July 27, 2008
New Electrosurgical Scalpel Approved by FDA
By Jose DeJesus MD
The FDA has approved a new electrosurgical scalpel called the plasma blade. It performs better than current electrosurgical scalpels (such as the Bovie) with less burning and collateral tissue damage, which leads to faster healing times.
Be using pulsed energy and better insulation of the electrodes, the device performs more like a knife and there is less generalized heating and burning of the surrounding tissue.
See the plasma blade demonstration video. Warning to laymen - this video is not for the squeamish.
Topics: Physician News | No Comments »
July 25, 2008
Take Stock of Your Progress
By Jose DeJesus MD
It is easy to be lulled into a routine, despite the apparent urgency of what we actually do. Take stock on a weekly basis of what you have accomplished and what you have done to move yourself closer to the goals you have set for yourself.
- If you have made some progress, congratulations.
- If not, then resolve to allocate a bit more time and effort to achieving those goals.
- If you can’t really remember what your goals are, now would be a good time to reflect on what they are and should be.
“Let me respectfully remind you, life & death are of supreme importance. Time passes swiftly and opportunity is lost. Each of us must strive to awaken. Awaken! Take heed, do not squander your lives.”
Zen proverb
Topics: Self Improvement | No Comments »
July 24, 2008
Retail Medical Clinics Plan Expansion - What Can You Learn From Their Success
By Jose DeJesus MD
Retail medical clinics, operating in drug stores and other convenient settings, have become increasingly popular ways for after-hours care and for low cost delivery of simple low-risk services, typically through nurse practitioners. Charging about $60 for a typical visit, and participating in most health insurance plans (which typically means that the patient pays the same copay as a doctor visit), the clinics are attractive to both the insured and uninsured, and those who belong to high-deductible health plans. To those who would choose between an emergency room visit and a retail clinic for a sore throat, the retail clinic costs much less and probably has a much shorter waiting time.
Like Jiffy Lube, the clinics started out with simple services, and as the public gained confidence in them, added more services, like camp physicals and vaccinations. The AAFP has studied the success of these clinics and offers their insights.
The public knows the difference between a nurse practitioner and a physician and consider their physician to be their medical home. However, you can and should look at the features of retail clinics that are popular with the public — it is always wise to learn from the competition.
For those physicians that are so inclined, in those jurisdictions where these clinics are permitted, there is no reason why you cannot hire one or more nurse practitioners and set up your own retail clinic or clinics, which will naturally refer the more serious cases to you for follow up. Naturally, you should study the competition, learn from their example, and if you decide this is a good idea for your practice, be sure to contact an attorney specializing in health care law to make sure that you are in compliance with all regulations and restrictions on this kind of clinic, and that you structure the clinic business to minimize the liability of your main practice for any claims against the clinic.
http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20080723retail-q-a.html
Topics: Physician Practice | No Comments »
July 23, 2008
Retirement Tax Planning Surprises
By Jose DeJesus MD
Conventional wisdom tells you that, during retirement, your income needs will be x% less and that you will be in a lower tax bracket. This may be OK if you plan an impoverished retirement.
On the other hand, if you maximize your opportunities for tax-deferred savings, and continue some professional activity (if only because you love what you do and can then afford to do it on your own terms), you may not see a significant drop in your tax rate.
Other factors that argue against a big drop in your tax rate in retirement include:
Fewer tax deductions in retirement
- With the children grown and finished with school, you will lose tax deductions associated with them
- You may move to a smaller home and pay less property tax (another tax deduction gone)
- You may choose to pay off your mortgage or move to a rented property (another large tax deduction gone)
Higher Effective Tax Rates
Finally, there will soon come a day of reckoning where government has to either severely curtail entitlement programs or raise taxes to pay for them. Most likely there will be a combination, in which a “needs test” disqualifies you for the benefits while taxing you more to pay for those that it still gives out. While nobody can guarantee what the future tax picture will be, effective rates are currently low compared to the recent past and unless there is a radical overhaul of the system, they are more likely to go higher rather than lower. Congress will likely throw in some kind of razzle dazzle to disguise the increase, such as phase out of certain tax benefits at higher income levels, but the effect will be the same - higher effective rates.
Topics: Wealth | No Comments »
July 22, 2008
Congress Postpones Medicare Cut - Now What
By Jose DeJesus MD
Congress has overridden President Bush’s veto and approved a bill (HR-6331) that reverses the 10.6% cut in physician Medicare payments. This bill was originally vetoed because it reduces payments to Medicare Advantage plans by $14 billion and is loaded up with over 100 other provisions.
An 18 Month Reprieve
Most people don’t want to know what goes into sausages or legislation, but in this case you may want to. The bill that was enacted into law postpones the cut in physician payments for only 18 months, after which time there is a scheduled reduction of 21% on 1/1/2010. Yes, that’s almost exactly double the cut that was just postponed.
Big Talk For Primary Care Physicians
The big news this week has been about a pilot program to pay primary care physicians an extra $30 to $35 per year to provide comprehensive case management and phone/email support for their patients, especially those with chronic diseases, while maintaining the current reimbursement rate for office visits. While compensating primary care physicians for spending more time with patients and better case management, $35 seems like a token payment that is only about 50% of a typical office visit reimbursement. How much physician attention over the course of a year is $35 supposed to pay for?
Medicare Advantage - At a Disadvantage
The last time that Congress reduced funding for Medicare Advantage, enrollment fell sharply. It’s not clear how Congress reconciles a call for better case management with a program that is built around the primary care physician and case management.
Your Next Step
You have 18 months to make your practice less dependent on Medicare, and to start building your financial independence. These topics will be covered in more detail in www.MDinfoNews.com
Topics: Physician News | No Comments »
July 21, 2008
Physician News Featured Articles for Week Ending 7/18/08
By Jose DeJesus MD
Here are the feature articles for the week ending 7/18/08;
PERSONAL
MONEY AND INVESTING
- Municipal Bonds as an Investment
- Consider Taxes When Relocating to Another State
- IndyMac Bank Failure - What it Means to You
BUSINESS
MANAGEMENT
Topics: Physician News | No Comments »
July 20, 2008
Laddering a Bond Portfolio
By Jose DeJesus MD
When you construct a laddered bond portfolio, you reduce the impact of fluctuating interest rates. In essence, a laddered portfolio contains a series of bonds with staggered maturities.
Suppose you buy a series of bonds that mature in 5, 5.5, 6.5, 7, 7.5, and 8 years, and anticipate that you will have no use for those funds for the next 5 years, at which time, you plan to draw on them over a period of time. This allows you to hold those bonds to maturity, because there will be a bond maturing within 6 months starting from the point in time when you start to draw on those funds.
In a normal interest environment, the longer maturity bonds have higher yields but if you only hold the longest maturity bonds, you may end up selling some before maturity. Using laddered maturities, you can lock in the higher yield of the longer maturities while making funds available at whatever interval you select — in our example, we laddered the portfolio with part of the portfolio maturing at 6 months intervals. Therefore, you get the best of both worlds - better returns with lower risk.
Bonds have a place in a balanced portfolio, but you should not make bonds the only type of investment in your portfolio. Instead, you should use a combination of dissimilar investments in a proportion selected according to your needs and tolerance for risk.
Topics: Wealth | No Comments »
July 19, 2008
Tips to Market Your Business
By Jose DeJesus MD
Your business can be effectively marketed with little cost. Creative strategies that are based on building relationships can get you the results you want.
Have a Marketing Plan
Your marketing plan is your blue-print that details the strategies you want to employ, the message you want to send and defines the customers you want to reach.
Learn to Network
Find others who share your passion. Let others know who you are and tell them about your business. Building trust is an important factor in the success of any type of business.
Get Your Name Out in Public
Be newsworthy - be helpful. Give talks, write articles, share your knowledge with the public. Find organizations in your area where you can make contacts, and be helpful without creating commitments that drain your energy and time. Your local chamber of commerce can often be a valuable resource and source of contacts.
Evaluate Your Results and Adjust Your Tactics
Look at the results you get from each approach you use to network and publicize yourself and your business, see whether they are worth the trouble, and avoid throwing your energy into avenues that do not benefit you. This is not to say that you should be selfish, because if you simply use other people for your own ends, this will quickly become obvious and it will backfire and hurt you.
On the other hand, there are people out there who ARE selfish and will latch onto you like vampires and load you up with so many extracurricular commitments that your own business and personal life will suffer. Strike a balance and if you see that something isn’t working out for you and you are being used rather than having a mutually beneficial relationship, then set boundaries and limits, and pull back if your boundaries are not respected.
Get Help
There are several low to no-cost ways to find help with your marketing plan. The Small Business Administration at: www.sba.gov and the Service Corps of Retired Executives at: www.score.org provide advice, and Entrepreneur.com has worksheets you can use to organize your marketing plan.
Update Your Plan
Update your marketing plan at least once a year. Evaluate your goals to see if they have changed, and align your strategies with those goals.
Topics: Marketing and Promotion | No Comments »
July 18, 2008
Consider Taxes When Relocating to Another State
By Jose DeJesus MD
Whether you are a young physician with a growing family or a retired physician looking for ways to save, always consider all the taxes that await you before you move. For example, if you are moving to a less expensive house in a state with no property taxes you may find other taxes wipe out your retirement. Research the state and city that you are interested in moving to. If they don’t have an income tax they will have to tax you somewhere else, and there may be other costs that may not be obvious until you look deeper. For practicing physicians, malpractice insurance rates and the presence or absence of tort reform are also important considerations. Homeowner and auto insurance rates, and other living costs also vary dramatically from state to state.
You Get What You Pay For
When you look at property taxes in a city and state you may find it lower than where you live. Do you have to take your own garbage to the local dump where in some communities they pick it up at the door? What about recycling — do you have to take the items to a local station or does the truck come to your door? Less property taxes means less services and the more time you have to spend doing things you may not have time for. Young and retired physicians may want those nice services some areas lose with low property taxes.
Consumption Taxes
Looking at all the taxes a state imposes is an important aspect of looking at the financial picture before you move. Many states have sales taxes — the highest are Tennessee, Louisiana, Washington, New York, Arkansas, Alabama, Oklahoma and California. This will eat up some of your income. Cigarette taxes are highest in New Jersey, Rhode Island, Washington, Alaska, Arizona, Maine, Connecticut, Maryland and Michigan.
Personal Income Tax
41 states have a personal income tax. The states of New Hampshire and Tennessee only tax the interest and dividends of personal income. The states of Alaska, Florida, Nevada, South Dakota, Texas, Washington and Wyoming do not tax personal income. If you are retired you will want to look at the states policy on social security retirement benefits. The states of Minnesota, Nebraska, North Dakota, Rhode Island, Vermont, Connecticut, Iowa, Kansas and Mississippi will tax your social security benefits to some degree.
Taxes on Retirement Income and Retirement Savings
How does the state or city you want to move to handle taxes on retirement plans. Some will heavily tax IRA’s and other accounts for retirement. Some states even tax military pensions and retirement plans. All these factors will eat up your retirement income when you factor it into the expenses you may be paying. The states of California, Nebraska, Connecticut, Rhode Island and Vermont don’t allow exemptions on tax credits for pensions and other retirement income. New Jersey, Massachusetts and Pennsylvania do not allow IRA contributions to be deducted from taxable income.
Estate and Inheritance Taxes
Eleven states still have an inheritance tax – a tax on money or property you inherit from someone else’s estate. An estate or gift tax is levied against you or your estate when you give or bequeath money or property to others.
Look at the Whole Picture
The old saying look before you leap makes sense with moving to another state. Check into all the taxes a new state and city can impose on you and your family. A good accountant or financial advisor can give you solid advice about whether a move is really in your best interest. Look at the income opportunities, cost of living, the amenities and attractions of the community, and tax considerations. Whether you are a young or older physician you need to think carefully about moving and plan accordingly.
Topics: Strategy | No Comments »
July 17, 2008
Getting More Done
By Jose DeJesus MD
Time is your most precious resource because you can’t replace it once it’s gone. You can lose money and then earn more or even go through bankruptcy and start over. Buildings, supplies, and staff can be replaced, but every second that goes by is lost forever and cannot be replaced.
Working harder does not equate to greater productivity. The key is work smarter - here are some ways to get more done in the time you have available:
1. Delegate. You really don’t have to do everything yourself. Showing a subordinate how to do something is worth the investment of time if it frees up your own time on an ongoing basis.
2. Take half an hour every week to sort out your priorities and build a “to do” list. Review it briefly at the start of each day. Be sure that you don’t keep things on your “to do” list that you should actually be delegating.
3. Multitasking is overrated. It’s a time management myth. Do one thing at a time until you finish it.
4. Invest in yourself: Invest some time in continuing education and personal improvement on a regular basis. Self-improvement has a higher rate of return than almost anything you can think of.
Topics: Self Improvement | No Comments »
