If you don’t, then here’s something that might help lessen the tax pain a bit.  This is just a summary based on my recollection (and I have only enough info to be dangerous), so ask your CPA during your own arduous tax planning session for all the details…

HIRE ACT – - This tax credit saves you the 6.2% in payroll tax you pay for employer matching of social security – for qualified employees hired February 3rd and before December 31st who have been unemployed or employed for 40 hours or less during the 60 day period ending on the date the new employment begins.  They cannot be employed to replace another employee unless the other employee left voluntarily or was terminated for cause. The credit is for the 6.2% matching of social security for the period of March 19 through December 31.  The employee must sign an affidavit indicating they are eligible for the credit (the IRS has Form W-11 which you can use).

If you keep the employee for 52 consecutive weeks, you are eligible for up to $1000 credit in 2011.

SMALL BUSINESS HEALTH INSURANCE TAX CREDIT – - This is a very complex credit but in a nutshell if you have fewer than 25 employees, with average wages of less than $50k, and you paid for 50% of the health insurance, it appears you qualify for a tax credit (beginning in 2010).

Presidio Insurance Solutions extends our deepest sympathies to the people affected by the devastating earthquake in Haiti. Our prayers are with the survivors, aid workers, and all the families and friends coping with the aftermath of this catastrophe.

For any questions about coverage for volunteer services in Haiti, please contact us at (800)317-6411.

The obvious barriers, ageism, for example, are certain to be there. But certifications and medical malpractice insurance are the largest part in the difficulty. If a physician has been out of practice for 18 months or longer, some states may require that he take expensive retraining and re-entry programs. Insurance carriers are also a bit leery, concerned that lack of use of skills and knowledge may leave the physician less mindful of important details, and out of date in his expertise.

Though it may seem strange, since the doctor was in practice for decades, there’s a certain amount of validity to the concerns. While the doctor was in retirement, certain medications may have been shown to be dangerous to the patient. Other drugs may have come out which are much better at treating a condition, and ways of performing certain procedures may have changed. Any of these can put a patient’s safety in jeopardy, and put the medical facility and their medical malpractice insurance carrier at risk.

Yet the industry could use the help of these experienced practitioners, and the doctors themselves may have no real choice. Where’s the solution, then? If you’re a doctor and have any concern that you may have to come back out of retirement, continue practice by volunteering or working part time, so that your currency doesn’t lapse. If you’ve already come out of practice by a bit, you may need to volunteer part time for a little while to demonstrate and reestablish your competency. Be prepared to act as a primary care physician, even if you were highly specialized. Be willing to work in the areas and shifts you’re most needed, and be prepared to take slightly less while you re-establish yourself.

Those who want to return to private practice may have difficulty acquiring medical malpractice liability. As an independent broker, Presidio is in the best possible position to find the best coverage at the lowest prices possible. Give Presidio a call, find out how we can help!

Presidio Insurance Solutions Expands into Pacific Northwest

Presidio Insurance Solutions is pleased to announce the addition of Susan Doherty as Senior Account Executive for Washington, Oregon and Northern California. Presidio now provides outstanding insurance services to physicians, surgeons and healthcare groups in those parts of the Pacific Northwest. We’re very excited about this expansion.

In all, Ms. Doherty brings over 20 years of professional liability insurance industry experience to us. The past 15 of those years have been spent working for Medical Malpractice carriers, within some 30 years in the insurance industry. These experiences (and the knowledge gained by it,) make her a very welcome and valuable asset to both Presidio and the healthcare providers in that part of the country.

Medical Liability customers can expect to receive the same excellent service and money-saving expertise in Medical Malpractice Insurance that other Presidio clients now enjoy. You and your practice are in good hands with Susan Doherty; Presidio is pleased and proud to add so qualified an agent to our family! Susan is a very customer service oriented professional who goes above and beyond the call of duty to ensure that each client receives the highest standard of honest, ethical advice and assistance. She genuinely cares that you get the most for your money, the policy that best protects you and suits the needs of your practice.

Susan’s office is in Medford, Oregon. Please give her a call, take a few minutes to get acquainted with one of the best Medical Malpractice agents in the country. Susan’s a very likable, genuine person, very easy to talk with. We’re sure you’ll get along famously!

Contact: SusanD@PresidioInsurance.com Office (503) 779-9758

Tightening the belt isn’t just for the rest of the nation.  We within the healthcare industry must make a painfully candid examination and see where we could afford to be less chubby, too.  Details of the President’s original budget proposal suggest that $643 billion in taxes over the next ten years will be no more than a down-payment on ensuring that everyone has health care available to them.

Take a look around you, and ask yourself where you’ve got some excess.  Consider time and materials.  What could the practice do without?  Look for the fat.  One office I visited recently had a couple large flatpanel TV screens in the lobby to keep patients occupied while they wait.   Thousands of dollars spent to look snazzy, when a $15 a year subscription to National Geographic would have served the same purpose?  Who pays for that?  The cost comes from the patients pockets, but eventually we all pay for that blatant luxury. Every little bit matters, and it all adds up.

Also take a look at other ways in which you could reduce the costs. Though it may not be popular, consider reducing your fees on procedures.  Do you really need to be charging that much in order to keep your practice afloat?  Could you perhaps afford to cut prices a bit, play a few less rounds of golf a year, to help make Health something we can all afford to live with?  An honest belt-tightening will show that we can all pitch in to make the goal more readily attainable.  The reduction in income will lower your taxes a little, while providing people with the changes they need immediately, right now.

Another oft forgotten aspect is prevention — both in patients’ habits and the operation of the office.  Medical Justice, for example, has several methods to reduce the risk of damage to your practice.  A quality Professional Malpractice protection provider will also be working with you, offering ways to reduce your exposure to frivolous lawsuits, providing informative articles and reminders.  Malpractice suit avoidance doesn’t necessarily mean redundant testing that will add to the cost.  Some steps may be as simple as adding a bit of phrasing to your waiver form, or a free professional review of your policy’s coverages,to make sure they are appropriate for your practice.  You want comprehensive protection, without spending any more than necessary.   Whether you’re a client of Presidio Insurance or not, the door and phone lines are always open.  We’re glad to be able to be of assistance.

As we face this economic crisis and set about changing the way we, as a nation, provide for the health and well-being of our fellow citizens, it’s both inspiring and reassuring to see us coming together, working intelligently towards that greater good.  Together, collectively, each of us doing a part, we can make a major difference, do some good.  Isn’t that why we got into medicine in the first place?

The U.S. Constitution’s 1st Amendment protects citizens against censorship by the government, not from each other.  The individual or business entity remains entirely within its rights to constrain speech, with or without cause.  More importantly, these patients are entirely free to go elsewhere if they’re unwilling to agree to this condition of service.

Angie Hicks, of Angie’s List, is apparently amongst those who don’t grasp the true nature of the First Amendment.  She goes so far as to call the waiver “an attempt to steal the consumers’ right to free speech.”  She claims her company “goes to great lengths to ensure accuracy and fairness in the member reports,” and that the vast majority of comments have been positive, suggesting that the physicians’ fears of baseless damaging statements being posted are unfounded.  

Ms. Hicks can speak only for her own online presence.  Craigslist, for example, shows a very different story, with unbridled mayhem occuring all over the nation, in the guise of free speech.  Ms. Hicks claims that “Doctors should stop underestimating their patients’ ability to measure the quality of care they receive and focus instead on providing good care and treating their patients with respect.”  The facts argue sharply against her Pollyanna perspective.

Though censorship is anathema to many, those with full facts would concur with Dr. Segal’s position; Uncontestable false allegation is far more anathematic.   Literally anyone can publish literally anything on the Internet, fact or fiction, baseless or valid. The site is not even required to post contrary views. (Its owners remain free to censor at will.)  Considering the potential for lawful libel, the measure isn’t censorship, as much as it is an attempt to protect against someone talking trash from a one-way pulpit.  It happens far too frequently, despite Ms. Hicks’ claim.

Many independent studies have consistently shown that 75% of the malpractice suits filed against physicians are frivolous, lacking in basis of fact. Even when reviewed by a tribunal of an independent doctor, lawyer and judge, the same percentage of cases are found to lack merit. This means that 3 times out of 4, a patient is wrongly accusing his physician.  Whether the reason is greed or because the patient has an axe to grind over a perceived wrong or loss, it still comes down to 3/4 of the cases filed (and endorsed by a lawyer willing to take the case) are baseless. Imagine how much more likely it is for the general public to speak falsely against that physician if they don’t even need to find an attorney willing to concur.

Once an allegation is made, the damage is done.  Consider that some medical malpractice insurance companies will settle smaller suits out of court, just because it costs less than the legal fees would have been to defend the frivolous case. Some professional malpractice policies don’t even give the physician a choice in the matter. The company pays, the doctor’s reputation gets trashed, and there never was a shred of validity to the claim in the first place.

Given the nature of online allegations and the potential for irreparable damage caused by such false accusations, Dr. Jeffrey Segal and his fellows are spot-on.  Potential patients who check online often do so with a “where there’s smoke, there’s fire,” mentality. They’ll avoid someone who is being spoken of badly, regardless of validity. “Why take a chance?” they figure, and instead go to a doctor who doesn’t (yet) have any question-marks alongside his name.

Doctors, patients, and insurance companies alike, we’re all for lower healthcare costs. Medical Justice is also in favor of healthcare reform.  Malpractice suits, and the measures physicians must take to protect themselves from them, create considerable increases in costs. These physicians are after reasonable protections from damage based on false allegation.  In doing so, they’re working to keep health care costs down. It’s entirely understandable, even laudable, that they’d require patients not type ill about them on such a one-sided forum.  Sensible citizenship would suggest that the patients support them as they do so.

In protecting one’s professional reputation, it is also very important that the physician’s malpractice policy lets the doctor choose whether or not to settle a claim.  As an independent broker, Presidio is free to direct physicians towards the carrier that offers their clients the best possible protections for their practice.

Needless to say, there is no agreement across the board.  Many of these movers and shakers are divided amongst themselves as to how to impliment such a concept.  Should employers be required to contribute?  What about those who cannot afford insurance?  Will the government then be required to pay for some or all of their insurance premiums?

It certainly would simplify things if everyone had coverage.  We’d probably also see an increase in demand for healthcare providers, as millions of Americans go without treatment for illnesses and injuries because they cannot afford to go to a doctor’s office without insurance coverage.  But how We The People make it criminal to not have coverage?  It’s not like a car one can choose not to own or drive if one is too poor to afford it.  Accordingly, it would most certainly fall upon the government to pay the premiums for those who cannot afford to do so.  This method has proven functional in countries like Holland, but would most certainly create another huge bureaucracy here in the U.S., just qualifying who can or cannot afford to pay premiums.

Some also point out that universal healthcare can’t even be considered until the costs of medical care are reduced.  It would be impossible, they say, to address the costs while those costs remain inflated.

What of those pre-existing conditions?  Will they raise premiums?  What coverage is considered basic and compulsary?  How many visits is a patient entitled to at that price?

Much as most everyone would like to see every person have access to medical care, making it mandatory may be going too far.  It may be that doing so brings healthcare beyond Universal, beyond a Right and on into an imposition. Can we compell young, healthy people to purchase coverage they feel they do not need?  Would it be wise to do so, even if we could?  There are many questions left to be answered.  If this were an easy problem to resolve, we’d have done so long ago.

The question that comes to mind now is that of how such legislation would impact physicians.  For example, would healthcare providers be required to turn in someone who presents without insurance?   It’s likely there’d be a minimum coverage available from the state when coverage is unaffordable to the individual.  With some states being so slow to pay, how will providing all of these new patients with care and medications affect those physicians and their facilities if they have to wait for several months to be paid by the state?  The longer one thinks on the day to day realities of a compulsary health insurance situation, the more one is forced to wonder if it is wise to pursue this avenue at all.  What do you think?

The study was based on mature claims-made manual insurance rates for $1,000,000/$3,000,000 policies covering internists, general surgeons, and OB/GYN specialties. While this may not be applicable to every specialty, it certainly is representative of a trend.

“This year was the first in recent history when the overall average rate change showed a decline,” MLM’s Michael Matray stated, as he commented on the sharp difference between this year’s rates and the 20% increase experienced by the same group in 2003. MLM claims a -4.3% decrease between 2007 and 2008, and atrtributes it to a supposed soft market in physicians’ liability insurance over the past 3 years.

Another factor suggests a different cause. The report also notes that fewer companies withdrew services from states in 2008 than in 2007. To see this as competition returning to the market may be a miscomprehension. Physicians are also finding themselves less motivated to leave for less oppressive malpractice rates as well. These two combine to suggest that perhaps the tort reform legislations enacted within several states are working. Premiums are less because malpractice claims are less. More restrictive underwriting requirements may play a part in the overall picture, but credit should be given to medical malpractice tort reforms as well.

Finally, congratulations are in order to the physicians themselves, for their part in the reduction of claims and premiums. It’s obvious that they’re paying closer attention, and their efforts are making a difference. We applaud the practitioners’ efforrts, and those of all healthcare professionals, in making medical malpractice and healthcare more affordable.

Regardless of the cause, the entire industry has cause to celebrate this reduction in medical malpractice premiums.

Arthritis Northwest, PLLC has been identified as the flagship tenant for the building to be developed in the first phase, and has announced their intention to bring a “Musculoskeletal Center of Excellence” to the project. In the RFP review that ended in May 2008, NexCore’s proposal was identified as the best programmatic fit for the campus for its emphasis on clinical, biomedical and health-related development.

WSU’s rapidly expanding health sciences programs are headquartered at WSU Spokane, and the Riverpoint Campus is developing with a focus on health science programs of both WSU and Eastern Washington University. “Health science programs at Riverpoint are already discussing the potential for partnerships with Arthritis Northwest and other practitioners,” said Brian Pitcher, chancellor of WSU Spokane and vice provost for WSU health sciences systemwide. “Our faculty and students will benefit from having practicing clinicians right on campus who can collaborate on research, provide practicum experience for our students, and draw people to the campus to see the exciting things happening here.” The letter of intent is a preliminary understanding of the general terms and conditions for the development, which includes a long-term ground lease, and outlines three phases for the development to be executed through three separate options in the lease.

Phase 1 includes parcels A, B, and D. New improvements include a healthcare facility of approximately 60,000 gross square feet on parcel A that will house Arthritis Northwest and other practices. Parking will also be provided in the first phase, which is expected to begin in late 2009. WSU and NexCore have agreed to work together to explore, develop, and agree on projects to be included in Phases 2 and 3. Redevelopment of the Jensen-Byrd Building will be considered in one of these future phases. Under the terms of the agreement, the development must be consistent with the Riverpoint Campus Master Plan; a process for updating the overall master plan is in the early stages.

WSU is entitled to “reasonably approve” the final plans and specifications for the development to ensure its fit.

In an email from John D. Podesta, Co-Chair of the Obama-Biden Transition Project, the team promised that they would provide volunteer leaders of these discussions with “everything you need to make your conversation as productive as possible, including a Moderator’s Guide with helpful tips.” Then those leaders are to return the thoughts, suggestions and other results of the meeting to Senator Daschle and his team.

Mr. Podesta notes that “no transition has tried something like this before,” and encourages the public to become involved, saying “your participation is essential to our success.”

What’s clear is that the Obama team is looking at rebuilding the healthcare system from the ground up. What’s less clear is what effects those findings may have. While it seems wise to gather thoughts from around the country, rather than limiting such an undertaking to those present in a cabinet meeting, this is all uncharted ground. The President-Elect’s team may find that the problems and woes of the healthcare system are the result of real issues that have become a very high mountain to climb.

In the first 100 days, most Presidents demonstrate their largest goals and priorities. If this is any indication of Barak Obama’s intent, the healthcare system may very well receive the revamping most everyone who works within it has been hoping for.

As health care professionals, your thoughts, opinions and suggestions will be especially pertinent and helpful. One link to share your thoughts and suggestions is found at http://change.gov/page/s/healthcare