessing the risks to the various business processes already documented. This is accomplished following a system or service function.

Phase Three: Prepare for Emergencies

The third phase includes identifying of back-ups and recovery strategies to mitigate the effects of an emergency. A storage area network (SAN) or redundant server could be used as back-ups.

Phase Four: Plan for Disaster Recovery

The fourth phase involves the development of procedures to be followed by a Disaster Recovery Team where human life may be at risk. A disaster might be caused by weather, sabotage, or electrical power and be specific to the particular organization and its business and IT infrastructure.

Phase Five: Plan for Business Recovery

The fifth phase is critical, and involves developing detailed procedures for the recovery of the business. Again, the BCP project manager could use each business or service procedure that was documented in phase two and detail which financial or clinical systems are involved, what would be done if the systems were down, and what the plan for recovering the system might be.

Phase Six: Test Business Recovery Procedures

The sixth phase involves simulating authentic emergencies and testing of the business recovery phase. For example, how would business processes or services be affected by an electrical outage? How fast can a power generator pick up the outage – and what might happen after a timely pause? How would patients who were receiving mechanical support be affected? What would happen to the clinical laboratory?

Phase Seven: Train the Staff

Phase seven covers the training of all employees in the procedures necessary to manage the business recovery process. These are the procedures tested in phase six, which may require modification.

Phase Eight: Maintain the Currency of the Plan

Phase eight includes treating BCP as a dynamic project to be kept up to date to reflect all changes to business processes and employee structure.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
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Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Current Outlook for the Hospital Industry

Posted on June 27, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Adaptation is Key in 2010 and Going Forward

By Robert James Cimasi; MHA, ASA, AVA, CBA, CMP™

www.HealthCapital.com

Hospitals today must continually adjust to deal with pressures to contain reimbursement and utilization levels. The continuing cost containment pressures manifest themselves in many patients being shifted not only to lower acuity treatments but also to other providers.

Reimbursement mechanisms are increasingly designed to control costs and access. Managed care insurance plans continue to be a strong influence as payers for acute care hospital services. Medicare’s HOPPS [hospital outpatient prospective payment system] has reduced many of the financial benefits of shifting more care to outpatient settings.

Personnel Shortages

Personnel shortages have plagued the industry, and with the pending retirement of baby-boomers, relief from these shortages seems remote. This population also heavily influences the consumer side of the industry, since healthcare plans are based heavily upon demographics. Aging baby-boomers are the fastest-growing segment of the population; the portion of the population over 65 years old is expected to increase from 20 million in 1970 to 69.4 million in 2030. Following closely behind is the increase in other minority populations. Both groups will influence how healthcare services are dispensed.

Additionally, despite pressure to limit ALOS [average length of stay] and the shift to outpatient and freestanding, off-campus care, there will continue to be demand for acute care hospitals and the demographic trends will support this demand for many years.

Technology

Technological advances always play a central role in changing the medical industry. The issue will be how healthcare providers will adopt new technologies under their current capital constraints.

Currently, health care insurance coverage is a major unfolding issue in the US, and there remains uncertainty about the future level of both public and private insurance coverage. Now, facing the recent economic instability, employers are looking at restraining healthcare benefits for their employees even more as a way to stay profitable.

Assessment

The decline in the healthcare workforce coinciding with the increase in labor costs and resource consumption poses an ongoing challenge. And yet, in the midst of the economic turmoil, hospitals must continue to provide services while remaining aware of the economic threats that may still lie ahead.

More:

Arkansas Medical News Interviews Dr. Marcinko

Conclusion

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Implementation of the Healthcare Deficit Reduction Act

Posted on June 23, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Signed by President Bush in 2006

By Gregory O. Ginn; PhD, MBA, CPA, MEd

By Hope Rachel Hetico; RN, MHA, CMP™

The Deficit Reduction Act (DRA), S. 1932, was signed by President Bush on February 8, 2006, and became Public Law No. 109-171. Implementation of the act includes these provisions:

www.HealthDictionarySeries.com

Subtitle A – Provisions Relating to Medicare Part A

hospital quality improvement (section 5001);
improvements to Medicare-dependent hospital (MDH) programs (section 5003);
reduction in payments to skilled nursing facilities (SNFs; section 5004);
phase-in of inpatient rehabilitation facility classification criteria (section 5005);
development of a strategic plan regarding investment in specialty hospitals (section 5006);
demonstration projects to permit gain-sharing arrangements (section 5007); and
post-acute care payment reform demonstration programs (section 5008).

Subtitle B Provisions Relating to Medicare Part B

title transfer of certain durable medical equipment (DME) to patients after 13-month rental (section 5101);
adjustments in payment for imaging services (section 5102);
limitations on payments for procedures in ambulatory surgical centers (ASCs; section 5103);
minimum updates for physician services (section 5104);
three-year extension of hold-harmless provisions for small rural hospitals and sole community hospitals (section 5105);
updates on composite rate components of basic care-mix adjusted prospective payment systems (PPS) for dialysis services (section 5106);
accelerated implementation of income-related reductions in Part B premium subsidy (section 5111);
Medicare coverage of ultrasound screening for abdominal aortic aneurysms; National Educational And Information Campaign (section 5112);
improvements to patient access and utilization of colorectal cancer screening under Medicare (section 5113);
delivery of services at federally qualified health centers (FQHC) (section 5114); and
waiver of Part B Late Enrollment Penalty for certain international volunteers (section 5115).

Subtitle C – Provisions Relating To Parts A and B

home health payments (section 5201);
revision of period for providing payment for claims that are not submitted electronically (section 5202);
timeframe for Part A and B payments (section 5203); and
Medicare Integrity Program (MIP) funding (section 5204).

Subtitle D – Provisions Relating To Part C

phase-out of risk adjustment budget neutrality in determining payments to Medicare Advantage organizations (section 5301); and
Rural PACE Provider Grant Programs (section 5302).[1]

The goal of the act is to save nearly $40 billion over five years from mandatory spending programs through slowing the growth in spending for Medicare and Medicaid. Has it been successful to-date?

Assessment

We know from personal experience that the DRA can be implemented by all healthcare stakeholders to the benefits of the industry sector in the aggregate. But, has it been?

Conclusion

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Editors Note: Gregory Ginn has been a professor in the Department of Health Care Administration at the University of Nevada, Las Vegas, since 2000. He received his doctorate, MBA, M.Ed., and undergraduate degree from the University of Texas at Austin, and is an inactive Certified Public Accountant registrant in the States of Nebraska and Texas. Before his current position at UNLV, he spent time teaching at Clarkson College, College of Saint Mary, University of Findlay, University of Central Texas, Stephen F. Austin State University, State University of New York at Buffalo, University of Houston at Victoria, University of Texas at Austin, and the Southwest Texas State University. Prior to his academic roles, he was an accountant for Touche Ross & Co., and an Internal Revenue Service Tax Auditor. Dr. Ginn has also been a reviewer for organizations such as: Health Care Management Review and the Health Care Administration Division of the Academy of Management. He is Treasurer for the Nevada Executive Health Care Forum and was a member of the Southern Nevada Wellness Council. His graduate teaching experience in healthcare administration is abundant, having taught courses in: Management of Health Services Organizations, Quantitative Methods, The U.S. Health Care System, Health Care Systems and Policy, Health Care Finance, Group Practice Management, Long-term Care, and Health Care Law. He has been published in numerous journals, including Journal of Healthcare Management, Hospital Topics, Nursing Homes, Journal of Nursing Administration, International Electronic Journal of Health Education, and Hospital and Health Services Administration. His current and former professional memberships include: American College of Healthcare Executives, Nevada Executive Healthcare Forum, Academy of Management, Association of University Programs in Health Administration, Certified Medial Planner (Hon.) and Heartland Health Care Executives.

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Filed under: CMP Program, Health Economics, Health Law & Policy, Managed Care, Practice Management | Tagged: Deficit Reduction Act, durable medical equipment, federally qualified health centers, Gregory O. Ginn, Medicare Integrity Program, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare-dependent hospital, National Educational And Information Campaign, prospective payment systems, Rural PACE Provider Grant Programs, skilled nursing facilities, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com | 1 Comment »

Understanding Patient-Focused Healthcare

Posted on June 17, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Emerging Trend Focuses on the Patient

By Gregory O. Ginn; PhD, MBA, CPA, MEd

By Hope Rachel Hetico; RN, MHA, CMP™

One swelling competitive medical administration and clinical trend is patient-focused and holistic healthcare, which centers on patient needs and attempts to humanize patient care.

Definition

Patient-focused healthcare therefore incorporates the following concepts, among others:

patient education;
active participation of the patient;
involvement of the family;
nutrition;
art; and
music.

These are thought to improve patient outcomes. Further, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes.

An example of this would be classes to prepare couples for childbirth. These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.

Assessment

We know from personal experience that this type of education is enormously beneficial in reducing stress and improving the decision-making ability of patients who are involved in healthcare processes.

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Conclusion

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What is M-Health for Physicians?

Posted on June 16, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

On “Smart Phones” and Mobiles Devices

By Shahid N. Shah MS

M-Health or “mobile health” is an industry term for collectively defining those tools and technologies that can be used on “smart phones” like iPhone, Blackberry, Android, or on traditional mobile phones from various vendors.

Unlike traditional computers, almost every patient that walks into your medical office, as well as all your own staff, have mobile devices already. If you can find mobile applications that can help your practice you can immediately put to use without large capital expenses, network configuration, and other technical tasks.

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The M-Health Initiative

According to the mHealth Initiative, there are 12 major “application clusters” in mobile health: patient communication, access to web-based resources, point of care documentation, disease management, education programs, professional communication, administrative applications, financial applications, emergency care, public health, clinical trials, and body area networks.

www.BusinessofMedicalPractice.com

The Applications

Almost all of these applications are focused around the patient but most of them will be directly useful to you and your staff as well. Here’s how:

Improving physician-patient communications. You can get your staff to send out text messages, e-mails, photos, and other information about your practice to the patient before their visit. You can remind them about appointments, tell them what to expect, ask them for their insurance and check-in information, or let them send you their personal health record link. During the visit you can send them patient education information directly to their phones instead of handing out paper. After the visit you can send medication reminders, additional educational resources, and update to their personal health record, or ask them to join a Health 2.0 social network. PumpOne, GenerationOne, Intouch Clinical, Life:Wire, and Jitterbug phones all have great patient user experiences and you should tell your patients about them.
Faster access to information for you and your patients. There are countless web-based resources that are now at your fingertips on a phone. Patients can lookup providers, labs, testing services, etc. that you can refer them to; you can help them join clinical trials, and manage their health records online. None of these require a computer either in your office or in their home, it can all be done on the phone. Check out companies like Healthagen and iSeek.
Real-time documentation of office or hospital visits. Most of the things you want to do in your EMR are possible on a smart phone today. You can get your patient profiles, document an encounter with basic order management and lab results review capabilities, and immediate storage into either your own EMR or your hospital’s information system.
Help those patients with the most time-consuming treatments. You already know that disease management is an important part of managing the health of chronic patients; diabetes and hypertension are two perfect examples. Help enroll your patients into Diabetes Connect, MediNet, HealthCentral, and similar applications that can help track compliance with your medical treatment guidance. If they use these applications they can simply give you printouts or login credentials so that you can track their progress without doing any data entry yourself. There are patient tools for most common diseases.

Editor’s Note

Shahid N. Shah is an ME-P thought leader who is writing Chapter 13: “Interoperable e-MRs for the Small-Medium Sized Medical Practice” [On Being the CIO of your Own Office] for the third edition of the best selling book: Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] to be released this fall by Springer Publishing, NY. He is also the CEO of Netspective Communications, LLC.

Conclusion

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On Hospital CPOE Systems [Part Two]

Posted on June 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Computerized Physician Order Entry Systems

By Brent Metfessel; MD, MIS

A significant initial cost outlay for an organization-wide CPOE system is necessary, which for a large hospital may run into the tens of millions of dollars. Understandably, the majority of the hospitals that have installed a CPOE system are large urban hospitals. The up-front cost outlay may be prohibitive for smaller or rural hospitals unless there is an increase in outside revenue or third-party subsidies.

However, although it may take a few years before a positive ROI becomes manifest, there can be a significant financial return from such systems.

www.CPOE.org

Potential Benefits

The potential benefits of a CPOE system go beyond quality. Significant decreases in resource utilization can occur. In one study, inpatient costs were 12% lower and average Length of Stay (LOS) was 0.89 day shorter for patients residing on general medicine wards that used a CPOE system with decision support. Rather simple decision support tools can reap cost benefits as well. When a computerized antibiotic advisor was integrated with the ordering process, one institution realized a reduction in costs per patient ($26,325 vs. $35,283) and average LOS (10.0 days vs. 12.9 days), with all differences statistically significant.

Studies have shown that CPOE systems can significantly reduce medication error rates, including rates of serious errors.

For example, one large east coast hospital saw a 55% reduction in serious adverse medication errors after the system was installed. However, on occasion errors can actually be introduced due to the computing process; in particular, errors can be introduced if the provider accidentally selects the wrong medication from the list or drop-down menu.

Accordingly, a CPOE system should not be viewed as a replacement for the pharmacist in terms of checking for medication errors. In addition, proper user interface design such as highlighting every other line on the medication screen for better visibility and having the provider give a final check to the orders before sending are some ways of reducing this kind of error. Overall, error rates from incorrect order entry on the computer are much smaller than other medication errors prior to introduction of the system.

Appropriate use of a CPOE system helps prevent errors and quality of care deficiencies due to problems with the initiation of orders. However, errors can also occur in the execution of orders, particularly with the administration of medications to patients. Bar coding of medications, discussed previously, is a simple way to close the loop in medication error prevention as well as further increase the efficiency of workflow.

Despite its advantages, a CPOE system has been implemented on an organization-wide basis in only about 45% of all US hospitals and growth in implementations has been relatively slow, although about 67% plan to add a CPOE system in the next few years. Implementing a CPOE system is not an easy task, and there is a significant risk of failure. Most hospitals utilize vendors for implementation rather than attempting to develop the system in-house given the difficulty of hiring full-time IT talent that specializes in CPOE systems.

One critical feature of any CPOE system is to obtain physician buy-in to the technology, since they will be doing most of the ordering. Actually, unless the system is of the highest sophistication, physicians may claim it takes more time to write orders using a CPOE system than using the paper chart, as there may be a number of drop-down menus to negotiate prior to arriving at the appropriate drug. Real-time retrieval of information and electronic documentation, provision of on-line alerts, and the ability to use standard order sets (prepackaged sets of orders pertaining to a particular clinical condition or time period in an episode of care), when relevant, can make the net time spent on writing orders similar to using paper charts.

Doctor Acceptance

It is also important, for physician acceptance, to not overwhelm them with on-line alerts. Clearly, the system needs to point out the more serious errors, but if the physician’s process is frequently interrupted by alerts, they may increasingly resist the system.

For example, medication allergy alerts may warn physicians not only of potential problems with medications that have an exact match to the allergen, but also, as a defensive maneuver (“better safe than sorry”), to other medications that have a related molecular structure,, even though the patient may already be taking such medication and tolerating it well. Furthermore, allergies to medications that may result in life-threatening anaphylactic shock may not be distinguished from “sensitivities” that consist of side effects that are not true allergies and are usually much less serious.

Thus, the potential exists for frequent alert generation that would interrupt the work flow and require time spent to override the alerts, making the system difficult to use and leading to user resistance. One suggested solution is to have a hierarchy of importance, with alerts for potentially life-threatening situations being allowed to interrupt the work flow and requiring specific override or acknowledgment, and alerts for less serious problems being “noninterruptive,” allowing easy visibility of the alert without requiring stoppage of the work flow.

CPOE Pitfalls

Other pitfalls with respect to CPOE systems include the following:

crowded menus making it easy to select the wrong patient or wrong drug with the mouse;
fragmented information necessitating navigation through numerous screens to find the relevant information;
computer downtime (scheduled or unscheduled); and
location of terminals in busy places, which can lead to distractions and resulting incomplete or incorrect entries.

Intelligent, well-thought-out system designs can serve to mitigate many of these problems. It is important that such difficulties appear on the systems designers’ “radar screen” and are explicitly considered in the implementation.

Pharmacists

As for pharmacists, a CPOE system will not take them out of the process. Although a CPOE system has the capability to capture many drug errors and remove the need for manual order entry, there will always be a need for pharmacists to not only give a second look at possible errors, but to take a more active role in patient care, including going on ward rounds for complex cases, defining optimal treatment, and giving consultative advice.

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Assessment

A CPOE system has the potential to give physicians ready access to patient data anywhere in the hospital as well as at home or on the road, especially with Internet-based connections. This is significant given the difficulty in obtaining patient charts for mobile providers.

In today’s environment of high expectations for care quality and pay-for-performance initiatives, enhanced quality of care can translate into financial gain. Although there is a significant up-front allocation of funds for CPOE systems, given present trends the time may arrive where there is no longer a choice but to implement such a system.

On Hospital CPOE Systems [Part One]

Conclusion

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Filed under: "Doctors Only", CMP Program, Information Technology, Practice Management | Tagged: Brent Metfessel, Computerized Physician Order Entry Systems, CPOE, eHR, eMR, LOS, pharmacists, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com | 5 Comments »

Sponsorship Opportunities

Posted on June 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Advertise on the ME-P

By Ann Miller RN, MHA

[Executive Director]

Become a sponsor on the #1 resource for medical management consultants and financial advisors in the healthcare space.

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The “Deal”

The Medical Executive-Post is offering sponsorship opportunities to market leaders in the fields of practice management, financial planning, health economics, business, HIT and pharma.

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Sponsors will gain visibility for their companies, products and services – demonstrate their support for our 50 related field topics in the healthcare industrial complex – and be afforded unique opportunities to interact with medical professionals, doctors, nurses, CXOs, each other and healthcare executives of all types.

Assessment

We reach more than 5,000 dedicated medical executives each week, and thousands more visitors.

But, the ME-P has limited sponsorship and advertising opportunities available. Reserve your space today.

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Conclusion

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On Hospital CPOE Systems [Part One]

Posted on June 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Computerized Physician Order Entry Systems

[By Brent Metfessel MD, MIS]

Since the late 1990s, there has been increasing pressure for hospitals to develop processes to ensure quality of care. The Institute of Medicine (IOM) has estimated the number of annual deaths from medical error to be 44,000 to 98,000. Manual entry of orders, use of non-standard abbreviations, and poor legibility of orders and chart notes contribute to medical errors. They also concluded that most errors are the result of system failures, not people failures.

www.CPOE.org

Other studies suggest that between 6.5% and 20% of hospitalized patients will experience an adverse drug event (ADE) during their stay. Both quality and cost of care suffer. The cost for each ADE is estimated to be about $2,000 to $2,500, mainly resulting from longer lengths of stay. The National Committee on Vital and Health Statistics reported that about 23,000 hospital patients die annually from injuries linked specifically to the use of medications.

The Joint Commission and the Leapfrog Group

In addition, the Joint Commission and the Leapfrog Group, a consortium of large employers, have pushed patient safety as a high priority and hospitals are following suit. The Leapfrog Group in particular highlighted CPOE systems as one of the changes that would most improve patient safety. These patient safety initiatives have further advanced CPOE systems, since these systems have the reduction of medical errors as a prime function. State and federal legislatures have also stepped up activity in this regard.

For example, back in July 2004, the federal government strongly advocated for electronic medical records, including the creation of the Office of the National Coordinator for Health Information Technology to develop a National Health Information Network. Consequently, regional health information organizations have been established in many states, and these are used for the purpose of expediting the sharing and exchange of healthcare data and information, although there still remain issues in terms of providing adequate funding to these programs.

In addition, consideration was given to the allocation of grants and low-interest loans to aid hospitals in implementing healthcare technology solutions. In 2000, California first enacted legislation (Senate Bill 1875) stating that as a condition of licensure, acute care hospitals, with the exception of small and rural hospitals, submit plans to implement technological solutions (such as CPOE systems) to substantially reduce medication-related errors by January 1, 2002. Hospitals in California had until January 1, 2005, to actually implement their medication error-reduction plans and make them operational. Unfortunately, many are still not in compliance today.

Health plans also entered the patient safety stage. In 2002, one large health plan in the northeast provided a 4% bonus to hospitals implementing a CPOE system and staffing intensive care units (ICUs) with “intensivists.” Today, this goal is almost the norm, but not yet reality for all.

More than Data Retrieval

Many hospitals have “data retrieval” systems where a provider on the wards can obtain lab results and other information. A CPOE system, however, allows entry of data from the wards and is usually coupled with a “decision support” module that does just that — supports the provider in making decisions that maximize care quality and/or cost effectiveness.

In this application of HIT, physicians and possibly other providers enter hospital orders directly into the computer. Many vendors of such systems make special efforts to create an intuitive and user-friendly interface, with a variable range of customization possibilities. The physicians can enter orders either on a workstation on the ward or in some cases at the bedside.

Features of a True CPOE System

Basic features of CPOE should include the following:

Medication analysis system — A medication analysis program usually accompanies the order entry system. In such cases, either after order entry or interactively, the system checks for potential problems such as drug-drug interactions, duplicate orders, drug allergies and hypersensitivities, and dosage miscalculations. More sophisticated systems may also check for drug interactions with co-morbidities (e.g., psychiatric drugs that may increase blood pressure in a depressed patient with hypertension), drug-lab interactions (e.g., labs pointing to renal impairment that may adversely affect drug levels), and suggestions to use drugs with the same therapeutic effect but lower cost. Naturally, physicians have the option to decline the alerts and continue with the order. In fact, if there are alerts that providers are frequently overriding, providers will often provide feedback that can lead to modification of the alert paradigms. Encouraging feedback increases the robustness of the CPOE system and facilitates continuous quality improvement.
Order clarity — Reading the handwriting of providers is a legendary problem. Although many providers do perfectly well with legibility, other providers have difficulty due to being rushed, stressed, or due to trait factors. Since the orders are accessible directly on the workstation screen or from the printer, time is saved on callbacks to decipher illegible orders as well as preventing possible errors in order translation. A study in 1986 by Georgetown University Hospital (Washington, D.C.) noted that 16% of all manual medical records are illegible. Clarifying these orders takes professional time, and resources are spent duplicating the data; thus, real cost savings can be realized through the elimination of these processes.
Increased work efficiency — Instantaneous electronic transmittal of orders to radiology, laboratory, pharmacy, consulting services, or other departments replaces corresponding manual tasks. This increase in efficiency from a CPOE system has significant returns. In one hospital in the southeast, the time taken between drug order submission and receipt by the pharmacy was shortened from 96 minutes (using paper) to 3 minutes. Such an increase in efficiency can save labor costs and lead to earlier discharge of patients. The same hospital noted a 72% reduction in medication error rates during a three-month period after the system was implemented. Alerting providers to duplicate lab orders further saves costs from more efficient work processes. And, in another instance, the time from writing admission orders to execution of the orders decreased from about six hours to 30 minutes, underscoring CPOE system utility in making work processes more efficient; thus positively affecting the bottom line.

Assessment

On Hospital CPOE Systems [Part Two]

Conclusion

Although a Computerized Physician Order Entry system alone will reap significant benefits if intelligently implemented, in order to realize the greatest benefit a CPOE system should be rolled up into a fully functioning EMR system where feasible.

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BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", CMP Program, Information Technology | Tagged: ADE, Brent Metfessel, CPOE, EHRs, EMRs, IOM, Leapfrog Group, National Coordinator for Health Information Technology, National Health Information Network, The National Committee on Vital and Health Statistics, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | 4 Comments »

Why Hospital IT is Almost like a Retail Mall

Posted on June 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Hospital Bar-Coding Systems

By Brent A. Metfessel; MD, MIS

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

Given anticipated benefits in patient safety, the FDA required in April 2006, that bar codes be installed on all medications used in hospitals and dispensed based on a physician’s order. The bar code must contain at least the National Drug Code (NDC) number, which specifically identifies the drug.

Unfortunately, by 2008 only about 18% of hospitals used bedside bar coding systems. Nevertheless, this ruling heightened the priority of implementing hospital-wide systems for patient/drug matching using bar codes and implementation that is still growing rapidly today.

Procedures

Conceptually, the procedure for bar coding is as follows:

The drug is given to the nurse or other provider for administration to the patient.
Once in the patient’s room, the provider scans the bar code on the patient’s identification badge, which positively identifies the patient.
The medication container is then passed through the scanner, which then identifies the drug.
The computer matches the patient to the drug order. If there is not a match, including drug, dosage, and time of administration, an alert is displayed in real-time, enabling correction of the error prior to drug administration.

Enter the FDA

The FDA estimates that over 500,000 fewer adverse events will occur over the next 20 years, a result of an expected 50% decrease in drug dispensing and administration errors. The decrease in pain, suffering, and lengths of stay from drug errors is estimated to result in $93 billion in savings over the next 20 years.

Avoidance of litigation, decreased malpractice premiums, reduction in inventory carrying costs, and increase in revenue from more accurate billing result from the improvement in quality and efficiency of care.

This makes implementation of bar coding technology relatively low-risk, although there needs to be sufficient informatics capability to capture and store drug orders.

Estimated Cost Savings

For a bar coding system, a 300-bed hospital may expect up-front costs of $700,000 to $1.5 million with about $150,000 in maintenance fees annually. The returns, however, in terms of improved patient safety and cost of care make an investment in bar coding technology one of the more cost-effective information systems investments.

Assessment

Also, given the increasing consumerism in healthcare, prospective patients will be more assured of care quality from a hospital investing in state-of-the-art technology in this area, giving the medical center a competitive advantage.

Conclusion

Thus, hospitals are becoming more like retail businesses every day … finally!

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Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: "Doctors Only", Health Economics, Information Technology, Quality Initiatives, Risk Management | Tagged: Brent A. Metfessel, FDA, hospital bar codes, medical bar codes, National Drug Code Number, NDC, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 2 Comments »

Building a Meaningful Medical Practice Marketing Campaign

Posted on June 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

What it Is – How it Works

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

[By DeeVee Devarakonda MBA]

The success of a knowledge driven healthcare organization depends on not only how data can be converted to information – and information into marketing insight – but also by acting upon and converting those insights into building meaningful patient acquisition campaigns.

Definition of Patient Recruitment

Patient recruitment or campaign managementis the process of designing, executing, and measuring marketing campaigns through the use of applications that help to:

Select and segment patients
Design campaigns and execute the campaigns to contact patients
Track the contacts made with patients
Measure the results of those contacts
Learn from these results to more efficiently target patients in the future.

Key Queries

Some key questions to ask while you build campaigns:

Do you have a Customer [Patient] Relations Management roadmap that fits in with your overall patient vision and strategies and outlines the course of action for campaign management?
What is your privacy policy and strategy? – It is imperative for healthcare organizations to be proactive and self-regulate with a coherent privacy policy and design their systems to comply with this strategy. This may affect the way you design and execute campaigns.
What tools should you use? – There are several campaign management tools available today but no one tool may solve all business problems. You need to decide: what works best for my technical/ business environment? Is any integration effort required, if yes, how much will it cost me? How user-friendly are the tools? How much should I invest in training?

Important Campaign Components

Critical components of campaign management include the following activities:

Patient Segmentation: Process of identifying groups of patients for better targeting marketing and communications efforts. Segmentation is critical for effective and intelligent one on one communications with your patient.

Ensure your data quality is excellent which can give you meaningful segmentation.
Consistency of treatments and processes are of paramount importance.
Buying a software tool is not enough for effective segmentation. You also need to understand what the software tool does in the backend. Watch out for anomalies and take steps to make reparations.
Make sure you administer the initiative to a small sample and the business rules are in place before you roll out your campaign to the larger group.

Personalization: Ability to customize your product/service to each patient:

Good personalization is possible especially when you have a good patient past history.
You also need to have all business rules in place for effective personalization.
Ensure your patient data is of high quality (e.g. addressing a female patient as a Mr. or sending mails to sign up for your service to a person who is already your patient can defeat the purpose of personalization)
If you model data before personalization, you can target more effectively and personalize.
It pays to have a clear privacy policy and ensure your personalization philosophies are in tune with that policy.

Execution – Actual implementation of your marketing programs and messages

Before you execute, ensure you are equipped to fulfill promises you are making in the campaigns (e.g. If you are printing a toll free phone number in your direct mail piece for your patients to use, that toll free telephone number should work)
Make sure your sales and service channels are aware of the campaigns and publish a general calendar for the whole company
Develop business rules and strategies for follow-up campaigns.

Learn more: http://www.CertifiedMedicalPlanner.org

The Mindset

Successful patient marketing campaigns begin with the proper mindset and practice culture. There is no technology silver bullet to any P[C]RM campaign. And today, patient privacy is the key element of loyalty with a commitment to build long lasting and profitable campaigns through mutual trust and engaging cross-functional teams that can pick and deploy the elements mentioned above, across the entire enterprise and IT network, as needed.

Assessment

Healthcare organizations should keep privacy and the above components as their laundry list of action items when considering a C(P)RM plan.

Conclusion

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FINANCE:Financial Planning for Physicians and Advisors
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Filed under: Career Development, CMP Program, Glossary Terms, Marketing & Advertising, Practice Management | Tagged: CRM, DeeVee Devarakonda, healthcare marketing campaigns, Medical CRM, medical marketing, www.certifiedmedicalplanner.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | 2 Comments »

Our New Face – Same ME-P

Posted on June 6, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

We Got Visual “Fly”

By Ann Miller RN, MHA

[Executive Director]

As you may have noticed, we have a brand new look; very visual and very photographic. ME-P got fly.

But, underneath it all, we’re the same ME-P you’ve come to count on for daily essays, updates, investigative reportage, comments, gossips, breaking news, expert advice and op-ed pieces, the classifieds, and much more!

All features and functionality are the same; and our goals, objective, mission statement and topic channels remain the same. Most importantly, your subscriber account information remains secure and unchanged.

IOW: Your experience should be exactly the same as it has always been, just a lot better looking.

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Why the Change?

After 3 years we felt it was time to freshen things up a bit and create a visual experience that reflects the forward-thinking and innovative partner, we are. In the healthcare and financial services space, you can count on us on to inform, gather data and make important insights, that ultimately help you make better decisions to grow your practice, assist patients and clients, and professionally thrive in an ethical business fashion.

Your Opinion Matters

And so, we’d love to know what you think of the changes we’ve made. There is a feedback / comment link on the bottom of every page, and you can always reach us through our reader / subscriber email center.

MarcinkoAdvisors@msn.com

Conclusion

As always, thank you for reading the ME-P, and purchasing our products and/or related consulting services. We appreciate the opportunity to serve you. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

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Filed under: CMP Program, iMBA, Inc., Media Mentions and PR, Sponsors | Tagged: certified medical planner, CMP, medical executive post, www.BusinessofMedicalPractice.com, www.certifiedmedicalplanner.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | Leave a comment »

Win a Free iMBA Inc Dictionary

Posted on June 5, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Dictionary of Health Insurance and Managed Care

ADVERTISEMENT

Health care and health insurance have become increasingly complicated for the average citizen. While we at the Benefits Group do our best to assist individuals and businesses with their insurance needs, we appreciate and understand the value of educating yourself on the subject.

With that in mind, we’re offering a no strings attached opportunity to win a book that will provide many answers to your health care questions.

From iMBA Inc: www.MedicalBusinessAdvisors.com

The book up for grabs is the Dictionary of Health Insurance and Managed Care by Dr. David E. Marcinko; FACFAS, MBA, CFP™, CMP™ [Editor-in-Chief] and Hope Rachel Hetico; RN, MHA, CPHQ, CMP™ [Managing Editor].

Click here to read the Amazon.com reviews for Dictionary of Health Insurance and Managed Care

Beyond that, all you need to do to win is provide your email below. We will not be using this email for any marketing purposes, nor do we participate with any lists. We just need your email to contact the winner so we know where to send the book.

The only rules are that participants be at least 18 years of age and live in the residential United States. Also, only one entry per person (our software knows how to sniff you out if you cheat, so please don’t bother). We will be announcing a winner on July 1st, 2010 and will be accepting entries until midnight EST on June 30th, 2010.

ENTER TO WIN

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Any how, thanks for subscribing to the ME-P and good luck!

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The Economics of Stock Market Fear for Physicians

Posted on June 1, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Panic Control and the Possibility of Severe Financial Degradation

By Somnath Basu PhD, MBA [www.clunet.edu/cif]

[Director California Institute of Finance]

An experiential learning of mammoth proportions occurred several weeks ago in the financial markets. The absolute 10 minute freefall of the prices of stocks and bonds, without any pre-notification froze the hearts of many physicians and lay others both in, and outside, of the investment community. The possibility of a one trillion dollar loss had suddenly and unexpectedly turned real. It happened in a matter of minutes. This experience of panic, of the possibility of a severe economic degradation of life becoming immediately real, is like none other that most of us can ever remember experiencing. Even the 1987 crash happened over a large part of that Monday. Like then, this time too there is no known reason of why it happened, though attempts are being made to understand the cause(s). Whatever the reasons may be, it will not change the experience we had of the realization of the fear of a sudden and unexpectedly large loss.

Event Analogies

Before going deeper into the experienced fear, it is useful to provide some analogies to the event. If the meltdown in the financial markets of 2008 was like an earthquake, then this was like a severe aftershock. It is also similar to going down one of those severe roller coaster freefalls that some may consider very undesirable. Alternately, what makes a 30 year old physician be mostly unconcerned about his/her lack of retirement savings while a 60 year old doctor in the same poor condition is much more concerned. Obviously, the possibility of a lower quality of economic life is much more real for the elder than the younger. In such cases we would expect the fear of an economically degraded life to spur people to take preventive or remedial action.

Understanding Fear

To truly understand our responses to fear, we need to go deeper into our minds. According to behavioral psychologists and neurologists both, there are various segments within our mind. For example, one segments of our mind (the frontal lobe) is understood to process analytical tasks. Similarly, other parts of our brain (the older limbic system composed of mammalian and reptilian brains) react to and affect/control our emotions and fear. When we are faced with an immediate threat, this older system takes over control of our reactions and often drives us towards instinctive responses and will not, in general, make the analytically reasoned response. It is similar to learning about all the different ways we need to behave in the wild if we came across a bear. When people actually are faced by such a situation, they rarely remember all their learning and respond with their instincts. Those are the limbic responses. In other words, when threats are real, our emotional mechanisms will dominate our rational mind and we will react according to our older and longer existing nature.

Shocked Limbic System

Such was the effect of the financial freeform. In those 10 minutes the economic shock to our limbic system was the first of its kind, in terms of magnitude. While discussions are held about sudden unexpected losses, typically the impact of sudden huge losses in a very very short period of time is rarely thought of in very meaningful ways because the probability is so very low. This time, it did actually happen! We will bear some consequences which will begin playing themselves out slowly over this summer. For one, the investing nation will be much more circumspect about stocks and other volatile financial instruments. In a more technical way, our risk aversion as a nation will have suddenly increased. This will have an impact on both trading volume and security market prices and eventually on portfolio values. How younger physicians and other investors will react is less known.