Healthcare

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How Good is Your Hospital – Finally a National Ratings System

We are all consumers and before I purchase anything of significance I look up reviews on line to make sure I’m getting the right product. One area of frustration has always been the healthcare industry, specifically hospitals. The assumption is that most insurance plans will cover, most if not all, of the hospitals in your area. Therefore we aren’t really shopping for price as much as quality of care.

This last week Medicare, by far the largest medical insurance payee, released its first ratings of more than 3,500 hospitals across the country. The ratings, based on patient reviews range from 0 – 5 stars. Medicare notes that “As for the stars themselves, a one-star rating doesn’t mean that you will receive poor care from a hospital It means that hospitals that received two or more stars performed better on this particular measure of patient experience of care.” This site no only rates hospitals in various categories but allows you to compare hospitals in a specified area.

While on the Medicare site you’ll also see:

  • Nursing Home Compare
  • Home Health Compare
  • Dialysis Facility Compare
  • Medicare Plan Finder
  • Supplier Directory

Here is the Medicare Ratings Site.

Here is a sample of hospitals in my area:

Hospitals

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6 – New Years Retirement Planning Resolutions for 2015

Summary

New Years is always a great time to prioritize the things that are most important in our lives, not just the “urgent” things that will always distract us. As Stephen Covey says, “Most of us spend too much time on what is urgent and not enough time on what is important.” As you age, and either contemplate retirement or are actually retired, financial planning is one of the important tasks you need to continually address.

Here are 6 “important” steps to get your retirement investments and plans in order for 2015:

  1. Take responsibility, become active, plan and manage your investments.
  2. Develop or update a written financial plan.
  3. Learn how to choose and analyze investments like a professional.
  4. Take action with your investments, set up rules for adding and eliminating.
  5. Set-up or revise your “In Case of Emergency” document.
  6. Determine if you need a Revocable Living Trust.

Take Responsibility.

The finances that you and your family will live on once you leave the workforce won’t just automatically fall into place; you need to make it happen. Your retirement is your responsibility, you need to take charge. You need to become a “Vice President of Financial Responsibility”. Many older workers just don’t feel comfortable or may not have the skills to plan and manage their retirement. This however is their responsibility and they either need to develop the skills or get someone they implicitly trust to help them. The internet, including most brokerage sites like Fidelity, have tools and educational materials to also provide help.

Written Plan.

Almost everyone I speak to about retirement planning and investing claim they have a “plan”, very few can honestly say they have a written plan. A written plan can help take you from concepts to an actual roadmap. The plan should include a written description of your current situation, your short and longer term plans, tax planning strategies and investment goals. In addition to the written descriptions it should also include annual goals for income to be generated, living costs, emergency funds and yearend portfolio values. If you just have a spreadsheet and no written document, you don’t have a plan.

Analyze Like a Professional.

You don’t need to be a day-trader or professional advisor to use the basic analytical tools to help choose and manage your investments. When I trade in my professional account I might look at a 60 and 5 minute stock chart, RSI and MACD indicators and “futures” charts. However when I review my retirement investments I’m looking at completely different set of metric’s. Why? Because my goals and time horizons are different. In a future blog posting I’ll give you the tools I use for managing the stocks and bonds in my retirement accounts.

Take Action.

One of the biggest mistakes people make in their investments is to “Buy and Forget”, see my story on this here. Most people know how to buy but don’t know how or when to sell or rebalance. You need to set up rules that will help you decide how to manage your investments. The poor people that couldn’t endure the pain anymore and decided to sell their key holdings in March 2009, and then sat in cash for the next few years as the market completely rebounded.  Those that stayed with blue-chips did well, those in cash will never again recover their losses.

“In Case of Emergency” Document

Everyone who is married or has any assets whatsoever needs to have a “In Case of Emergency” document.  Check here for a detailed list of what should be in your document and how to manage it.

Revocable Living Trust

Why would you need a Trust, the new federal estate tax exclusion has been raised to $5,340,000 per person and twice that much for a married couple. Most people don’t have assets that exceed these amounts. Maybe you should just have a simple will. The issue isn’t about federal estate taxes, it about the other benefits of a trust. Here are some reasons to consider a Revocable Living Trust:

  1. Protection for or from your beneficiaries and their creditors. Do you have a 20-30 year old “child”, should they just be given the money outright, might hey spend it foolishly?
  2. Control of your wealth beyond just a will. How should the money be distributed and when. What can it be used for?
  3. Keep your privacy and money out of state probate court and avoid the high cost of probate. In general most states require a will to be implemented through the probate process and can include some substantial fees, along with being public. A Revocable Living Trust does not need to go through the probate process.
  4. Manage or avoid state estate taxes. 20 states currently have various forms of estate taxes and a Revocable Living Trust may help you batter manage or even avoid these extra costs.
  5. Always seek the help of a qualified attorney who specializes in Estate Planning and Tax law to help you determine if a trust is right for you.
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1st Thing to do in 2015 – Develop an “In Case of Emergency” Document

2014 was a big year for me personally. It was my first full year in retirement, we moved from Pennsylvania to Florida and I focused a great deal of time fine-tuning my retirement plans. This included an updated Revocable Living Trust, and a written 5 year financial, income, tax and expenses plan. One of the most important tasks was to create an “In Case of Emergency” document.

EmergencyThe “In Case of Emergency” document is a complete explanation of everything someone (like my wife, family or executor of my estate) would ever need to know about everything in my/our lives. It also includes immediate specific steps to take in case something happens to me or “us”. Keep in mind that the emergency may not be your death, but may be you becoming incapacitated, there is a difference.

It is an on-going document that is constantly being updated and enhanced. This document is stored on my computer, on a secure web site and in our safe deposit box. Every family member knows about it and understands what it is.

An “In Case of Emergency” document should include:

  • The location and attorney involved with the creation of our Revocable Living Trust, individual Wills, Durable Powers of Attorney, Healthcare Surrogate and other legal documents.
  • The names, account numbers, and contacts information for all bank accounts, investment accounts, pensions, and past/current employers. Also confirm the structure of each asset and in the case of IRA’s the beneficiary since these may fall outside of your Revocable Living Trust.
  • How income is generated, what steps are necessary to keep income coming in. Budget for living income and expenses. If you are still working, who at work to contact and what benefits might a spouse of a deceased worker get, like unused vacation pay, life insurance etc.
  • Location of safe deposit box and the location of the keys. It might be best to give multiple family members access to the box.
  • Business owned (if applicable) with complete details on tax and ownership structure, location of stock certificates and other important documents.
  • Birthdates, social security numbers and contact information for all family members.
  • The location of Tax records, past returns and contact information of tax preparer.
  • Social Security information. Explain if any benefits are currently being provided and the strategy for future benefits including how to file for Survivor benefits.
  • Your digital information including all login and passwords information, it’s best to have a software program or web site where these are stored and protected. All family members email accounts, your digital photographs, music, key documents on your computer and location of all back-ups.
  • Your home information, mortgage holder (if applicable), how payments get made, contact and account information for utilities, trash collectors, newspapers, landscaping and other service providers. How are property, school and other taxes paid?
  • Insurance information, including location of policies, account numbers, contacts, etc. Be sure to include homeowners, car, healthcare and life insurance
  • Automobile information, including loans (if applicable), location of title, registration #’s, license plate #’s etc.
  • List all healthcare providers like family doctors, insurance policy renewal information and an updated history of healthcare issues. Reference any Durable Powers of Attorney, Healthcare Surrogates and other healthcare information.
  • Credit Cards, loans and other obligations. List all account numbers, and toll free numbers to call to cancel cards or pay off balances.
  • Family cell phone accounts and structure of plans.
  • Churches, Clubs and organizations along with contact information
  • Neighbors and friends that should be notified with full contact information.

Finally, include a list of specific steps to immediately take in the days after an emergency.

 

 

 

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Hate a Colonoscopy – Fine, Buy This Stock and Get This New Test

Colonoscopy

I don’t know anyone who claims to enjoy a Colonoscopy, the preparation and the procedure are not things that are my fun list. There is no doubt that a Colonoscopy can help detect colorectal cancer. Starting at 50, the American Cancer Society recommends you begin regular colorectal cancer screening. More than 9 out of 10 diagnoses of colorectal cancer occur in patients at least 50 years old.

Due to new technology, we now have another option to detect colorectal cancer. Exact Sciences Corporation (EXAS) released their Cologuard DNA test kit this year. Cologuard is an easy to use, noninvasive colon cancer screening test based on the latest advances in DNA science. Cologuard finds both cancer and precancer situations. You can perform this test from their kit in the privacy of your own house and send the results to their lab for evaluation. Cologuard requires a doctor’s prescription and most doctors are just now coming up to speed on the benefits of this test. Centers for Medicare and Medicaid Services (CMS) have approved payment for this test in 2015, other insurance carriers should be jumping on this bandwagon. Traditional Medicare (Part B) patients should not have any co-pays, deductible amounts, or co-insurance for Cologuard. Medicare Advantage patients might be subject to laboratory co-pays or co-insurance as determined by their plan.

Now for the stock. Exact Sciences Corporation (EXAS) has already been up over 130% this year as compared to 18% for the S&P500. I started buying this stock in early summer in the $12-$15 range, it closed Friday at $28.52. Of 14 analysts who follow the stock, 4 rate it a Strong Buy, 6 a Buy, 3 a Hold and 1 an Underperform. EXAC is a somewhat volatile stock with a 1.48 beta.

EXAC

I like buying stocks with a real life benefit and a great revenue growth story. This could easily double again in 2015 as the new Cologuard test kits get used by millions of people and the company starts to expand internationally.