september 2015 | physician magazine

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O F F I C I A L M A G A Z I N E O F F I C I A L M A G A Z I N E SEPTEMBER 2015 O F F I C I A L M A G A Z I N E O F F I C I A L M A G A Z I N E A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY ICD-10: TEN STEPS TO HELP ASSURE YOUR PRACTICE IS ON TRACK Financial Planning & Retirement

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Page 1: September 2015  |  Physician Magazine

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A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com

R E P O R T I N G O N T H E E C O N O M I C S O F H E A L T H C A R E D E L I V E R Y

I C D - 1 0 : T E N S T E P S T O H E L P A S S U R E Y O U R P R A C T I C E I S O N T R A C K

Financial Planning & Retirement

Page 2: September 2015  |  Physician Magazine

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Apply by September 30, 2015, and upon approval, receive a 0.25 percentage point reduction on your interest rate.*

Page 3: September 2015  |  Physician Magazine

SEPTEMBER 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 1

Volume 146 Issue 9

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Advertising rates and information sent upon request.

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COVER STORY8 FINANCIAL PLANNING

& RETIREMENTFor many physicians, the prospect of a comfortable retirement raises many questions: How do I create a retirement income plan? What contribution plans are available? What do I look for when shopping for a financial plan? What role does inflation play on my retirement plan? In this issue we provide you with answers to all of these questions along with strategies you can immediately implement to plan ahead for your golden years.

6 ICD-9 to ICD-10: Ten Steps to Help Assure Your Practice Is on Track for a Successful Transition

14 How to Save More Money for Retirement and Beat the IRS

FROM YOUR ASSOCIATION

4 President’s Letter | Peter Richman, MD

16 CEO’s Letter | Rocky Delgadillo

146

Page 4: September 2015  |  Physician Magazine

SUBSCRIPTIONSMembers of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

The Los Angeles County Medi-

cal Association is a profes-

sional association representing

physicians from every medical

specialty and practice setting

as well as medical students,

interns and residents. For more

than 100 years, LACMA has

been at the forefront of cur-

rent medicine, ensuring that its

members are represented in the

areas of public policy, govern-

ment relations and community

relations. Through its advocacy

efforts in both Los Angeles

County and with the statewide

California Medical Association,

your physician leaders and staff

strive toward a common goal–

that you might spend more time

treating your patients and less

time worrying about the chal-

lenges of managing a practice.

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at [email protected] or 213-226-0304.

EDITOR

DISPLAY AD SALES / DIRECTOR OF SALESCLASSIFIED AD SALES

EDITORIAL ADVISORY BOARD

PRESIDENT PRESIDENT-ELECT

TREASURER SECRETARY

IMMEDIATE PAST PRESIDENT

CMA TRUSTEEALTERNATE RESIDENT/FELLOW COUNCILOR

COUNCILOR – SSGPF COUNCILOR – DISTRICT 9

CMA TRUSTEE COUNCILOR

COUNCILOR – DISTRICT 2COUNCILOR-AT-LARGE

ETHNIC PHYSICIANS COMMITTEE REPCOUNCILOR – DISTRICT 1

COUNCILOR – DISTRICT 17COUNCILOR – DISTRICT 14

COUNCILOR – USCCOUNCILOR – DISTRICT 7 COUNCILOR – DISTRICT 6

COUNCILOR-AT-LARGE COUNCILOR – ALLIED PHYSICIANS

COUNCILOR-AT-LARGECOUNCILOR – DISTRICT 3

COUNCILOR – DISTRICT 10MEDICAL STUDENT COUNCILOR/USC

COUNCILOR – SCPMG RESIDENT/FELLOW COUNCILORYOUNG PHYSICIAN COUNCILOR

COUNCILOR-AT-LARGECOUNCILOR – SSGPF

ALT. MEDICAL STUDENT COUNCILOR/UCLACOUNCILOR-AT-LARGE

CHAIR OF LACMA DELEGATION

Sheri Carr 858.226.7647 | [email protected]

ADVERTISING SALES

Christina Correia 213.226.0325 | [email protected] Pebdani 858.231.1231 | [email protected] H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD

HEADQUARTERS

Physicians News NetworkLos Angeles County Medical Association707 Wilshire Boulevard, Suite 3800Los Angeles, CA 90017Tel 213.683.9900 | Fax 213.226.0350www.physiciansnewsnetwork.com

LACMA OFFICERS Peter Richman, MDVito Imbasciani, MDWilliam Averill, MDRichard Baker, MDPedram Salimpour, MD

LACMA BOARD OF DIRECTORS

David Aizuss, MDErik Berg, MDRobert Bitonte, MDStephanie Booth, MDJack Chou, MDTroy Elander, MDHilary Fausett, MDSamuel Fink, MDHector Flores, MDC. Freeman, MDSidney Gold, MDJinha Park, MDStephanie Hall, MDDavid Hopp, MDKambiz Kosari, MDSion Roy, MDPaul Liu, MDMaria Lymberis, MDPhilip Hill, MDNassim Moradi, MDVamsi AribindiAshish Parekh, MDJerry Abraham, MDPo-Yin Samuel Huang, MDMichael Sanchez, MDHeather Silverman, MDAnnie WangNhat Tran, MDFred Ziel, MD

Page 5: September 2015  |  Physician Magazine

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AS A PHYSICIAN, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

That’s why the LACMA/CMA sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company:

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With this critical protection, you’ll have one less thing to worry about until your return.

Page 6: September 2015  |  Physician Magazine

4 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

P H Y S I C I A N S & R E T I R E M E N T | As pre-med students we studied hard and for-went some extracurricular activities that other students enjoyed. The same occurred in medical school. In residency we spent several years working exorbitant hours and studied in our spare time. We delayed gratification to achieve the goal of being well-trained practicing physicians. Following graduation, many of us had student loans that needed to be paid. We also saved in order to purchase a house. We had

immediate expenditures for building a practice, and for many, starting and raising a family. Planning and saving for retire-ment was the furthest thing from our minds. However, accord-ing to Albert Einstein, the most powerful force in the universe is compound interest. Starting a retirement plan early in our careers and making yearly contributions allows greater flex-ibility in later life.

Physicians retire for several reasons. Many come to the conclusion that it is “the right time.” We desire time to enjoy hobbies, travel or visit family. Some grow tired of the daily grind and no longer enjoy practicing. The loss of autonomy with growing regulations and requirements leads to over-whelming frustration for some. Health deterioration may force some to end the stress of practice. Self-recognition of cog-nitive impairment or declining physical skills leads others to refrain from work. Finally, diminishing income may make it im-practical to continue. Part of the decision is based on financial security. With sufficient retirement funds, there is no longer a financial consideration.

Determining how much we need to save is an individual decision. To maintain the same standard of living to which a person has become accustomed, he or she needs approxi-

mately 70% of his or her last working year’s income per year. Based on historical data, one may multiply this number by 25 to calculate the amount needed for a fully funded retirement account. Since doctors just starting out only know the current year’s income, an additional multiplier of 3 is needed to account for income infla-tion over the course of his or her career.

In general, physicians do not save enough for retirement. The good news is that we do better than most of the population. We do not save enough early in our ca-reers, and we attempt to make up the underfunding later in our careers when we have less time for the benefits of compounding interest. With further education and financial planning, one may assure that his or her retirement will be secure and there will be sufficient funds for his or her remaining significant others. At whatever stage in one’s career, reviewing the retirement plan status will safeguard that proper milestones will be met on the path to retirement.

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Page 7: September 2015  |  Physician Magazine

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Page 8: September 2015  |  Physician Magazine

6 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

1. UNDERSTAND ICD-10 Review the major differ-ences between ICD-9 and ICD-10 and how those dif-ferences will affect a clinician’s specialty as well as your organization as a whole. Reviewing the “Official Guidelines for Coding and Reporting” for ICD-10 is a good starting point.

2. CREATE YOUR INTERNAL IMPLEMENTATION AND COMMUNICATION TEAM Include staff from adminis-trative and clinical sides of your practice and divide up the work that needs to be accomplished. Make sure you communicate the changes required by ICD-10 both from a workflow standpoint as well as clini-cal documentation.

3. REVIEW THE IMPACT AREAS OF YOUR PRACTICE AND MODIFY PROCESSES Consider all the different systems you use, what organizations you exchange data with, as well as what electronic and paper-based workflow processes you use that drive clinical encounters and the billing process. Make sure all of these are updated and/or modified appropriately for ICD-10 compatibility.

4. REACH OUT TO YOUR SOFTWARE VENDORS Ask about any needed upgrades to use ICD-10, what training (if any) will be needed, and cost estimates. Don’t forget to ask about the ability to concurrently use ICD-9 and ICD-10 and how long you’ll have the ability to do that.

5. DEVELOP YOUR BUDGET Make sure you consid-er software and hardware upgrades; education and training costs; the cost of temporary staff during tran-sition should it be needed; changes to printed mate-rials; additional time for documentation review; and the cost of lost coder, clinical and/or revenue cycle staff productivity.

6. CONTACT YOUR CLEARINGHOUSES AND HEALTH PLANS Ask when they will complete their upgrades to accommodate ICD-10, how will they help your practice with the transition, when can you test claims

and other transitions with ICD-10 codes, and whether they provide a list of any data content changes need-ed. Don’t forget to ask the health plans when they expect to announce their revised ICD-10-related cov-erage/payment changes.

7. IMPROVE CLINICAL DOCUMENTATION This may be one of the most challenging aspects of ICD-10. Identify potential documentation issues by beginning to crosswalk ICD-9 codes to ICD-10 codes now. The goal should be to identify any gaps in the documenta-tion that prevent a coder from selecting the appropri-ate ICD-10 code.

8. TRAIN YOUR STAFF Identify your education needs; while everyone will need to be trained, not everyone will need to be trained at the same level, so identify who should be trained on what. You will also need to identify the best training mode for each group and the timeframe for providing that training.

9. TEST YOUR SYSTEMS Testing is critical to success with implementation. Plan for both internal testing, as well as external testing. This will need to be sched-uled, so begin the planning now.

10. PLAN FOR CONTINGENCIES Every practice needs to plan for decreased staff productivity and prepare for the possibilities of other financial challenges dur-ing the initial implementation period. You should set aside some cash reserves for the practice. It may also be wise to consider establishing a line of credit.

Preparing now for the transition to ICD-10 will help ease the burden of compliance on October 1, 2015, and assure you will not have a major disruption in your practice revenue.

Mary Jean Sage is president and founder of The Sage Associates and expert consultant in billing and coding for the Cooperative of American Physicians, Inc. (CAP). CAP offers a range of products and services, including medical professional liability protection and risk management services, in the healthcare field. The Sage Associates is a leading multispecialty provider of healthcare management services. www.CAPphysicians.com.

BY MARY JEAN SAGE, PRESIDENT, THE SAGE ASSOCIATES; EXPERT CONSULTANT FOR THE COOPERATIVE OF AMERICAN PHYSICIANS, INC.

T H E D E A D LI N E F O R I M P L E M E N T I N G I C D -10 is quickly approaching. Providers and prac-

tices should be preparing for the transition and approaching the implementation with confidence.

Even though on July 6, 2015, CMS announced a one-year grace period for ICD-10, it did not delay

the implementation. Effective October 1, 2015, a valid ICD-10 code from the correct family will still

be required on all claims. These 10 steps will help you prepare successfully for the transition.

TEN STEPS TO HELP ASSURE YOUR PRACTICE IS ON TRACK FOR A SUCCESSFUL TRANSITION

ICD-9 to ICD-10 Success.

Protect Your Online Reputation With CAP’s Free Physician’s Action Guide!

Since 1977, the Cooperative of American Physicians

(CAP) has provided superior medical professional

liability coverage and valuable risk and practice

management programs to California’s finest

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As a physician-directed organization, we understand

the realities of running a medical practice, and

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The Physician’s Online Reputation Action Guide can

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Learn how to:

• Encourage patients to post positive reviews.

• Appropriately respond to negative reviews.

• Optimize social media to establish your credibility.

Request your free electronic or hard copy today!

800-356-5672 | CAPphysicians.com/ReputationPro

Page 9: September 2015  |  Physician Magazine

TEN STEPS TO HELP ASSURE YOUR PRACTICE IS ON TRACK FOR A SUCCESSFUL TRANSITION

Success.

Protect Your Online Reputation With CAP’s Free Physician’s Action Guide!

Since 1977, the Cooperative of American Physicians

(CAP) has provided superior medical professional

liability coverage and valuable risk and practice

management programs to California’s finest

physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand

the realities of running a medical practice, and

are committed to supporting you with a range of

value-added programs and services. These include

a 24-hour adverse outcomes hotline, HR support,

EHR consultation, a group purchasing program,

and payment and reimbursement education and

support, to name a few.

It’s what California’s finest physicians strive for. . .and what CAP can help you achieve.

The Physician’s Online Reputation Action Guide can

help you build a strong and positive reputation.

Learn how to:

• Encourage patients to post positive reviews.

• Appropriately respond to negative reviews.

• Optimize social media to establish your credibility.

Request your free electronic or hard copy today!

800-356-5672 | CAPphysicians.com/ReputationPro

Page 10: September 2015  |  Physician Magazine

8 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

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If you’re among the one in four doctors who will be reaching retirement age in the next four years, you’re hopefully looking for-ward to reaping the benefits of disciplined saving and smart financial planning.

For many doctors, however, the prospect of a comfortable retirement still raises many questions: How do I create a retirement in-come plan? What contribution plans are available? What do I look for when shopping for a financial plan? What role does inflation play on my retirement plan?

In this issue, we provide you with answers to all of these questions along with strate-gies you can immediately implement to plan ahead for your golden years.

Financial Planning & Retirement

BY MARION WEBB

Page 11: September 2015  |  Physician Magazine

SEPTEMBER 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 9

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Most people, including doctors themselves, may think that a six-figure income should be more than adequate to set them up for a comfortable retirement.

But that isn’t always the case.“Most people don’t realize that rich doesn’t mean having a high income, but rather a high net

worth,” a whitecoatinvestor.com article suggested.A doctor who finishes residency at age 30 and puts away 20% of an annual salary of $200,000

will end up with a net worth of $3.4 million by age 65 — a comfortable nest egg for the golden years. But this idealistic scenario is not the norm. Few doctors are actually in such an enviable position.

Here are are some of the reasons why more doctors don’t follow that plan.

1. A late start Non-traditional students don’t complete their residency and fellowship until they are in their 40s or even 50s, which means they are losing valuable years of earning compound interest in savings. To make up for the loss, some doctors have to work until later in life or may choose a higher-paying specialty.

2. High student loan debt In 2009, the American Medical Association said the average student had a debt of $140,000, including scholarships and “parental grants,” leaving him or her with a negative net worth of $200,000 to $300,000 at age 30. That debt is likely to be even higher today. Some medical students, especially those with families, borrow more or have credit card debt, all of which can leave a huge dent in their eventual net worth. Consider that $200,000 invested at 5% for 35 years is worth $1.1 million, or nearly a third of the expected nest egg. The bottom line is that students should not take out money to pay off student loans from their retirement savings. It has to come out of the lifestyle.

3. Inadequate savings Whether it’s a lack of financial sophistication, a sense of entitlement or lack of self-discipline, doctors can’t invest if they don’t know how to save. Choosing to skip on retire-ment plan contributions, especially early on when compound interest has time to work its magic, can devastate a retirement plan. The author of the whitecoatinvestor.com article gave the follow-ing as an example: A doctor who saves $50,000 for the first 15 years in practice, then nothing for 25 years, ends up with $750,000 in total savings. A doctor who saves nothing for the first 15 years, then saves $75,000 a year for the next 20 years, saves a total of $1.5 million. Yet, in the end, the first doctor still ends up with twice as much money, or $2.68 million, compared to the late-saving physician who ends up with $383,000 less, despite having saved twice as much. That is the magic of compound interest and saving early on. The longer you wait, the more money you need to save, the author said. Saving 5% to 10% is not enough and will leave doctors with a lower standard of liv-ing. A doctor earning $200,000 a year who saves $50,000 a year needs only 75% of pre-retirement income to have the same standard of living, but a doctor who saves $20,000 a year will need 90% of his or her pre-retirement income to keep the same standard of living. A good goal is to save

15% to 20% of your annual income every year, more if you want to retire early.

4. Failingtoinsureagainstfinancialcatastrophe Insuring against death, disability, natural disaster and liability is very easy and a must do.

5. Improperinvestmentplan High income and high savings should get any doc-tor well into the golden years, but too many doctors have improper investment plans ranging from day-trading tech stocks to huge swings in asset allocation into the asset class with impressive recent performances (buying high and selling low) to being overly conservative and leaving money in assets without adequate long-term returns. Compounding doesn’t do doctors any good if it doesn’t happen at a higher rate than inflation.

6. Excessiveinvestmentcosts Getting help from a financial advisor can thwart the pitfalls above, but getting bad advice introduces a new problem. The author said you get what you pay for. If investment costs are 1%, 2% or 3% a year, that is de-ducted from the returns, and a 3%-a-year cost could reduce after-inflation return of 5% to 2%. After 35 years of saving $50,000 a year, that is a difference of $2 million. Taxes can have a similar effect.

Page 13: September 2015  |  Physician Magazine

SEPTEMBER 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 11

What to do look for when hiring a financial expertWhen it comes to finding a good financial advisor, there’s more confusion

than good advice out there. Here are some pointers to put you on the right track in terms of which person

is right for you:Financial analyst: Financial analysts typically work for an investment firm

and carry the Certified Financial Analyst (CFA) certification, a rigorous multi-year course of study of exams. Their role is to put together portfolios for institutions and investment firms, and these professionals aren’t trained to provide general financial advice.

Financialplanners: Many people call themselves professional planners or financial advisors, but the important thing is to find out how they are being paid and what type of training they have. A financial planner should have a Certi-fied Financial Planner certification, which requires a college degree and specific studies in financial planning as well as passing a rigorous exam and at least three years of experience.

The other important aspect is how the planner is paid. Doctors should look for “fee-only,” which means they are truly putting your interests first. Look for 12B-1 fees on the funds, which are hidden fees. Find a fee-only planner through the National Association of Personal Financial Advisors.

The role of inflation Since retirement can span three to four decades, it’s key to

consider the role of inflation on funds coming from different sourc-es including Social Security; pension income from military service, government or corporate plans; non-portfolio income such as in-come from business interests or real estate; and finally savings.

Social Security is adjusted annually for inflation based on a variation of the Consumer Price Index, which is a real positive. Some pension streams, mostly government-based, are also ad-justed for inflation. Yet, income from corporate pensions is “fixed,” which means that doctors need to account for a steady loss of buy-ing power in their planning.

Given that assumption, it’s key that doctors “step up” the with-drawals from their investment portfolio over time.

The whitecoatinvestor.com article posted the “10 Command-ments of the White Coat Investor” provided by Andy Walker, MD, an emergency room physician who managed to retire at age 53 thanks to savvy and early planning for retirement.

Here are Walker’s 10 tips for successful early retirement:

1. Frugal, frugal, frugal Walker said he learned conservative frugal management from his father, who was president of a small bank in a small town. Like his father, he never bought a new car. He said his other financial guide is John Bogle, found-er of Vanguard.

2. Livebelowyourmeansandminimizedebt He said noth-ing else matters more than living below your means. He said he started paying off his loans from medical school while still being an intern and always paid off his credit card debt in full

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Dealing with a retiring medical practice partnerWith the high number of physicians nearing retirement age, it’s good practice to start think-ing about how to handle this situation well in advance of the event. Here are several tips for planning for the retirement of a medical practice partner.

1. Consider getting professional advice from a financial planner with expertise in medical practices.

2. Each partner should write down expectations for the retirement process, including a time frame, to be discussed as a group.

3. Determine the value of your practice by ob-taining an independent evaluation that in-cludes hard assets as well as accounts receiv-able.

4. Discuss options and determine a plan for pay-ing out the retiring partner. Consider options for buying out the retiring partner, paying a percentage of his or her final salary and also how to pay it out, such as in a lump sum or via installments over time.

5. Consult with other practices in your area about how they dealt with or plan to deal with a retiring partner.

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12 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

• DEFINE WHAT RETIREMENT MEANS TO YOU – For physicians who aren’t ready to face full-time retirement, a scaled-back version of their current role might be the ideal way to slowly step back from the practice. There are many advantages to this approach, including building additional income and delaying Social Security benefits, but it’s important to establish clear parameters that will support this plan. Take time to outline what retirement means for you, and build that into your plan.

• SET RETIREMENT GOALS AND OBJECTIVES – Explore business and personal goals, and set a target retirement date that makes sense for you and your practice. This can include learning more about your personal financial situation, identifying business transition op-tions, and if you have employees, understanding who will be im-pacted by your retirement.

• GET FAMILIAR WITH AVAILABLE CONTRIBUTION PLANS – For-tunately, there are a variety of retirement plans available to help with future planning. From profit sharing plans that offer you and your employees a portion of your annual profits, to IRAs and 401(k) plans, there are many choices. Make time to meet with your finan-cial advisor and your tax advisor to find a plan that works for your practice.

• CREATE A RETIREMENT INCOME PLAN – The money you save now needs to be enough for 20-30 years of retirement. Take advantage of “catch-up” rules, which allow people in their 50s to contribute an additional amount to an IRA or 401(k). Work with a financial advi-

sor and a tax or legal advisor to determine how much money you should put away now and when you should plan to start withdraw-ing your retirement savings, and include this in your overall retire-ment plan.

• REVIEW STRATEGIES FOR FINANCING THE TRANSITION INTO RETIREMENT – Physicians may consider selling their practice when it comes time to retire. Most of these business transitions will in-volve some form of financing, and oftentimes, sources and uses of available funds can determine or limit a physician’s options. Do you have a succession plan in place? Does your business carry any debts? Will you have funding from an equity sponsor, such as a com-mercial bank? These are important questions to ask as you develop your retirement plan. Meet with your banker to learn more about your financing needs, the business evaluation process and product choices.

While planning for retirement can be complex, it doesn’t have to be a difficult or stressful experience. After you’ve developed a strong retire-ment plan, take time to review and update it annually to ensure you’re staying on track.

Steve Bernstein is Wells Fargo’s Business Banking Manager for the Southern Califor-nia region. He can be reached at [email protected] help more small businesses achieve financial success, in 2014 Wells Fargo introduced Wells Fargo Works for Small BusinessSM – a broad initiative to deliver resources, guidance and services for business owners. For more information about Wells Fargo Works for Small Business, visit: WellsFargoWorks.com. Follow us on Twitter @WellsFargoWorks.

Evaluating the health of your retirementBY STEVE BERNSTEIN, WELLS FARGO BUSINESS BANKING MANAGER FOR THE SOUTHERN CALIFORNIA REGION

As a physician, you likely spend most of your day caring for others’ long term health and well-beinsg, but how much time do you spend thinking about your long term financial health and the well-being of your retirement? When it comes to retirement, the earlier you start planning, the better off you will be long-term. Today more than ever there are many retirement planning resources and tools available to physicians. Here are five tips to help you start thinking about retirement planning:

every month. “If you find yourself using a credit card for credit rather than convenience, you should get rid of them,” he said. By age 30, he was out of debt, except for a mortgage.

3. Don’tbuytoomuchhouse He said he and his wife never spent more than the money that came in and that was true for real estate as well. His father’s advice: Your mortgage debt should not exceed twice your annual income, advice his son lived by.

4. Haveanemergencyfund After paying off debt, the next task is to save at least three months of income in case of unexpected emergencies, which always come up. He believes that emergency doctors should have at least six months’ worth of savings, because their jobs are inherently unstable.

5. Minimize incomeand save for retirement He believes in saving 20% or more of monthly income, excluding any contributions to retirement funds from employers. He said he and his wife were unable to have children, which freed up money to invest. He also went from an academic job to an independent group at a community hospital that came with a $70,000 raise, including benefits, which didn’t lead to a lifestyle change, but rather more savings. He said by working for a democratic group rather than a corpo-rate management group, he reaped more fruits of his labor.

6. Invest in index funds He said his father taught him to invest in the long-term game rather than speculating,

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and since no one can predict the market, or control it, he favored index funds. They have low fees and low taxes.

7. Rebalancetheportfolio He said failing to rebalance his portfolio as he aged was one of two investing mistakes he made himself. He said he lost about 40% of his portfolio when the market crashed in 2007-2008, and looking back, he said he should have had more money in bonds than in stocks. He was able to reclaim the losses and in retirement reallocated his assets to be more conservative.

8. Don’tbuycash-valuelifeinsurance He said to provide security to his wife and charities in case something happened to him, he let an insurance salesman talk him into buying a “variable universal” life insurance policy, which he was told would provide life insurance and tax-free income if he put enough money in in advance. He said that even the underperforming market would have made more money than the fees he paid.

9. Givetocharity Besides having a plan for the family after you pass, leave a legacy of ongoing work. He believes in donating to charity consistently now, which does good for others and makes one a more re-sponsible money manager.

10.QuityourjobsoonerthanyouthinkWalker said that after reviewing his financial position while gather-ing data for filing taxes, he realized he didn’t have to work part time, but could retire if he wanted. He said that was important to him because he had gotten increasingly unhappy at work with longer wait times in the emergency department, inadequate staffing, lack of supplies and other complaints, so he quit.

His final words: “Money may not bring happiness but it does bring freedom, and freedom is pretty damn good. So I encourage you to live frugally, save aggressively, invest wisely, give charitably, minimize debt, and be free.”

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Page 16: September 2015  |  Physician Magazine

14 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

You’ve worked hard to achieve success, dedicating time and energy over the years to build your practice. You’ve taken out loans to build your practice that had to be repaid, paid off massive student loan debt, and worse yet, put off saving for retirement. Now that your earning po-tential has started to peak, your tax liability has also risen (as if you need-ed something more than ICD-10 to stir things up). Don’t worry, you’re not alone. Retirement planning is one of the top concerns for most self-employed physicians, and it’s time you started a Defined Benefit Plan.

What is a Defined Benefit Plan? The best solution for a doctor with retirement and tax concerns is a Defined Benefit Plan (DB Plan). A Defined Benefit Plan is an employer-sponsored retirement plan where employee benefits are sorted out based on a formula using factors such as salary his-tory and duration of employment - Investopedia. In laymen’s terms, this means it is an employer-sponsored plan that will provide a “defined” ben-efit for a retiree based on their salary and years of employment. These plans offer two distinct advantages for business owners. First, since the owner(s) are doing most of the funding, their company receives a huge tax break. Second, in most cases, especially with small-business owners, nearly 80% of the contributions will go towards funding the owner’s por-tion of the retirement plan. Why? Because the owner(s) of the plan will most likely have the highest salary of all of the participants and, by default, would have more years with the company than anyone else.

Defined Benefit Plans vs. Traditional 401(k) Plans A good retirement plan solves two problems: savings and tax reduction. A DB Plan solves both of these problems much better than Traditional 401(k) Plans. Here’s why. A Traditional 401(k) Plan will allow a self-employed 50-year-old physician to defer up to $24,000 in salary while his company is allowed to contribute up to $29,000 for a total combined tax deduction of $53,000 per year. However, a well-designed DB Plan allows that same physician’s company to contribute over $200,000 per year to their retire-ment plan, and they can still defer up to $24,000 in salary for a combined maximum amount of $252,746 (calculated figures for a 412(e)(3) Plan for 2015). Ready for more good news? Since these plans are adjusted according to age and salary history, an older physician could have their company contribute even more to the plan resulting in a greater tax break and much more savings!

Guaranteed Returns Let’s talk guarantees! Another big difference between the Traditional 401(k) Plan and a DB Plan is that the latter is fund-ed with an insurance product that can either be an annuity or a combina-tion of an annuity and life insurance. Money placed into these plans will never be placed into the stock market. This means no losses during mar-ket crashes. Moreover, during retirement, a well-planned and -funded DB Plan can provide up to $215,000 per year during retirement…guar-anteed! So, if you’re into more savings, reducing tax liability, and guaran-teed returns, Defined Benefit Plans are the answer.

To reduce tax liability and save more money for retirement, roll your 401(k) into a Defined Benefit Plan now! Contact us at 310-346-0850.

How to save more money for retirement and beat the IRSBY WALTER HINES, OWNER, BISON BUSINESS SOLUTIONS

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Page 17: September 2015  |  Physician Magazine

SEPTEMBER 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 15

SPONSORED CONTENT

Can a Physician Home Loan Be the Solution for You?BY MICHELLE MOLLURA

With student loan debt at an all-time high, millions of Americans are faced with the uphill battle of paying off their debt while beginning their careers. This can be especially true for new physicians.

According to the Association of American Medical Colleges, 84% of medical school graduates last year reported hav-ing an average of $180,000 in student loan debt. Tackling this debt can be especially difficult for most new doctors, and especially residents who typically start out with modest salaries and little-to-no savings.

Like most people on the brink of their careers, homeownership is a logical next step in the equation. Saving for a down payment is typically the biggest hurdle to overcome on the road to homeownership. RPM Mortgage, Inc.’s Physi-cian Mortgage Program is designed to benefit doctors, dentists and optometrists who are licensed or in a residency/fellowship. With low down payment options, flexible qualification guidelines and no PMI (private mortgage insurance), the program is an ideal solution for those building a career in the medical profession.

Student Loan Debt? RPM’s program excludes student loan debt from the debt-to-income ratio. This is one of the main benefits that distinguishes RPM’s Physician Mortgage Program from a conventional loan.

Down Payment? For most physicians carrying student loan debt, coming up with a 20% down payment is a real chal-lenge. Fortunately, RPM’s Physician Mortgage Program requires only 10% down for single family home purchases. In addition, a gift of funds from your family and/or friend is also permitted to help meet the down payment.

Loan Amounts? For established physicians who are out of residency for at least one year, one may qualify for higher loan amounts (up to $850,000).

Since 1986, trust, knowledge and community focus have been the core values upon which RPM has built a reputa-tion as a trusted mortgage lender. RPM’s commitment to meet the needs of the communities in which we live and work inspired us to create a financing solution to match the unique needs of the physicians who are a part of, and serve, many of those same communities.

As someone who understands your commitment to your practice, I am committed to helping you find the right home loan. My 14 years of real estate loan experience, creative financing solutions, competitive rates and excellent service have led to happy and successful home buyers. Don’t let your student loan debt deter you from owning your dream home. Through RPM’s Physician Mortgage Program, we can make it happen.

Michelle Mollura (NMLS # 320542) is a Branch Manager for RPM Mortgage, Inc.’s Rolling Hills Estates office, a private mortgage lender. For more information on RPM’s Physician Mortgage Program, contact Michelle Mollura at [email protected] or at 310.703.1806.

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Page 18: September 2015  |  Physician Magazine

16 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

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W I T H S C H O O L B A C K in session and fall on the horizon, LACMA is excited to offer its physician members new and exciting opportunities for education and celebration.

This October, we will be offering a special workshop for Physician Health Committees, presented by California Public Protection and Physician Health Inc. Ira Lesser, MD, chair of the Physician’s Wellbeing Committee of Harbor-UCLA Medical Center, will deliver the welcome address to attending members and staff of hospital medical staff, medical groups, specialty societies and county medical associations.

The workshop will take place from 9:30 a.m. to 12:30 p.m. on Saturday, Oct. 31, at the LAC/USC Medical Center Inpatient Tower at 2051 Marengo St., Los Angeles. The event is free, but advanced reg-istration is required. Please contact Ashley Burke at [email protected] to reserve your spot.

In LACMA’s continued efforts to reach out to other physician groups here and elsewhere, I recently had the great pleasure to meet with a Japanese physician group of 30 doctors from Hiroshima, Japan.

The delegation was led by Masayasu Yoneda, MD, PhD, a lecturer from the Department of Molecular and Inter-nal Medicine Institute of Biomedical & Health Sciences at the Hiroshima Univer-sity Department of Endocrinology and Diabetic Medicine at the Hiroshima Uni-versity Hospital.

The exchange was thought provok-ing and insightful, and helped further our leadership role in establishing fruit-ful relationships with physician groups locally, nationally and worldwide. I look

forward to even more relationship building with other physician groups in the near future.

In our efforts to honor our own top physicians in LA County, I would like to encourage all physicians to help celebrate LACMA’s biggest annual celebration dinner, the 2015 L.A. Healthcare Awards Dinner on Nov. 19.

Thanks to all who have taken the time to nominate individuals who made exemplary contributions in providing and improving access to quality healthcare in LA County.

There is still time to sponsor, register and purchase your tickets. The deadline is Oct. 23 and you can learn more as well as register for the event by visiting lahealthcareawards.org. If you can’t make it to our big event this year, we kindly ask you to consider a contribution to the Marshall Morgan, MD, Scholarship Fund.

Finally, LACMA has a new address, 801 S. Grand Ave., Suite 425, close to Staples Center. We are in temporary space now while our permanent space is built out. We will have an open house when the space is completed. In the meantime, we are fully operational.

We’ll keep you posted on that and the many exciting issues and events ahead.

Regards,

Rocky DelgadilloChief Executive Officer

SPONSORED CONTENT

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In today’s world, healthcare professionals are confronted with unprecedented challenges in an increasingly competitive business environment. In the Los Angeles area, UCLA offers one of the only healthcare management degrees for full-time work-ing professionals, with classes that meet on campus to build your network with other successful profes-sionals and UCLA faculty. The UCLA Executive Master of Public Health (EMPH) program offers working physicians, clinicians, and administrative profession-als a comprehensive business and policy education fully-integrated with the most critical issues facing healthcare today.

The EMPH Program at UCLA is a two-year, fully accredited MPH degree in the Department of Health Policy & Management. Located in UCLA’s Fielding School of Public Health, the program attracts a di-verse group of highly experienced and motivated individuals who bring both private and public sector experience into the classroom. Each year, a class of ap-proximately 25 students representing various clinical, managerial and professional specialists is admitted as a single cohort into the Program. The small size and cohort structure promote close collaboration in an in-timate learning environment, enabling participants to take full advantage of each other’s knowledge and ex-perience in healthcare and its allied fields. The diverse student cohorts and team-based learning contribute to a unique and tightly knit alumni network for years and years after graduation, evidenced by networking events, career assistance, financial support, and class-room lectures and cases.

In addition to improved business acumen, healthcare policy and strong advocacy are critical in improving healthcare delivery and population health and play a role in the education of working professionals. From patient rights to antitrust leg-islation, bioethics to resource allocation, and social justice and sustainable competitive advantage – the EMPH students understand how these issues must weave together if they are to improve health and health service delivery.

The Program’s curriculum is developed by fac-ulty that includes renowned researchers, practitio-ner-scholars, and top tier Los Angeles healthcare executives using competency-based educational standards. Content and coursework are developed so that graduates achieve exemplary competence in areas such as analytical thinking, creativity and prob-lem-solving, written and oral communication, team leadership, and business planning and execution.

UCLA’s Executive Programs in Health Policy & Management brings programmatic innovation and technological advancements that create a more rel-evant degree for many busy physicians and health-care professionals. The program is interested in help-ing each individual find the career path that best fits your needs. For more information on the EMPH pro-gram or other programs in the area please call (310) 206-6885.

Page 19: September 2015  |  Physician Magazine

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Page 20: September 2015  |  Physician Magazine

1 8 P H YS I C I A N M AG A Z I N E | SEPTEMBER 2015

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Page 21: September 2015  |  Physician Magazine

SEPTEMBER 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 19

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Page 23: September 2015  |  Physician Magazine
Page 24: September 2015  |  Physician Magazine

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