THIS MONTH’S ADVISOR IS SONSORED BY…

Grow Your Medical Practice Profitably

Let the PROFIT EXPERTS Show You How

You are busy running your practice. You have patients but also employees – and costs. Many physicians find out too late that adding more billing does not always mean more profit. Our clients have thriving medical practices because they have a profit roadmap. They know how to easily maximize their profits, so they can focus on their patients. My name is Fred Parrish, Author of “The Profit Mentality,” Former Practice Management CFO/COO, Advisor and current CEO of The Profit Experts. My company can help maximize your profitability:

CONSULT: Real world advice, customized for you. For example, determine how the Affordable Care Act will affect your business and what you must do now to safeguard your practice.

ANALYZE: Using our model, identify the profit leaks in your practice. Simply, in just a few minutes, we can

show you areas of concern – and options to fix.

PREDICT: Using historical data and our forecasting tools, run highly accurate “what if” scenarios to determine present and future profit impacts (staff, equipment, facilities, etc.) For example, what’s the financial impact of hiring a PA or adding a new piece of equipment

FREQUENTLY ASKED QUESTIONS: Q: I already have accounting software. Great, we’ll need that information into our database. We work “hand and glove” with your current software, giving you tools that complement and enhance your current system. Q: How difficult is the process and how much does it cost? It’s easy. We load your information, conduct the initial consultation, and you see the results immediately. The cost is a fraction of what you’d spend for traditional CFO services, only a few hundred dollars monthly. Q: What’s the ongoing process afterwards? We conduct a joint monthly online consultation with you to do a comparative analysis and review Q: What benefits should I expect long term? Increased profitability and cash flow – of course. But mostly peace of mind by knowing that your decisions are strategic, not reactive. Predictive knowledge that is accurate and highly useful really can maximize your profitability. Just call us at 214-383-0500 or email info@profit-experts.com to schedule a free 15 minute consultation. Stop hoping and guessing about your financial next steps. Profit Experts can show you the way!

Beware of What You Ask For By: Anthony J. Ogorek, Ed.D., CFP Ogorek Wealth Management LLC www.ogorek.com This week I attended a meeting of the local estate analyst community. This group is comprised of some very high-end accountants, attorneys, and advisors, among others, who were being briefed on some of the intricacies of stretching out required minimum distributions from retirement accounts. Toward the end of the presentation it occurred to me that the advice they were giving, although technical in nature, could conflict with why any of us save money in the first place. The thrust of the presentation was a reaffirmation of what all of us have been trained to advise our clients: in order to save taxes, defer payments from retirement accounts for as long as possible. “Success” is viewed as keeping the greatest amount of money from Uncle Sam’s hands. The only drawback with keeping it out of our Uncle’s hands is that it also keeps it from our hands! To better frame this conflict, how would you answer this question: ‘Who is wealthier, someone with a $1 million account who refuses to spend it, or someone with $100,000 who intends to spend it on activities that give him or her enjoyment?’ Obviously this is a very skewed example, but you can appreciate the point: does money really matter if you have no intention of deriving any economic value from it? I am sure that none of the professionals at the meeting would advocate that a client sacrifice their lifestyle in order to save on taxes. However, if saving taxes is your sole gauge of success, perhaps you need to reassess what having money is all about. No one, including yours truly, wants to pay more tax than is required by law. However, there are situations when denying you just to spite the tax man makes little sense. In our line of work, everything comes with a price. There are no silver bullets that produce remarkable results without creating tradeoffs in other areas of your life. Before you engage any financial professional, be sure that you carefully weigh what you are looking to accomplish, with the tradeoffs that are sure to accompany any strategies you decide to employ.

The Great California ShakeOut. Are you ready for an emergency? On Thursday, October 15, 2015, schools, universities, government agencies, and businesses across California participated in The Great California ShakeOut. We all know how important it is to be ready with a plan in case of an emergency like an earthquake. Not only did our children participate in this earthquake drill at school, but here at ACap we also participated in the #ShakeOut. Drills and emergency kits (we update ours yearly with medicines, nonperishable foods, clothes, batteries, etc…) are vital for the moments during and immediately following an emergency. But what happens after the ground stops shaking? Equally important to practicing procedures and preparing a physical emergency kit is establishing and maintaining a financial emergency preparedness kit. What is a financial preparedness kit? List of Accounts: What if something were to happen to you that would prevent you from arranging your financial affairs for your dependents and loved ones? Is there someone who knows where your bank accounts are held, which credit cards you have, or whether you own/rent your house? In many marriages, one of the spouses takes on the role of household Chief Financial Officer while the other spouse is left uninformed. To prevent confusion and additional stress should something happen to your household Chief Financial Officer, maintain and update a master list of all your accounts: banks, credit cards, mortgages, etc. The list should also include whose name the account is in and the type of account. One great method to catalog such items is by preparing a net worth statement. Ensure that both spouses are aware of where this information is held and how to proceed in the case of a family emergency. Net Worth Statement: A net worth statement is an individual’s equivalent of a company balance sheet. A net worth statement lists all of your assets, liabilities, and net worth; your net worth is your assets minus your liabilities. Your net worth statement should list the name of each account, the account number, the value of that account on a given date (to be updated periodically), who the account belongs to, and whether a beneficiary is designated on the account. A well crafted net worth statement is essential to see how your assets grow over time. It will also allow you to run ratios to determine your debt to income, debt to assets, and debt to equity – all measures of one’s financial health.

Just as a natural disaster can cause catastrophic physical damages, an unexpected death can leave spouses and loved ones in the dark about your financial matters. Don’t let a financial earthquake happen to alert you about the importance of creating and maintaining a financial plan. Contact ACap and we will show you how to get started. Have a financial question? Contact ACap Asset Management at info@acapam.com or 818-272-8511. Ara Oghoorian, CFA, CFP® is the president and founder of ACap Asset Management, Inc., a “Fee-Only” investment management firm located in Los Angeles, CA specializing in helping doctors and physicians make sound financial decisions. Visit us at www.acapam.com.

Four things you need to know about long term care By Melissa Barnickel - Baygroup Insurance

Chances are, you are going to need it.

70% of today’s 65-year-olds will need long term care at some point.

That means… Only 3 of 10 persons over age 65 will not need assistance with bathing, dressing, eating,

transferring,* toileting, continence or cognitive impairment.

Feeling Lucky? Or do you think it might be time to learn more about how issues related to long term care can

impact your future? ….just in case, that is. It can be expensive. Very expensive. Depending on your circumstances, long term care expenses can lower your standard of living, ravage your savings, prematurely deplete your retirement income, force you to liquidate real estate, make you dependent on family members, prevent you from leaving a legacy and even ruin your family relationships. Costs of care vary significantly- by location and type and amount of care needed. Maryland Median Long Term Care Costs 2015 Home Care - $20/hour Adult Day Care - $80/day Assisted Living - $3,800/month Note: Costs can range as high as $ 8,042 mo. Semi-Private Nursing Home - $289/day or $8,670 for a 30- day month Private Nursing Home - $328/day or $9,840 for a 30-day month This translates to annual median cost of care figures ranging from $ 20, 670, for a year’s worth of adult day care, to $ 119,720, the annual rate for a private room in a nursing facility. Source: Genworth Cost of Care Survey 2015 (4/2015) It can have devastating effects on family members and finances. In 2009, according to the AARP Policy Institute, “about 42.1 million family caregivers in the United States provided care to an adult with limitations in daily activities at any given point in time and about 61.6 million provided care at some time during the year.“ According to the AP-NORC Center for Public Affairs Research survey conducted between March and April 2014

o 53% of Americans 40 or older have provided long-term care services on a regular basis to a family member or

close friend. o Significant numbers of caregivers said caregiving- takes a toll on many relationships, particularly between

spouses; o Almost half (49%) of those taking care of a spouse or partner indicated that caregiving was a burden on personal

finances and 35% said that it took away from family life.According to the CDC website, “Caregiving exacts a

tremendous toll on caregivers’ health and well-being, and accounts for significant costs to families and society as

well. Family caregiving has been associated with increased levels of depression and anxiety as well as higher use

of psychoactive medications, poorer self-reported physical health, compromised immune function, and

increased mortality.2 Over half (53%) of caregivers indicate that their decline in health compromises their ability

to provide care. It can force you and your spouse into a state of poverty. In order to receive a Medicaid insurance benefit to pay for your long term care expenses, you have to qualify for poverty. To qualify for Medicaid, applicants must spend down available assets- including those which are jointly owned4, until a qualifying level is reached. In Maryland, the qualifying level is $2,500 for a single applicant and $3000 for a married couple both in a nursing home.

o Barring listed exceptions*, assets which are co-owned are subject to be used to pay for a person’s healthcare

expenses. While there are additional methods to protect assets, actions for this generally requires a minimum of

five years advance planning and may restrict the use and amounts of money you have available to spend and

distribute in later years. While getting educated on long term care won’t prevent you from needing it, it will help you understand its possible impact. It could even prevent a family feud, save you a lot of money, preserve your wealth and allow you to leave a legacy. Ultimately, this preparation will enable you to handle the often devastating financial and personal effects long term care can have on your life and the lives of your loved ones. *Assets Exempt from the Medicaid Rule:

o One automobile for the spouse as long as s/he lives at home. o Life insurance with a face value of $1,500 or less o Burial spaces for immediate family; and burial funds up to $1500 for the person or the spouse o Property used in business or trade o The home, if a spouse or other qualified dependent resides there. o Life estates that cannot be transferred or sold o Irrevocable burial contracts o Household goods and personal effects

MD Preferred Services invites you to join our LinkedIn group

Networking for Healthcare Professionals is all about our members and the healthcare industry coming

together. Share ideas, opinions and industry news. Establish connections with other MDP members and share your

knowledge with the healthcare field. The goal of this group is to establish business to physician relations as well as

physician to physician networking. We also hope that this will become a resource for physicians and healthcare

professionals looking for tools to help them grow in their career or career search and meet their everyday needs.

https://www.disabilityquotes.com/mdpps.cfm

The Potentially Devastating Impact of ICD-10 on Small Private Medical Practices After years of delay, the U.S. Department of Health and Human Services (HHS) has finally adopted and implemented the International Classification of Disease – 10th Revision (ICD-10) effective October 1st. A recent survey by the Professional Association of Health Care Office Management estimates that most small medical practices have invested approximately $2,500 per provider to implement the conversion to ICD-10. They are advising their members to prepare for a potential sharp rise in claim denials and a corresponding drop in revenue. The dimensions of the potential train wreck here cannot be understated. Many industry experts are predicting a 30 percent or greater drop in cash flow over the first 90 days of implementation. Some trade associations are going so far as to advise their members to set aside cash reserves and apply for a bank line of credit to cover a 50% drop in revenue! The heart of the problem is that there is no way to accurately predict how the insurance industry is going to handle the new demands of ICD-10. Without going into mind numbing technical detail, payers are having to literally rebuild their bundled reimbursement models for everything from an upper respiratory infection to a heart transplant and every medical event in between. And until they sort these issues out and provide guidance to the billing and coding contractors no one is quite sure how to proceed. Let’s say that a worker breaks his arm on the job and goes to an outpatient center for treatment. The doctor charts the patient diagnosing the location and severity of the break and treats the patient, documenting each step. The doctor may or may not be completely aware of every aspect of new ICD-10 standards as they apply to the tens of thousands of potential patient presentations he may face. Once he has completed treating the patient his chart enters the reimbursement pipeline. The chart is forwarded to the coding company (5-7 days). The chart is assigned to a coder who attempts to read and understand the chart and apply new ICD-10 codes (2 days). The coder discovers that the doctor has not provided the needed information in great enough detail and kicks the chart back to the coding company who in turn kicks the chart back to the practice who in turn kick the chart back to the doctor. At best the chart is now over two weeks old. The doctor in all likelihood has no distinct recollection of the patient and even if the doctor could recall the event in detail may not understand what revisions to the chart are needed. But let’s, for the sake of argument, assume that changes are made and the chart works its way through the pipeline and arrives at the billing company properly coded (or as properly as anyone can determine). The chart is now probably 30 days old. The billing company forwards the chart to the payer (private insurance company, Medicare or Medicaid) and the process comes to a screeching halt. No one is sure how the new ICD-10 classifications will be processed by payers. Even the payers are not yet able to provide useful guidelines. And once new standards are established it is very likely that a significant percentage of claims are going to be denied on what amounts to technical coding errors. At which point the chart retraces its journey and ends up back on the doctor’s desk 90 days later. In the past these charts might represent 5% or less of a practices claims. And in many cases the claims are simply written off as a budgeted cost of doing business. But now the numbers are simply too significant to ignore. And unless the industry comes to grips with the problem, many small medical practices could be facing collapse. As a result of all of these new threats to a practice’s very survival, practice managers are turning to a new breed of medical practice consultant who is prepared to take on the responsibility of analyzing the impact of variations in patient mix, shifting fee schedules and changing reimbursement rates as well as all other operating factors to optimize the return on the clinical efforts of the groups providers. For more information on how your practice can minimize the impact of ICD-10 you can call 214-383-0500 or send a request to info@profit-experts.com.

NEW HEALTHCARE OPPORTUNITIES Provided by MedicalMatch.org

Emergency Medicine - Atlanta, GA - EmergiNet You may know Atlanta as the unofficial capital of the South, but there’s more to this city than its southern location. If you make your home in the Peach City, you’ll find an undeniable mix of Southern charm, sophistication and traditions. Atlanta continues its reputation as a transportation hub with the world’s largest airport and easy access to I-75 & I-85. When it comes to Atlanta’s reputation for growth and innovation, health care tops the list as the city’s facilities expand and improve services across the metro area. Serving some of the fastest growing hospitals is EmergiNet. EmergiNet has positions available for BC/BP, EM residency trained physicians for work in hospitals surrounding the Atlanta metropolitan area. We work as a team emphasizing quality emergency care, dedicated customer service, professional and personal growth. Highlights include: Fee-for-service model having most MD’s starting at around $350k with no ceiling; Profit sharing plan after first year including tax-deferred compensation to supplement 401k(100% vested immediately); Physician-centric practice owned and run by physicians; All facilities located within 30 minute drive from downtown Atlanta. EmergiNet provides a full range of clinical and administrative professional services to the facilities we serve. Our mission is to maximize patient care and facility resources, as well as educate, facilitate and integrate the delivery of health care within the community. We continually seek ways to enhance the level of excellence and quality in the services we provide to our clients. To review this and other opportunities E-mail CV to Neil Trabel, ntrabel@emerginet.com; fax 770-994-4747; or call 770-994-9326, ext. 319. Please visit www.emerginet.com for more information. Diagnostic or Interventional Radiologist – Providence, RI A great opportunity for Diagnostic or Interventional Radiologists to join a well-established Imaging Network in Providence, Rhode Island. The group is open to a Diagnostic; Interventional or any other subspecialty you possess. Excellent compensation offered along with generous benefits. In addition, there would be an opportunity to teach and or do research, if desired. One year to partnership for an experienced Radiologist and Two years for a new grad. There is no buy-in…! 1:6 call. Providence has a lot to offer and is just under 45 minutes to Boston. OBGYN – Indiana Exceptional opportunity to join a busy, vibrant team Call 1:6. State of the art Medical Center. Very competitive compensation and comprehensive benefits including Educational Loan Assistance, Signing Bonus, Paid Malpractice, Paid CME, Relocation, and much more. This city offers excellent public and private schools, University/Colleges and airport. Enjoy an abundance of cultural and recreational activities including water sports, low tax base, safe neighborhoods, low cost of living, and more. Enjoy an exceptional quality of life. Indiana is among the top 3 places in the nation in which to practice medicine due to its favorable malpractice climate. (Medical Economics)

Family Practice – Greenville, IL Greenville Regional Hospital, a 42-bed full-service hospital located in Greenville, Illinois, is seeking a BC/BE Family Medicine Physician to join their team. The ideal candidate will be interested in performing the full range of Family Medicine, have the ability and desire to build long-lasting relationships with patients and be a part of the community. Greenville Regional Hospital is hospital employed, outpatient only; competitive salary with productivity bonuses; relocation reimbursement and sign-on bonus offered; student loan repayment options; full benefits package including malpractice and tail coverage; rural background or preference for rural medicine is a plus. Greenville, Illinois is located approximately 45 minutes east of St. Louis, Missouri. The home of Greenville College, Greenville is a modern small town that offers solid, Midwestern values and an intellectual feel. The community is close to a major metropolitan area and access to cultural events, shopping, sports and other amenities, yet its residents are able to embrace the advantages of a rural setting with a lack of congestion, pollution and crime. Family Practice – Illinois Excellent opportunity to join a very busy practice adding to their team due to continued growth. State of the art, award winning health system. Very competitive compensation and comprehensive benefits including flexible insurance plan, generous vacation, flexible retirement plan, relocation, Academic appointment available, and much

more. Located in a vibrant city with excellent public and private schools and numerous cultural and recreational activities. Easy access to Chicago. Primary Care – Cincinnati, OH Primary Care Cincinnati, Ohio One of the top integrated health systems in Greater Cincinnati is seeking physicians trained in Family Practice, Internal Medicine, Emergency Medicine, Internal Medicine/Pediatrics or Occupational Medicine to practice in one or more of their facilities. These physicians will staff a Priority Care facility for internal primary care patients, as well as community urgent care illnesses. Employed opportunities located in Cincinnati, Ohio Full-time and part-time positions are available No inpatient or call responsibilities Flexible 2015 start dates New state of the art facilities with fully equipped lab and x-ray services Complete benefit package with malpractice, long term disability, medical/dental coverage, relocation, retirement plan with matching employer funding. Competitive guaranteed base with bonus incentives Weekend and holiday pay differential. To learn more, contact Arleen Richardson arleen.richardson@rmmedicalsearch.com Job #21463 Dermatology – Quincy, Illinois Blessing Hospital is seeking a Dermatologist for a full-time employed position with Blessing Physician Services in Quincy, IL. Must be Board Certified or Board Eligible in Dermatology. The candidate must have a solid work ethic and dedication to providing comprehensive healthcare to patients and their families. The ideal candidate will strive to become an active member of the community, as well as uphold the core values of the hospital.

MD PREFERRED PHYSICIAN CONSULTANTS

Drawing on personal experiences on all sides of health care –as a patient, a

physician, a family caregiver, a business owner and an entrepreneur – Dr.

Vicki Rackner helps health care professionals thrive in the era of ObamaCare.

This former surgeon and nationally noted authority in the doctor-patient relationship helps

clients achieve the personal, professional and financial goals that drew them to a career in

medicine. She offers a bridge between the world of medicine and the world of business.