Living with GASB 45: how to manage liabilities associated with retiree medical benefits.

The Governmental Accounting Standards Board Statement 45 (GASB 45) obliges public employers to disclose liabilities related to postretirement medical benefits. Most state and local government entities are beginning to analyze and quantify how GASB 45 liabilities will affect their balance sheets and credit ratings. This article describes the many ways to reduce those liabilities without eliminating retiree medical plan benefits altogether. Now is the time for employees and employers to work together and make difficult choices for keeping retiree medical costs and GASB 45 liabilities manageable.

The new caring: financial asset management and older people.

Increasing longevity and the growing proportion of the aged in the population in most countries have served to focus on the question of how governments and older people can finance living, health, and care options in retirement. Prudent management of income and assets is an increasingly complex and important aspect of aging as assets and expectations of self-financing increase. Although many informal caregivers act as asset managers and/or substitute decision-makers for older people, little attention has been paid to this increasingly important aspect of care. This paper summaries key findings of a broad research program exploring family involvement in the management of older people's assets and the practices that constitute good practice as well as financial mismanagement and abuse. It identifies multi-level and multi-strategy responses needed to address the issues raised by the research and outlines an innovative community demonstration project aimed at improving financial management practices in relation to older people's assets.

Roald Dahl charity funds network of specialist nurses.

As the author of some of the most famous children's books, Roald Dahl's impact on the lives of young people is obvious. But less well known is his legacy in terms of helping the sick and injured.

The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review.

While pay-for-performance (P4P) programs are increasingly common tools used to foster quality and efficiency in primary care, the evidence concerning their effectiveness is at best mixed. In this article, we explore the influence of welfare systems on four P4P-related dimensions: the level of healthcare funders' commitment to P4Ps (by funding and length of program operation), program design (specifically target-based vs. participation-based program), physicians' acceptance of the program and program effects. Using Esping-Andersen's typology, we examine P4P for general practitioners (GPs) in thirteen European and North American countries and find that welfare systems contribute to explain variations in P4P experiences. Overall, liberal systems exhibited the most enthusiastic adoption of P4P, with significant physician acceptance, generous incentives and positive but modest program effects. Social democratic countries showed minimal interest in P4P for GPs, with the exception of Sweden. Although corporatist systems adopted performance pay, these countries experienced mixed results, with strong physician opposition. In response to this opposition, health care funders tended to favour participation-based over target-based P4P. We demonstrate how the interaction of decommodification and social stratification in each welfare regime influences these countries' experiences with P4P for GPs, directly for funders' commitment, program design and physicians' acceptance, and indirectly for program effects, hence providing a framework for analyzing P4P in other contexts or care settings.

Measuring Return on Investment for Professional Development Activities: Implications for Practice.

What is the return on investment (ROI) for the time and resources spent for professional development activities? This is Part 2 of a two-part series to report findings and demonstrate how financial analysis of educational activities can drive decision-making. The resources consumed for professional development activities need to be identified and quantified to be able to determine the worth of such activities. This article defines terms and formulas for financial analysis for nursing professional development practitioners to use in analysis of their own programs. Three fictitious examples of common nursing professional development learning activities are provided with financial analysis. This article presents the "how to" for the busy practitioner.

Making the End as Good as the Beginning: Financial Planning and Retirement for Women Plastic Surgeons.

Financial planning is critically important to ensure financial security both during a plastic surgical career and in retirement. Unfortunately, plastic surgery training includes very little in the way of financial planning. The information that is available in the literature is mostly geared toward men. Women, with longer lifespans and more family care responsibilities, have unique needs when it comes to financial planning. Adequate attention must also be paid to life after retirement. A plastic surgical career can be all-encompassing, and thus women need to carefully plan volunteer activities, new hobbies, and even a second career to make their retirement years fulfilling and enjoyable. Key points regarding financial planning during the various phases of a woman plastic surgeon's career are discussed. Options for retirement are presented.

Outsourcing: friend or foe.

With rising costs and tight controls on reimbursement, physicians need to dig deeper into expenses and find ways to reduce costs while tapping into an equal or higher level of expertise. Outsourcing offers an attractive solution. This article identifies the areas where outsourcing is most valuable and effective, and provides some methodologies for achieving a successful result.

Segmenting health maintenance organizations to study productivity and profitability.

As the decade ended, health maintenance organizations (HMOs) were increasing in popularity as a means of health care delivery. These groups take many forms, so it is important for the analyst to see if the efficiency and financial results for these different forms vary. The four major forms are profit vs. not-for-profit, chain vs. non-chain, group/staff vs. individual practice association (IPA), and federally qualified vs. non-federally qualified. Using a nationwide database of all the HMOs in the United States, the article compares liquidity rates, leverage ratios, profitability ratios, marketing, and per member ratios across the four groups using paired t tests. The two classifications that showed the most differences were group/staff vs. IPA and federally qualified vs. non-federally qualified. IPAs have a better liquidity position and lower leverage ratios than group/staff but their administrative costs are higher and the time to receive payments and to pay debts is higher. Non-federally qualified have somewhat higher liquidity ratios and higher profitability ratios. These significant differences in financial outcomes indicate that studies of HMOs should segment different major forms of organizations and study them separately before trying to show the effects of different policies on HMO efficiency and effectiveness.

Personal financial strategies.

Personal and professional characteristics should be considered when planning a financial future. Analyzing income, expenses, net worth, investments, insurance, and taxes are important for sound financial health.

Breaking even: How low can you go?

Here, learn strategies to assess and operationalize your expense cutting and revenue generating ideas.

How to establish a position and hours budget.

Learn how to convert your full-time equivalent (FTE) allocation into a position and hours budget.

Turning your practice around.

The techniques of managing a medical practice are no different from those required to manage any other business. Planning is the first step, and establishing a realistic budget is essential to creating a successful plan. Knowing your patients and the sources of your revenue are next. Understanding the weaknesses within your practice and developing courses of action to correct them is essential. This includes developing ways to increase revenue as well as control expenses. Once a plan has been developed a basis for monitoring that plan is required. We suggest tracking financial performance monthly. If these basic management techniques are put into place, the actions discussed above will become both easier and more effective.

Making it fair: how to balance schedules and compensation in a group practice.

Physicians prefer simplicity and would prefer to work out their differences among themselves. However, when money and personal time are at stake, a more sophisticated income distribution formula--one that prevents problems--is an excellent trade off.

Creating a more efficient physician practice: six steps toward turbo-charged practice revenues.

Health care providers face reimbursement and expense constraints. They will be helped in streamlining their operations by adopting financial benchmarks and following a six-step formulation to improve and assess their efficiency and effectiveness. These include: revenue and cost analysis; improved staffing and training procedures, attention to scheduling; developing functional patient intake procedures; selecting appropriate information systems; and evaluating the patient encounter by surveys and the examination of financial results.

Employment agreement: what every doctor (junior and senior) needs to know--Part 3.

The final article in a three-part series, this article covers what should and should not be included in an employment agreement. For new recruits and hiring physicians alike, it provides a step-by-step guide to the key issues involved in contract negotiations. Four main topics are addressed: compensation, working conditions, termination provisions, and buy-in provisions. Contractual compensation issues include, among others, salary, bonus, insurance premiums, pension, moving costs, and loans. Contractual working condition issues include the term of the contract, vacation policy, call coverage, governance, CME policy, permissible outside activities, office hours, degree of physician autonomy, physical and human resources, and sick leave. Contractual termination provision issues include rights to termination, covenants not to compete, medical record ownership, and assignment. Contractual buy-in provision issues include probationary periods, the assets being purchased, valuation formula and financing.