April 2017 | Physician Magazine

H E A LT H Y F I N A N C I A L P L A N N I N G S E R I E S | R E T I R E M E N T

MEDI-CAL PATIENTS

Face Hurdles Accessing Specialists

P RES IDEN T ’S LET T ER | VIT O IM B AS C IANI, M D

Vibrant Nursing Homes

“It may sound contrary to common understanding, but nursing homes are a vibrant environment to practice medicine, and there is a role there for physicians of all specialties and skills.”

You may pass one or two on your drive to work. You may refer your patients to one. You also may visit your mother or mother-in-law in one. But how many physicians in Los Angeles really know what’s going on inside any of the 1,400 nursing homes in California? (There are 15,000 licensed nursing homes in the entire United States.) Many physicians, especially younger ones not struggling with caring for elderly parents or other family members, may never have even ventured into one, as a student, a resident or while in practice. And if you do visit a parent there, you may see only what is directly in front of you: the quality of nursing care, the laundry service, the food. You may not be aware of the medical infrastructure supporting a particular home.

A long-term care (LTC) facility in California is most likely to be a 99-bed (or fewer) facility, where one RN cares for about 45 patients. The facility has a home administrator and a director of nursing who maintain certification and licensing standards. The medical director probably has oversight responsibility for several homes. Attending physicians are typically contracted to care for up to 10 or more patients, but patients can certainly have their own physician attend them. Patients must be seen at least once every 60 days; most are seen once a month and can be seen more frequently, even daily, by private physicians. Most LTC physicians are either general practitioners or family medicine diplomats. Some medical directors are orthopedists or physiatrists. The California Medical Directors Association pushes professionalism among its members and suggests the attainment of advanced training in geriatric medicine — either by certificate or full board certification — as a means of doing this. Physicians in LTC facilities must keep abreast of the changing legal and regulatory landscape, demonstrate proper antibiotic stewardship and use of antipsychotic medications, and become adept in the field of medical ethics. Nursing home and hospice residents present unique problems regarding informed care and medications. Geriatricians deal routinely with assessing each medication for appropriateness, route of administration, dose and timing.

Perhaps because I now find myself responsible for the administration of eight long-term care facilities, with almost 3,000 residents, the curtain of unfamiliarity has been pulled back. It may sound contrary to common understanding, but nursing homes are a vibrant environment to practice medicine, and there is a role there for physicians of all specialties and skills. Even surgeons can find satisfying work dealing with the large number of post-op patients in residence. Educational opportunities abound for physicians with no formal geriatric exposure to gain the necessary skills to function well in this environment. And while I would never actively entice anyone away from his or her work, I can now see that becoming a physician in a nursing home could satisfy the evolving practice needs of physicians at any stage in their career.

AP RIL 2 0 1 7 | TAB LE OF C ON T EN T S

Volume 148 Issue 4

ON THE INSIDE

President’s Letter | Vito Imbasciani, MD

2 CEO’s Letter | Gustavo Friederichsen 4 Medi-Cal Patients Facing Hurdles Accessing Specialists

6 Healthy Financial Planning | RETIREMENT 4

6

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A P R I L 2017 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1

”What you have to remember is that baseball isn’t a week or a month but a season — and a season is a long time.”

Chuck Tanner

SINCE BASEBALL SEASON IS UPON US (which

can feel like an eternity to non-fans), this quote

by Chuck Tanner seemed fitting. It came from an interview he did a couple of years after leading the Pittsburgh Pirates to a World Series Championship in 1979. Some would say that we are in a long “season” of uncertainty for healthcare.

“I welcome the chance to listen and learn from other physicians, leaders in public health, and hear the concerns and questions of the general public. I will report back in future messages.”

The changes since the passage of the Affordable Care Act in 2010 have been a boon to some providers and patients; others are staunchly opposed to some or all of the ACA’s regulations. We’re still sorting out rules for MACRA. CMA is challenging Gov. Brown’s budget with appropriation of funds from Proposition 56 to be added to the general fund instead of being used to improve access to care. Most practices weathered adoption of the ICD-10. But for many, healthcare is feeling like a “season” that’s lasting a long time.

As we go to print, I’m about to participate (along with other LACMA leaders) in two talks on the future of healthcare and how we weather the changes. The first talk will be at The California Endowment as part of the LA County Public Health Annual Health Care Provider Practice Conference. David Aizuss, MD, and I have been asked to speak for an hour on Healthcare Reform 2.0: The World Has Changed But Will We? I talk with physicians every day, and I put together my slides for the conference using their input, questions and challenges. Sticking to the hour David and I have been allotted may be challenging with such a big topic. As I struggled to identify the main points, one thing became abundantly clear — LACMA’s one voice comes from listening to many. I’ll continue to work with my team to share news. Education around political and advocacy issues remains essential. As a leader, I’m committed to transparency in the organization and continuing the dialogue among our diverse group of stakeholders.

The second speaking opportunity coming up is with the Santa Monica Democratic Club. LACMA Secretary Sion Roy, MD, serves as co-chair of their Executive Board. Through his involvement, I’ll be joining Paul Song, MD, and Professor Gerald Kominski in a talk about the future of healthcare. This promises to be another wide-ranging discussion with top experts in the field. I welcome the chance to listen and learn from other physicians, leaders in public health, and hear the concerns and questions of the general public. I will report back in future messages.

In case you’re not a baseball fan, the Pittsburgh Pirates haven’t won a World Series since 1979.

While there’s a lot of movement around passing the American Health Care Act, it’s unclear how quickly the Republicans will have a comprehensive new healthcare law in place and what that will mean for California. But we’re in a season of change, and as Tanner and the Pirates know, a season is a long time.

Gustavo Friederichsen Chief Executive Officer

2 P H Y S I C I A N M A G A Z I N E | A P R I L 2017

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MEDI-CAL PATIENTS

Facing Hurdles Accessing Specialists

By Elizabeth Zima

CA L I F O R N I A’ S C O M M U N I T I E S FAC E A S E V E R E S H O RTAG E O F P H Y S I C I A N S , a situation that is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement. Medi-Cal enrollment has surged since 2014, but the percentage of California physicians serving Medi-Cal patients has dropped, a trend that is hampering access to care for enrollees. One in every three Californians (14 million) is dependent on Medi-Cal for healthcare, so this disparity also negatively impacts a patient’s ability to access needed treatment, according to a recent study by the California Health Care Foundation.

There is a fundamental problem with Medi-Cal that is hindering patient access to care, and to specialists in particular — Medi-Cal physician reimbursement is so low that physicians cannot cover the cost of providing care. Currently, California has some of the lowest reimbursement rates for providers ($18 for an office visit), creating an unsustainable disparity between the number of Medi-Cal patients and the physicians who are able to accept them as patients.

“Specialists are paid so poorly that they don’t want to take MediCal patients,” said Mark Dressner, MD, a Long Beach clinic family physician and former president of the California Academy of Family Physicians. “We’re really disappointed and concerned with what it’s going to do for patient access.”

The volume of poor and uninsured patients who need to see specialists has overwhelmed the healthcare system in Los Angeles and is causing appointment delays.

Dr. Dressner says he is extremely frustrated with the problem. “If I have patients that need a rheumatology consultation, it can take two years for them to get an appointment,” he explains. Some of his patients have to travel over 50 miles to see specialists who will take Medi-Cal because none of the specialists in the immediate area will.

Not only are physicians frustrated with the lack of access to care, the patients themselves are frustrated with their treatment. Barbara Appling, a 56-year-old diabetic, was referred to an orthopedist in the Los Angeles area near her home.

“I called the office repeatedly for an appointment. It took four months to get one. Then, when I went to the office, I was there for 4 P H Y S I C I A N M A G A Z I N E | A P R I L 2017

Not only are physicians frustrated with the lack of access to care, the patients themselves are frustrated with their treatment.

40 minutes waiting to be seen—until the office manager told me they could not see me.” Appling has both Medi-Cal and Medicare insurance. The office staff member told her the doctor didn’t take either.

“I’m very frustrated that I cannot see a doctor when I need to.

People have refused to take Medi-Cal since I got it,” she said. Due to low Medi-Cal reimbursement rates, physicians who see MediCal patients often do so at a financial loss to their practices. In order to maintain viable practices that can continue to serve their communities, physicians who take Medi-Cal often need to limit the number of Medi-Cal patients who can be treated in their practice.

Because they do not have ready access to physicians, MediCal patients are more likely to postpone needed care due to

long appointment wait times. They are also twice as likely to use emergency room visits to access specialty care (compared to individuals with private insurance or Medicare). In areas where the numbers of specialists are low, physicians are more likely to report difficulty obtaining referrals for Medi-Cal patients than for privately insured patients.

Debra Lupeika, MD, a family physician providing care through the Shasta Community Health Center in Redding, says some of the most difficult issues she faces are getting her sickest patients referrals to specialty providers.

The frustration of not being able to refer wears on her, like the time her patient suffered without an appointment. “She had complicated medical problems, and she was homeless,” Dr. Lupeika says. “She had a cancer on her face that had been partly removed, but it came back. We couldn’t get a biopsy. It is really hard to get our patients into specialists due to insurance issues.”

Lack of access to specialists also plagues San Diego County.

“The challenge that we face is that reimbursement to physicians is the third-lowest in the country. So that limits access to specialty care,” says Patrick Tellez, MD, MPH, a pediatric allergy and immunology specialist and chief medical officer for North County Health Services, which provides healthcare to a diverse community of low-income patients at 13 health centers in North San Diego and Riverside counties.

“Our mission, as a primary medical, dental and behavioral health practice attending to over 65,000 patients annually, is to assure that our patients are able to access and receive needed primary and specialty care that meets the high standards that every one of us expects when we are the patient,” says Dr. Tellez. “However, when the reimbursement for specialty care is so low, specialists can only afford to accept a small percentage of patients that truly need and deserve the care.”

“So, while in an average month we as primary care providers may make about 2,500 or more referrals to specialty care, due to affordability, wait times and constrained access, less than half are able to be seen. As a result, this has the long-term adverse impact of increasing the cost of care for everyone. Improving access to specialty care has been shown to help prevent preventable complications of chronic disease, which lowers the long-term cost of care — it acts like a rising tide that floats all boats.”

Of California’s 58 counties, Merced County has the 43rd worst physician-to-patient ratio, with just 45.4 family physicians per 100,000 residents. That’s far less than California’s statewide ratio of 77.3 doctors per 100,000 residents. According to the Merced County 2016 Community Health Assessment, the entire county is considered a health-professional shortage area.

Eduardo T. Villarama, MD, family physician and regional medical director of Golden Valley Health Centers in Merced, says he is aware of many instances when patients who needed to see a specialist were turned away. “We have more than 70% Medi-Cal patient population, and specialty care providers regularly turn them away or are not able to accommodate the demand because the specialists are not reimbursed appropriately.”

He says two of his patients, “one with seizure disorder and the other we suspect to have multiple sclerosis,” have had to wait for at

least six months to be seen by a specialist in neurology. “I know for a fact that the patients being insured by Medi-Cal played a role in our abilities to get them in sooner.”

Ample research demonstrates that the Medi-Cal system is struggling from persistent underfunding. Last year, the California Medical Association (CMA) co-sponsored the Proposition 56 tobacco tax to raise money to improve access to and quality of medical services for all Californians —especially the most vulnerable communities who rely on Medi-Cal. Gov. Jerry Brown’s $120 billion budget proposal for the 201718 fiscal year appropriates $1.2 billion of the Prop. 56 tobacco tax money to cover cost increases for the Medi-Cal program. Although the measure was written to explicitly prohibit the use of the new tobacco tax revenue to offset general fund obligations, Gov. Brown’s budget does exactly that rather than using those funds to improve California’s dismal provider reimbursement rates, as the voters intended.

With more than 14 million Californians relying on Medi-Cal programs to provide basic and specialty care for serious diseases,

With more than 14 million Californians relying on Medi-Cal programs to provide basic and specialty care for serious diseases, the stakes are high. the stakes are high. Californians voted for the tobacco tax to remove these barriers to reliable and quality care. California cannot afford to continue starving this program by diverting Prop. 56 revenues to cover the state’s general fund obligations.

“The language of Prop. 56 was clear — the people voted overwhelmingly in support of improving payments for programs and providers to ensure that patients can see a doctor when and where they need one,” says CMA President Ruth Haskins, MD. “We must honor the will of the voters and use the estimated $1 billion in new healthcare revenue for its intended purpose, instead of writing a blank check to the general fund.”

CMA is working with the Legislature and the Brown administration to develop a solution that doesn’t supplant the will of California voters or put low-income families and communities at risk.

Elizabeth Zima is a staff writer with the California Medical Association.

If you have a story to tell about how low Medi-Cal reimbursements have adversely affected your ability to care for patients, contact CMA at communications@cmanet.org.

A P R I L 2017 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 5

RETIREMENT Healthy Financial Planning for Doctors

BY W. BEN UTLEY, CFP, PRESIDENT OF PHYSICIAN FAMILY FINANCIAL ADVISORS

PHYSICIAN RETIREMENT PLANNING is tricky business since doctors get a late start on saving for retirement.

Medical practitioners begin earning “real money” in their mid-30s, but during their first 10 years of practicing medicine— when the power of compound investment growth has the biggest impact on retirement accounts—doctors are strapped with student loan payments, childcare expenses and mortgage loan payments that make it challenging to contribute to tax-qualified retirement plans. And young physicians, fresh out of training and excited about a new career, seldom understand the burnout that causes almost half of mid-career physicians to wish they were better prepared for retirement.

5 WAYS PHYSICIANS CAN SAVE FOR RETIREMENT A successful plan for retirement means saving money and saving taxes. Doctors have at least five ways to save for retirement before considering other options like real estate, cash value insurance and other vehicles. Most of these retirement strategies receive a measure of asset protection via the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 (BAPCPA).

1

TAX-DEFERRED RETIREMENT PLANS FOR PHYSICIAN EMPLOYEES

Physicians who receive a Form W-2 showing wages or salary may have a workplace retirement plan that allows them to defer income by making a contribution to the plan.

• 401(k) plans allow employees of for-profit healthcare organizations and self-employed doctors to defer up to $18,000 per year ($24,000 per year if age 50+) to the plan on a pre-tax basis. Account balances can grow tax-deferred.

6 P H Y S I C I A N M A G A Z I N E | A P R I L 2017

Qualified distributions are taxed as ordinary income when withdrawn. Other withdrawals, including those made before age 59½, are generally subject to income taxes and a 10% penalty.

• 403(b) plans work the same way that 401(k) plans do, but they are offered by government and nonprofit healthcare organizations.

• Government-sponsored 457(b) plans are offered by state and local government healthcare organizations. Physicians can defer up to $18,000 per year ($24,000 if age 50+) to the plan on a pre-tax basis in addition to the money they contribute to a 403(b) plan. Account balances can grow tax-deferred.

Qualified distributions are taxed as ordinary income when withdrawn. Other withdrawals, including those made before age 59½, are generally subject to a 10% penalty and income taxes. Balances from these plans are generally available to roll over to IRAs (Individual Retirement Accounts) or other

Healthy FINANCIAL PLANNING

employer-sponsored retirement plans, provided that the receiving plan allows for inbound rollovers.

• Non-government organization 457(b) plans, or NGO 457 plans, present a special risk for unwary physicians saving for retirement. While these plans also allow for pre-tax contributions and tax-deferred growth, they only gain these tax benefits due to a “substantial risk of forfeiture” imposed by the Internal Revenue Service (IRS). Doctors who hold these plans can lose everything if the sponsoring employer goes bankrupt. While account balances from one non-government 457(b) can usually be rolled over to another non-government 457(b) plan, they cannot be rolled over to an IRA or any other type of plan.

• 401(a) plans are offered by nonprofit employers who may make contributions on behalf of physicians. Contributions by employees are usually mandatory deferrals based on a flat dollar figure or a percentage of compensation. 401(a) plan balances may be rolled over to an IRA or other qualified retirement plan.

2

TAX-DEFERRED RETIREMENT PLANS FOR SELFEMPLOYED PHYSICIANS

Physicians who receive income reported on Form 1099 (including doctors who “moonlight” or work locum tenens) and self-employed physicians have other options to help save for retirement.

• SEP-IRA is a Traditional IRA established under a Self Employed Pension Plan document (often the Form 5305-SEP) that allows a physician to contribute more to a Traditional IRA than they could contribute outside the plan.

Physicians with a SEP may still be able to contribute to a separate Traditional IRA or Roth IRA. Physicians can contribute the lesser of $54,000 or 25% of compensation (as adjusted for self-employment tax). Like other Traditional IRAs, account balances can grow tax-deferred, are taxable when distributed, and may be rolled over to other qualified plans.

• One-participant 401(k) plan (as it’s described by the IRS) is also known as a “solo 401(k)” or solo-k for short.

This plan works like a traditional 401(k) plan except that (1) it’s for a practice with only one owner or a practice that employs only an owner and spouse; (2) it is not required to perform nondiscrimination testing;

(3) if it holds less than $250,000 at the end of the year, it is generally not required to file Form 5500-SF. Many brokerage firms and mutual fund companies offer off-the-shelf or “prototype” documents that physicians can use to establish a solo-k, though few of these firms are qualified to give advice regarding compliance with IRS, Employee Retirement Income Security Act of 1974 (ERISA) and Department of Labor rules that govern their creation and maintenance.

3

TAX-QUALIFIED PENSION PLANS OF PHYSICIAN EMPLOYERS

Physicians who are self-employed may establish a special kind of retirement plan known as a defined benefit plan, and physician employees may be fortunate enough to work for an organization that has adopted one of these plans. Traditionally known as “pension plans,” defined benefit plans have been around for decades. Actuaries — the professionals who design and administer these plans — refer to them collectively as “DB plans.” The most recent incarnation of the DB plan is called a “cash balance plan” because the plan’s annual statement shows a 401(k)-like balance representing the present value of the plan’s future benefits, making it easy for doctors and other plan participants to grasp.

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Healthy FINANCIAL PLANNING

• Contribution limits vary according to a physician’s age, but younger doctors might contribute as little as $40,000 per year to a plan while doctors nearing retirement might contribute as much as $200,000 per year, all on a pre-tax basis.

• Regulatory compliance is burdensome since these retirement plans must comply with ERISA and the IRS code. Physicians who are interested in setting up a plan can consult a thirdparty administrator (TPA) who generally handles the plan documents, the plan adoption process, ongoing testing and required filings. Most TPAs will neither manage the account nor act as a custodian for the plan’s assets. These services are typically provided by a brokerage and a registered investment advisor.

• A strong case for a defined benefit plan includes a stable medical practice with a small number of highly compensated physicians who are substantially older than the average staff member (e.g., radiologists and anesthesiology practices).

• Layering a defined benefit plan on top of a defined contribution plan (401(k) or profit sharing plan) may allow physicians to substantially increase their own ability to save for retirement while costing very little in the way of required additional contributions to staff.

4

TAX-ADVANTAGED PERSONAL RETIREMENT ACCOUNTS FOR PHYSICIAN FAMILIES

Physicians who receive earned income from employment and their spouses who are under age 70½ are eligible to contribute to an IRA even if their contributions may be non-deductible.

• Traditional IRA allows doctors to defer up to $5,500 per year ($6,500 per year if age 50+) to the account. Physicians who are not covered by a workplace retirement plan may deduct pretax contributions while those covered at work can make nondeductible or partially-deductible contributions depending on their earned income and filing status. The non-deductible portion of the account, also known as “basis,” is tracked with each year’s tax return on Form 8606. Account balances can grow tax-deferred. Qualified withdrawals (excluding the basis) are subject to ordinary income tax while non-qualified withdrawals generally result in a penalty.

• Roth IRA contribution limits are the same as Traditional IRA limits, but most physicians earn income at levels exceeding the adjusted gross income (AGI) limitations, so they simply are not allowed to contribute directly to a Roth IRA. Doctors can make “backdoor Roth IRA contributions” by first contributing to a Traditional IRA and then converting the Traditional IRA to a Roth IRA. (Note: This tactic requires careful planning to avoid unnecessary taxation.)

Roth IRA balances can grow tax-deferred, and qualified withdrawals are free of income tax. For more details, see IRS Publications 590-A and 590-B.

8 P H Y S I C I A N M A G A Z I N E | A P R I L 2017

• Spousal IRA is a Traditional IRA or Roth IRA that receives contributions on behalf of a non-earning spouse. In order to contribute, the non-earning spouse must meet the ordinary requirements for making an IRA contribution, but they are not required to have earned income. Instead, the earning physician must make enough income to cover the spouse’s contribution. Otherwise, the same IRA contribution limits apply to the Spousal IRA. • Health Savings Account (HSA) is not truly a “retirement account,” but physicians may allow balances to grow tax-deferred and make tax-free distributions for qualified healthcare expenses in retirement. While contributions are tax-deductible, a doctor must first be covered by a High Deductible Health Plan (HDHP) in order to be eligible to contribute to the account. Physician families covered by a HDHP can contribute up to $6,750, while doctors with selfonly coverage can contribute $3,400. For more details, see IRS Publication 969.

5

TAX-EFFICIENT INVESTMENTS IN TAXABLE ACCOUNTS

Physicians that manage to max out contributions to all their tax-advantaged retirement accounts can still make use of a taxable account (a.k.a. joint account, trust account or individual account) by investing in certain securities that are inherently tax-efficient.

• Tax-exempt bonds and bond funds pay dividends or interest that can be federally tax-free or doubly tax-free when owned by a physician who lives in the state where the bonds were issued.

• Low-cost index funds and other passively managed mutual funds that have a low internal “turnover” seldom pay out capital gains distributions, and when they do, these distributions tend to be small and are taxed at favorable capital gains rates.

• Stocks of U.S. corporations, certain foreign corporations and mutual funds that own them may pay dividends that qualify to be taxed at favorable capital gains rates.

We hope that our Physician Retirement Planning Guide can help you make sense of the personal finance issues that affect doctors while helping you avoid mistakes and seize opportunities as you and your family plan for financial security that can last a lifetime.

W. Ben Utley, CFP, is president of Physician Family Financial Advisors, a fee-only firm helping doctors save taxes and time while managing student loans, financing a home, saving for college and investing for retirement.

To learn more, call (541) 463-0899 or visit www.physicianfamily.com.

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A P R I L 2017 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 9

Healthy FINANCIAL PLANNING

Tax

NOW, LATER OR NEVER

by Victor Chavez

BY SOME ESTIMATES, less than 15% of the population has access to a pension plan today. As a result, more

people are taking control of their retirement savings. There are essentially three major avenues used for retirement savings. In simple terms, they can be referred as tax now, tax later or tax never.

TAX NOW

Investments that earn interest and returns and are taxed the same year. These include: • CDs • Money Market accounts • Corporate bonds interest and dividends

• Gains from investment assets • Rental real estate income

Tax now investments are taxed at your usual income tax bracket percentage. For most physicians who are high-income earners, the “net” return on these investments after taxes may be significantly lower than expected. These types of investments are conservative in nature, however, and are usually more effective when used for short-term planning purposes that can provide more immediate liquidity as opposed to long-term substantial returns.

TAX LATER

• Defined Benefit Plans (an alternative to a pension)

TAX NEVER

Tax-free Income is the most underutilized method of retirement savings but can potentially be of the most value in times of high income tax rates. Tax-free income financial planning tools can also be referred to as “Roth” assets. When done properly, one or a combination of these tools can be used to generate tax-free income for retirement. Here are three ways you can create tax-free income: • Tax-exempt (Tax-free) Municipal Bonds

• Cash Value Life Insurance

• Roth IRAs or Roth 401(k)s

When planning for the long-term, there is one key factor you want to make sure your retirement account provides — tax deferral.

Tax deferral allows you to take advantage of the power of “compound interest,” which is the key to a larger nest egg in the future. This is especially important with today’s longer life expectancy causing Americans to face the risk of outliving their retirement savings. The money you save in these plans acts as an immediate “deduction,” since you will not pay taxes on that money. However, you will pay taxes when you withdraw it in the future. Most of these are known as qualified plans: • 401(k)s

income. In addition they often incur a 10% penalty for withdrawal before the age of 59½ years of age. At time of withdrawal, income from qualified plans will be taxed as ordinary income at the effective tax bracket at the time.

• Traditional IRAs, Simple IRAs • SEP IRAs.

These plans come with certain restrictions and limitations from a contribution standpoint, and what you may be able to qualify for is based on the amount of your income and how you earn your 1 0 P H Y S I C I A N M A G A Z I N E | A P R I L 2017

When creating proper tax-efficient retirement strategies it is always best to work with a financial services professional who can guide you through your options and educate you more on what might work best on your personal situation. Most physicians Victor Chavez will be looking to maintain Financial Services Professional their current lifestyle. In order CA Ins Lic. #0I38414 714-493-7174 to do so, it will be necessary vchavez@ft.newyorklife.com to build a retirement nest Jonathan Barrera egg that will minimize risk Financial Services Professional and taxes and maximize CA Ins Lic. #0H73984 investments and returns. A 512- 423-3250 jmbarrera@ft.newyorklife.com diversified approach with assets that are taxed differently Arica Ohanisian Agent will provide options in an CA Ins Lic #0I40094 uncertain economic future 818-434-2474 aohanisian@ft.newyorklife.com and will lead most individuals in a successful direction.

5 SIGNS

LACMA PARTNER SPOTLIGHT:

OF A HEALTHY PRACTICE PHYSICIANS ARE FACING BURNOUT at unprecedented rates. Changes around EHR, ICD10, MACRA and the fate of the Affordable Care Act all have standard practice management turned upside down. But we’re not telling you anything you don’t know. We spoke with a couple of experts in practice management about weathering the pressure and uncertainty.

Maria Wong and Jeff Cohen from Best Practice Management shared 5 tips for having a healthy practice that come from their experience working with physicians.

1. Everything changes and keeping up is a challenge.

You see this playing out in your practice for you, your staff and your patients. Pace yourself and find the best resources you can for updates on regulations.

2. Take care of yourself.

We know you’ve heard this before, but it’s true. Your well-being matters. Spend time with family, sleep in once in a while, take time for yourself. In the end, you’ll be better at helping others. We know how hard it is to find the time, but the payoff is well worth it.

3. Build an effective practice.

What does that mean? By effective, we mean doctors who are fulfilling their mission, their dream, with their practice. That dream is different for everyone and it’s worth exploring what drew you to medicine. Being clear on this point helps you have an effective practice by not losing sight of the big picture and dealing with the challenges that arise.

4. Build an efficient practice.

We look at an efficient practice this way—customer service is in place, your staff is happy, billing and collections are up-to-date, and you have a financial plan in place. It’s the nuts and bolts of running a business.

5. Connect efficient and effective practice.

Since you are actively involved in your business, the workday is full of distractions and you often end up managing moment by moment. This makes it easy to lose sight of the big picture. That’s why we stress bringing together the ideas of efficient and effective practice. When you bring these things together, your practice serves the needs of your life and meets the needs of patients, staff and everyone it touches.

Daily operations and practice management run smoothly and work toward the bigger goals around fulfillment. In our work, we’ve helped physicians solve problems and keep their goals front and center.

Thanks to Jeff and Maria at Best Practice Management for sharing their experience in helping doctors. If you’d like to learn more about how they help physicians, they’re offering LACMA members an exclusive evaluation of billing, coding and other office practices. Call them today at (844) 222-8100.

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