The push to develop the EMR was part of the 2009 economic stimulus bill and thus predates the “Obama Care” legislation of 2010. Its real intent was to incentivize medicine in general and physicians in particular into adopting the EMR and used the carrot and stick approach to have this happen. The program has provided a lump sum payment (to help defer the initial cost of the soft and hardware) to the providers for meeting certain criteria described as “meaningful use” of the computer programs (the carrot) and a decrease in Medicare reimbursement beginning in 2014 and ending in 2020 of approximately 5% to the groups eligible for the above payment if they do not adopt the EMR (the stick).

Therefore it is no accident that most of the physician offices you now frequent have started to use the EMR.  You will notice that all the information you previously provided to the doctor’s office have to be redone to be able to “data load” the record. Also other forms about privacy and access to your record have to be filled out and then signed by you before the record can move forward and be utilized on your behalf. After the initial introduction, the physician or other well trained personnel in the office must take the time to enter information from your paper chart including drugs, allergies and previous diagnosis. This obviously takes time and skill to correctly enter the information.

Additionally, when you have an appointment, the physician must enter quite a complicated set of data or notes into the record to make your visit “count” electronically. I liken the use of the computer in the exam room as encountering two patients on every visit. If the physician does not pay attention to both the patient and the EMR, with equal amounts of scrutiny, then there will possibly develop a problem in either the patient or the EMR and the outcome may be uncertain.  The time spent attending to the medical record lessens the amount of time spent speaking to and directly addressing the patient even though you may be in the same room with your doctor. It would be possible to take advantage of the time saving advantages of the EMR by creating templates for various diseases, but these so called “macros” are not looked upon with favor by Medicare. This is due to their concern that the macros represents not enough time spent according to the Medicare coding system and then up coding for the services provided could exist. My contention is that more time could be spent with the patient and less time would be spent tending to the computer.

One area of positivity for the EMR lies in the field of prescriptions. Built into the system are three areas that are actually helpful.  The first is an easy method of alphabetizing and thus keeping track of the medications the patient is taking. The second is the ease of printing out or electronically sending prescriptions to a designated pharmacy. The third is the ability of quite easily identifying interactions and absolute conflicts of different medications is easy to see.

Thus when you visit your physicians office in the near future do not be surprised that an EMR exists, but please do not be lulled into thinking that this modern, 21 first century iteration of the medical record in any meaningful way has lead to improved medical care for you or your loved one. The truth is that it was mandated by legislation and is just another way of documenting your health care record.

CrossFit

What is it?

CrossFit has experienced rapid, widespread popularity.  The aim of CrossFit is to prepare participants for any physical task or situation.  It claims to achieve this by optimizing fitness through a variety of high intensity exercises.

Pros:

CrossFit uses traditional strength, cardiovascular, and sport-specific exercises in various combinations.  Participants who are familiar with exercise will be familiar with the majority, if not all the exercises involved.  Due to the high intensity format, people who train with the program on a consistent, frequent basis should see significant and rapid results.

Cons:

CrossFit is extremely dangerous.  The online community allows participants to follow the workouts on their own without oversight in regard to form, which causes a high risk of injury, and participating in a structured class setting may not ensure a qualified professional that is capable of decreasing this risk.  To become a CrossFit instructor, one simply has to attend a 2-day course on the program and pass a 50 question multiple-choice test.  Instructors are not required to hold any type of exercise-related degree or certification.

Fusion Classes

What is it?

Fusion classes mix two different styles of exercise into one class.  Common combinations include Pilates and boxing (Piloxing), yoga and cardio, and dance and aquatic training.

Pros:

Fusion classes provide participants with a great amount of variety in their workouts.  The combinations often pair a high-intensity discipline with a moderate-intensity discipline, which provides a strenuous, yet manageable workout.  Additionally, fusion classes are convenient for individuals that are interested in both disciplines because it eliminates the need for a second class.

Cons:

The experience will not be as pure as it would be in a class that teaches a single discipline and you may find that instructors do not have the expertise of those that teach the discipline alone.

Personal Training

What is it?

Personal training provides individualized attention from certified professionals who have studied movement and the human body.  The American College of Sports Medicine (ACSM) is one of the most respected personal training certifying organizations in the United States.  Each year, ACSM publishes a list of the top ten predicted fitness trends for the year.  Not only are personal training and group personal training on the list for 2013, all of the other eight trends are areas covered by personal training.

Pros:

Qualified personal trainers are certified in personal training and often have a degree in an exercise-science related field.  Individuals who work with personal trainers often experience expedited results to their goals and have a lower incidence of exercise related injuries.

Cons:

Personal trainers are not required to hold any sort of state or national license, so there is always a chance that someone calling themselves a personal trainer is not qualified for the title.  Additionally, personal training can be quite expensive.  Group personal training is lower in cost than individual sessions, but weekly sessions can still become a financial burden.

Julie and Craig experienced precisely that threat in no uncertain terms. The 60-year-old business-owner duo had been fairly aggressive investors prior to the 2008 stock market tsunami, after which their nest egg shrank by almost 50 percent. Among other things, the couple is looking to retiring in the next 10 years with an annual income of $85,000. Social Security is only scheduled to bring in about $35,000 a year, so their goal is to somehow turn their once-upon-a-time million dollar nest egg – now worth approximately $600,000 – into a yearly income of $50,000 for the rest of both their lives. Given that they’re both from families with pretty long life expectancies they’re rightfully concerned about the longevity of their income.

Here’s the even trickier part. Every advisor they’ve met has told them it might be possible to achieve their desired $50,000/year income, but offers no guarantees.

Good news is, there are products available today that can easily solve Julie and Craig’s problem. They can make sure their money grows at a certain guaranteed rate for the purposes of their income, while guaranteeing a specific income for their joint life spans, however long that may be, regardless of what the stock market does. In their specific case their contract guarantees a 6.5 percent annual compound rollup rate. So in 10 years, their $600,000 is guaranteed to be worth exactly $1,216,385.08 in their “income account.” That works out to a guaranteed yearly income of $60,819.25 for as long as they both live. It’s as simple as that.

These figures do not depend on what the stock market does. And when one spouse dies, the survivor will keep receiving the same $60,819.25 for the rest of his/her life. Should they both die before depleting their “contract value,” any money left goes to their named beneficiary. However, if they follow their families’ trend and outlive their contract value, their guaranteed $60,819.25 a year will not stop. Of course, should they decide to retire sooner than scheduled, their income account value, and therefore, guaranteed yearly income would be smaller.

The interesting question here is how come none of the previous advisors they met with discussed this option with the couple? We can only speculate, but perhaps they’re not even aware that programs like this even exist. Or maybe they are captive advisors working for companies that offer a certain limited number of choices. In the end, Julie and Craig found the peace of mind they were seeking by securing their future.

If you’d like more information about how these contracts work in general, as well as some important caveats, please call 877.656.9111 or visit LaserFG.com to schedule a complimentary, no-strings-attached consultation with one of our experienced professionals. You may also download a complimentary copy of our special report at SetForLifeReport.com.

_______________________

Samuel N. Asare, MBA, CRPC, CMFC, CLU, CTP, CBM, is a noted retirement planner, principal and senior strategist at Laser Financial Group. His firm trains financial professionals on a variety of retirement-related subjects. Samuel has authored several personal finance publications, designed instructional videos, training workshops, and is featured regularly in various media outlets. You can read his acclaimed blog at LaserFG.blogspot.com, follow him on twitter@LaserFG, get practical retirement insights at LaserFG.com, or call 877.656.9111 to schedule a complimentary, no-obligation consultation.

Spring is a frustration!  This season is about budding, flowers-to-be, getting garden beds ready and planted, cleaning-up the Winter’s messes, and it seems to make us wake-up and get moving quicker because, well, Spring is coming and we had better get ready!  To emphasize the urgency, we lost an hour of sleep!  So perhaps a poached Quail appetizer (birds) followed by a light, herbed seafood broth (brooks?), then something stormy…flambé of…Mad Cow, ending with a (bird)…Partridge sorbet?  No!  Nothing works for Spring!

Spring is, to me, the most feminine of seasons—if that is possible, Mother Nature, and all.  Maybe that’s why my masculine self struggles so!  Spring is unpredictable, gives forth its blossoms in its own time, is filled with mystery and excitement, very moody, cold, then warm, and then maybe a late snow to ruin it all, and fragile and, of course, wonderful.  Spring, it seems, commands:  she causes me to stop and notice the miniature, the nearly naked details of the landscape and the delicacy of young buds.  So my cuisine must attempt to honor, to obey, to hold…this idea.  I’ll have a Pasta Primavera (Spring) of course, but it will change as the young herbs, blossoms and baby vegetables appear:  I will be the servant of her timing.

We make our hand-made raviolis weekly, but I’ll let the unfolding of Spring dictate the sauces and fillings.  I’ll keep my hand-cut dry aged meats, but the garnish will change with the excitement of new offerings.  Mother’s Day will be an entire week of the special parade of Spring’s femininity when motherhood is honored.  And so, though Vivaldi does not help much, I’ll hope that my cuisine will be as a crown for this celebration and maybe play Vivaldi in the restaurant!

What is the Cellar Club?  

The Cellar Club is a monthly dinner where members bring two bottles of the same wine per couple from their Cellar to share with other guests, while enjoying a multi-course dinner, prepared by Chef Marc and tailored to the wine selections.

What is the Wine Criteria?

Typically members share red wines that are at least ten years of age, white wines that are at least five years of age, or something they believe to be rare or exciting and worth sharing with their fellow guests. 

How do I join the Club? 

Very easy! Just call to reserve a spot and share your wine picks for that evening.

Costs (no corkage fees)

$75 per person (tax and gratuity not included)

Why wait for the weekend…

Tuesday: ½ price bottles of wine (dine in only)

Wednesday:   ½ price Burgers & Beer (dine in only)

Thursday:  Ladies Night, complimentary Bistro cocktail with dinner

                  Live Music every Thursday featuring Damon Foreman

   Now, as a professional permanent makeup artist I help women with a variety of  health issues, including cancer, arthritis, alopecia (lack of hair growth), muscular dystrophy, multiple sclerosis, Parkinson’s Disease, scleroderma (an autoimmune disease that can be extremely painful), stroke, and vision impairment/blindness.

  The procedures I offer, which also include lip color and eye liner, help on both a practical and emotional level. Permanent makeup is ideal for anyone who just wants more time in their lives – spending less time in front of the mirror can mean more time with your family, doing the things you enjoy most in life – but for those who are also facing medical challenges it is literally about putting your best face forward.

   “Brows Before Chemo” is a perfect example of this, and an especially important service I offer women preparing to undergo chemotherapy. By applying permanent makeup to existing browlines prior to treatment and hair loss, I can create a natural appearance that can be seen and felt both physically and emotionally. I truly believe that when women feel good about how they look on the outside, it builds their confidence on the inside.

   Permanent makeup is cosmetic tattooing – a technique that implants a pigment into the dermis layer of the skin. I use a device called the Nouveau Contour Intelligent Machine – a fully computerized, digital machine that provides excellent results with little trauma to the skin. Safety and cleanliness are my top priorities. Everything I use is “one time” use, which means I only use it once and then it is safely disposed of. All of my needles are individually packaged to ensure the highest standard of safety. I follow the highest industry standards and practices.

   The length of time the permanent makeup will last varies. Usually it will last from three to five years before a touchup is needed, whereas some people will require a touchup every year or two, depending upon their amount of collagen, unprotected sun exposure, or if the permanent makeup is exposed to microderm abrasion/chemical peels.

   I am conveniently located in the historic downtown district of Mount Airy. I offer free consultations in private surroundings, I invite you to call me today at (301) 829-3223 to schedule your appointment.

After my third aria, something from Tosca, the Artistic and General Managers thanked me and invited me to return when my technique was more secure. They were right, of course, but I had been given moments to dream of success in a very narrow and competitive career of talented performers. So close! At least I now had a really nice suit!

A few years later I was singing the same aria from Tosca for a Broadway show called Master Class and my agent told me I was second in consideration for the show. So close!  Maybe I should have sung a different aria?  Well, for this singing Chef, Valentine’s Day is forever associated for me with that one door of opportunity that did not open, so now this cooking Valentino’s “dream” is to open our doors to songs of love and passionate cuisine for Valentine’s Day week!

I’m a big theme-type of dreamer, so this upcoming Valentine’s week, February 14 through February 17, I am inviting former artistic colleagues to come to Drovers Grill and Wine, Co., to sing with me Songs of Love every night. These are world class talent and one only experiences such beautiful singing at concerts and opera halls, but my little Hall of Passionate Cuisine will host these four days with fixed price menus and inspired dishes.

Diners will have to forgive if menu items are inspired and titled by love themes and feature Hearts of Palm, Romaine, etc. Music and cuisine will unite in some romantic inspirations. Here’s one pairing I’m sure to offer:  I’ll sing the theme from The Godfather and a make a dish inspired by the movie, and I promise it won’t be horse!

The senate did pass some provisions that were important to homebuyers, sellers, builders and real estate professional like myself. For the distressed homeowner in circumstances such as foreclosure, deed in lieu, and short sales, the Mortgage Forgiveness Debt Relief has been extended through 2013.  If this didn’t occur, homeowners would have been responsible for paying the taxes on the principal deduction forgiven by banks as income, which likely could have caused the foreclosure rate to increase and the bankruptcy rate to increase.

Also deductions for mortgage insurance premiums were retroactivated, which extended benefits to qualified candidates (borrowers adjusted gross income below $110,000). Borrowers who pay private mortgage insurance premiums or guarantee fees on conventional,  low-down-payment home loans, FHA, VA, and Rural Housing mortgages will be able to write off those premiums along with their mortgage interest on federal tax returns to cover all of 2012 and 2013.

The energy efficiency tax credit of 10 percent but not to exceed $500  was extended through 2013 on improvements to existing homes.

Tax credits for new energy-efficient new houses allow builders and contractors to claim a $2,000 tax credit on new homes constructed in 2012 and 2013 that meet federally specified energy-conservation standards. The bill also extends credits for U.S.-based manufacturers of energy-efficient refrigerators, washing machines, and dishwashers. As with other energy-related tax provisions, this had expired last year but will now be continued through 2013.

 Capital gains tax stays at 15 percent for those making under $400,000 single and $450,000 joint income.

 For individuals, the first $5 million on their estates and $10 million for family estates are now exempt from estate taxes. After that the rate is 40  percent.

So who is affected? Income-producing individuals making $400,000 or $450,000 for joint income producers  will have a new federal tax rate of 39.6 percent.

On top of that, 20 percent is added on long-term capital gains, such as those from investment real estate and home sales that rack up gains beyond the$250,00 single and $500,000 joint thresholds.

Also, because of Obamacare, a 3.8 percent surcharge on certain investment income, currently in effect, could possibly raise rates on capital gains for upper income bracket  households to 23.8 percent. As a result, some investors in rental property and commercial real estate may begin looking again to Section 1031 tax-deferred exchanges to hang onto their profits.

If you have any more questions about how you are affected by this year’s tax provisions or want guidance in the matter, please feel free to contact me at 301.332.5659.

According to the American Cancer Society, in 2012 about 22,000 women were diagnosed with ovarian cancer. Unfortunately, about 15,000 women died of this cancer. This statistic makes ovarian cancer the ninth most common cause of cancer among women and is the fifth most common cause of cancer death in women. An average woman’s risk of getting ovarian cancer is 1 in 71 and the risk of dying from ovarian cancer is 1 in 95. Although the risk of getting this cancer is much lower than breast cancer (which carries a lifetime risk of 1 in 8 in women), ovarian cancer can frequently be connected genetically to breast cancer in women carrying a mutation called the BRCA mutation.

Ovarian cancer generally occurs in women over the age of 60 and is more common in Caucasians than in African Americans. Fortunately, the incidence of ovarian cancer has been decreasing over the past 20 years.

Ovarian cancer develops in any one of the two ovaries, which are glands in women with the function of producing hormones and eggs for reproduction. Three different types of cells make up the ovaries: epithelial cells, germ cells, and stromal cells. Each of these types of cells has the ability to develop into cancers. The treatment may vary based on what type of cell is involved. 

Ovarian tumors can either be benign or cancerous. If benign, a simple removal of the tumor is sufficient. If cancerous, they have the ability to spread and additional treatment by your oncologist will be needed after removal of the tumor. Often, ovarian cancer can be undetectable until it has already spread.

Women at risk for breast cancer include those who have:

-  family members with ovarian cancer

-  a genetic mutation that runs in the patient or family called BRCA1 or BRCA2.

-  had breast, uterine, or colon cancer.

-  an Ashkenazi Jewish background

-  never given birth or have had trouble getting pregnant

-  had endometriosis (when cells from the lining of the uterus grow in other areas of the body)

According to the Mayo Clinic, ovarian cancer should be suspected in women with:

- abdominal pressure, fullness, swelling or bloating

- pelvic discomfort or pain

- persistent indigestion, gas or nausea

- changes in bowel habits, such as constipation

- changes in bladder habits, including a frequent need to urinate

- loss of appetite or quickly feeling full

- increased abdominal girth or clothes fitting tighter around your waist

- a persistent lack of energy

- low back pain

Unfortunately, a Pap smear done by a gynecologist does not detect ovarian cancer. The important thing is to pay attention to any of the above mentioned symptoms and then speak with your doctor. If ovarian cancer is suspected by your doctor, he or she will then perform a pelvic exam, transvaginal ultrasound, and/or a CA-125 blood test to detect ovarian cancer.

In the event that ovarian cancer is suspected, a surgery will need to be done by a gynecologic oncologist who will remove the tumors. This surgery not only confirms the type of ovarian tumor, whether malignant or benign, but also determines the stage of the cancer. The stage of the cancer then helps guide further therapy that your medical oncologist will deliver and also gives information on the expected survival.

The stages of ovarian cancer are as follows:

Stage I.   Cancer is within one or both ovaries.

Stage II. Cancer has spread to other nearby areas such as the uterus or fallopian tubes.

Stage III. Cancer has spread outside of the pelvis to lymph nodes or other areas in the abdomen.

Stage IV. Cancer has spread elsewhere and to other organs.

Once surgery has been completed, most patients with ovarian cancer will require some form of chemotherapy. Depending on the findings during surgery and the stage of the cancer, chemotherapy will be given in the veins and may also need to be injected directly into the abdomen through a catheter. The purpose of chemotherapy is to get rid of any remaining cancer cells after the surgery and to reduce the chance of the cancer from returning. Once a women has been treated successfully for her ovarian cancer, she will need regular follow-up visits and physical examinations with her doctor for life and will have her CA-125 blood test monitored on a scheduled basis.

 The tax we pay is based on our taxable income, not total income—something that many retirees discover the hard way. Also, these advisors are completely ignoring the fact that your future taxes will be based on future rates, vis-à-vis exemptions and deductions—all of which are totally up to Congress’ discretion. Obviously, your taxes could be lower. But you do realize how unlikely that is, right?

  In fact, most experts believe that it would be naïve to expect Washington, D.C. to do anything different from what they’ve always done—seek more revenue, also known as raising taxes. The fact that no agreement was reached during the recent fiscal cliff negotiations until “spending cuts” were dropped entirely should highlight the attractiveness (and ease) of tax hikes as a congressional solution. Those of us who don’t consider ourselves to be “rich” must not accept promises to keep our taxes low just because in the days preceding the Fiscal Cliff deal, President Obama and politicians from both parties promised exactly that. On the contrary, that is now just another broken promise.

 So, if you have a yet-to-be-taxed 401(k) or IRA, would a tax hike ruin your retirement? Are you aware that every single dollar from your 401(k)/IRA will count toward your “provisional income” and may, in turn, cause you to pay additional taxes on up to 85 percent of your Social Security retirement checks? Does your advisor really understand the ramifications of what they are suggesting you do?

 You’d be thrilled to know that IRS rules provide some simple alternatives that would permit you to save  basically “unlimited” sums of money that you can access later (including all of your gains) or leave to your heirs, completely income-tax free!

 Irrespective of where you are in your planning process—even if you’re already retired—call 877.656.9111 or visit LaserFG.com today to schedule a complementary, totally no-obligation consultation to speak with experienced professionals who can help you to structure your retirement assets so that you can KEEP your hard-earned money.