Doctor’s Rounds™

*The views expressed by the authors below do not represent the views or opinions of MD Preferred Services.

Insurance Protection for Physicians – pt 1

Thursday, July 23, 2015

by David I. Katz, AAMS®
connect with me on LinkedIn and Twitter

Successful medical professionals accumulate assets as they build their net worth, but it’s important to protect those assets from a variety of perils, including losing all your savings and having to start over again. Managing those risks in a cost-effective manner, while still saving and investing for the future involves maintaining a delicate balance. 

Purchasing insurance protection is an important piece of the financial package you should assemble as you begin your professional career. There may be financial benefits in purchasing multiple types of coverage from one insurer, and you may also have the benefit of single-source accountability. You should also consider your income level, personal circumstances and personal wealth as you make decisions about coverage.  READ MORE


A Number is Not a Plan

Monday, July 13, 2015

By: Anthony J. Ogorek, Ed.D., CFP
Ogorek Wealth Management LLC

There are any numbers of people who are pitching ways to get rich. They know that there is no magic to saving regularly and then investing intelligently. So actually leveling with you will not be effective. They need to provide you with a shortcut. Now that has appeal to people.

Shortcuts have been used for years to not only sell us dubious propositions, but to make the purveyors wealthy. For instance, you may recall sure fire weight loss schemes that require just taking a pill; or wearing a garment that will melt the pounds off of you, or offer you a return that you know is too good to be true.

In a sense you can’t blame us for falling for shortcuts since we all have limited time, and want superlative results. In our experience financial shortcuts may not just disappoint you, but can cause permanent damage to your financial health.

Creating and maintaining a financial plan can be a real effort. The payoff is that you have reasonable assurances that you will not outlive your money, and are managing the full array of risks that can tank your lifestyle. People without a plan often substitute a number for a plan. In other words they boil their future financial security down to a number or two. They may say that they need $1 million in assets and a 5% annual return to hit their retirement objectives. That is their plan.

This motivation is so powerful that even some people who already have successful financial plans persist in ignoring their plan and pushing for their number. The danger with this approach is that you may be forcing yourself to accept more risk than necessary to meet your objectives.

You may also deprive yourself of one of the most important things in life, peace of mind. Constantly worrying about the future is nobody’s idea of a good time. It is also no fun when you realize that your number forced you to live much more frugally than necessary. I am all for simplification, but mapping out the next 20 or 30 years requires more than a number and a hoped for return on your portfolio.  READ MORE


Don't let the additional work of ICD-10 drive you into physician burnout

Monday, July 06, 2015

In my work with hundreds of over stressed and burned out physicians, one thing is constant. Documentation is always one of their biggest sources of stress. 

In fact, if you ask the average working doctor to make a list of their top five stresses, documentation chores will take up three of the five slots.

EMR - especially if you use multiple EMR software programs that don't talk to each other
Dealing with lab reports and refill requests
Returning patient and consultant calls and documenting them adequately
and all the other places information streams have to be forced together by the sweat of your brow.

The average doc is walking the cliff edge of overload on a significant number of office days in any given month. Now comes ICD-10 and my biggest fear is the extra work of the new coding system will push many physicians over the edge into burnout.

How much more time will ICD-10 take?

I have talked with several ICD-10 implementation experts who toss out comments like, "Only a couple minutes per patient", as if that were no big deal. If you see 25 patients a day, that is 50 minutes added to your office day starting October 1st. That amount of additional documentation work will drive many docs over the edge if you don't start preparing now.   READ MORE


A TED Talk Every Physician Should Watch

Monday, June 29, 2015

Maryn McKenna: What do we do when antibiotics don’t work any more?

Penicillin changed everything. Infections that had previously killed were suddenly quickly curable. Yet as Maryn McKenna shares in this sobering talk, we've squandered the advantages afforded us by that and later antibiotics. Drug-resistant bacteria mean we're entering a post-antibiotic world -- and it won't be pretty. There are, however, things we can do ... if we start right now.

Here is the link: What do we do when antibiotics don't work any more?   READ MORE


MERS: Here we go again

Friday, June 26, 2015

After the recent outbreak and spread of the Ebola virus, we have heard numerous follow-up stories of all that we learned about the epidemic; all of the mistakes made and lessons learned.  “If we knew then what we know now, we would have acted sooner, implemented safeguards, introduced protocols and rushed the development of antibodies and vaccines,” healthcare authorities have lamented.  But we will be ready next time.

Well, with the recent outbreak of the MERS virus in South Korea we are seeing many of the same errors and lack of preparedness surfacing.  And when one considers that the virus is far less virulent than Ebola or SARS, and originates in Saudi Arabia and is passed from camels to humans only in rare occasions, one has to wonder how this outbreak could get out of hand so quickly.  READ MORE


Estate Planning for Doctors

Thursday, June 25, 2015

by David I. Katz, AAMS®
connect with me on LinkedIn and Twitter

“While most people look at estate planning as planning for death, it’s really planning for life.”
~ attorney Seth Ellis

According to the AMA 2013 Survey on Physician Financial Preparedness:

more than 1 in 3 doctors say they don’t have an estate plan
44% of female physicians don't have an estate plan, versus 31% of men who don't have an estate plan
68% of physicians under 40 don’t have an estate plan

A number of different documents may be needed for effective estate planning, including a last will and testament, which provides a good starting point.  A will typically includes several elements: 

a listing of who will receive personal possessions, such as jewelry or artwork 
a provision for the guardianship of any minor children
the appointment of a fiduciary—someone who can “step into your shoes” and manage the disposition of your property.  READ MORE


The White Mouse Chip

Wednesday, June 24, 2015

I had never heard of the London Design Museum until recently.  And it still would not be at the top of my bucket list of must see spots on any future trip to England.  But they offer an annual Design award for the best in bioengineering.  And this year’s winner caught my attention.

And the winner is…The Human Organs-On-Chip designed by Harvard University’s Wyss Institute.  For decades we have read how Canadian white mice have developed cancer after drinking five gallons of iced tea every day for a month or how their brains have been implanted with micro chips or electrodes that have increased this or decreased that.  Animal testing of medical procedures, devices and pharmaceuticals has been an accepted part of the development process that improves the human condition through medical advancements.

Advocates for the humane treatment of lab animals have for the most part concentrated on the environment within which the subject animals live rather than the larger question of our species using other species to advance our condition.  And now we may be on the eve of a technology that could one day eliminate or greatly decrease the use of animal testing all together.  READ MORE


Marijuana is legal in Colorado, right?

Monday, June 22, 2015

Everybody knows that the state of Colorado has for some time now legalized the medical use of marijuana.  In fact the state is now experimenting with the first sales of recreational pot use.  So, pot is legal.  Right?  Well, not exactly.

The Colorado Supreme Court has just ruled on a case involving a gentleman by the name of Brandon Coats who was fired by his employer after a random drug test conducted in the work place revealed traces of the chemical component of pot in his blood stream.  The case dates back to June of 2010 when Coats was fired after failing a drug test.  Coats sued alleging wrongful termination.  He based his suit on the fact that he was fired, not because he was impaired or “under the influence” while working or even for using marijuana in the work place; but rather because his offsite use of the legally prescribed substance left trace amounts in his blood stream.  

To summarize, Coats, a quadriplegic, was using medically prescribed marijuana, on his own time in a state that had legalized marijuana for that very use.  He was not using while on the job and he was not impaired by any legal definition while at work.  He simply tested positive during a random drug test.  READ MORE


The Cash Balance Retirement Plan Solution

Tuesday, June 16, 2015

The Cash Balance Retirement Plan Solution:
Accelerate Savings and Reduce Taxes

By James J. Di Gesu 

Although April 15th was weeks ago, the impact of paying income taxes may still have a lingering affect for many doctors. Many of these same doctors find themselves with a retirement plan dilemma.  They have high earnings, pay high income taxes, but have inadequate retirement savings.  This is due to limits on 401(k) tax-deferred savings and because they have invested heavily in building their practices.  If you happen to find yourself in this situation, and would also like to save on paying income taxes with a significant tax deduction, adding a Cash Balance Plan may be the perfect solution.  

Keep in mind that a Cash Balance Plan must be established by December 31st to take advantage of tax deduction in 2015, although the plan doesn’t need to be funded until the firm’s tax return is due.

Cash Balance Plans provide participants an annual pre-tax contribution limit of up to $275,000, typically double or even triple what is allowed in a 401(k) profit sharing plan ($59,000 for 2015 if age 50 or older). Since the contributions are tax deductible, it is possible to accumulate a retirement plan benefit of $2.6 million over 10 years without consideration of investment growth potential.  If income tax rates rise in the future this tax deferral feature becomes more attractive.

Within a Cash Balance Plan, each participant has a hypothetical account which is credited with annual pay credits (contribution) and interest credits (typically around 5%). Furthermore, unlike a 401(k) plan the participant does not have any investment risk. The nature of Cash Balance Plans and the investment structure typically insulates them from market volatility. The investment goal for a Cash Balance Plan is to protect the tax deduction rather than maximize investment returns. The investment goal for the investment manager of the Cash Balance Plan is to optimize the returns by meeting the interest credit rate each year.

When paired with a 401(k)/profit sharing plan, the two are combined for nondiscrimination testing.  The Cash Balance Plan combination arrangement allows maximization of benefits to doctors and other “key” participants while keeping employee contribution costs relatively low. Contributions can be a percentage of salary or a flat dollar amount and are stated in the plan document.

Since Cash Balance Plans are “defined benefit” plans the contributions and interest credits are not discretionary and require an actuary to provide the funding requirement to the plan sponsor. Employers can designate different contribution amounts for various participants which allows for greater flexibility. Once participants retire or terminate employment, they are eligible to receive the vested portion of their account balance.  Cash Balance accounts are portable and can be rolled over to an IRA.   READ MORE


Interesting definition of “moral precedent”

Monday, June 15, 2015

As you have read in this blog and in mainstream media across the country, the Supreme Court is considering another challenge to Obama Care with a decision due soon.  Without covering old ground, in King vs. Burwell conservatives are challenging the subsidies that the federal government is dispensing to citizens purchasing insurance through the federal exchange in states that did not create state-run marketplaces.  A literal reading of the law did not clearly spell out the federal government’s authority to provide such subsidies, authorizing only those distributed through state exchanges.

In a recent interview, Peter Lee, executive director of Covered California, the California state run exchange, made a remarkable statement.  “I think it would set a horrible moral precedent if the Supreme Court was to find that we can leave Americans without that financial leg up.”  He was referring of course to insurance premium subsidies that are available to any family of four making less than $97,000 per year.

“I think it’s a fundamental flaw to not understand how every American needs a leg up.”  Hmmm…fundamental flaw?  He almost got carried away and said what he was really thinking; namely that insurance subsidies are a “fundamental right.”  But of course he couldn’t come right out and say that because obviously even the most liberal reading of the Constitution doesn’t find such an inalienable right.  

Mr. Lee’s definition of a moral precedent must run something like this:    READ MORE