There goes the family doctor!

In researching healthcare for retirement, I have heard over and over from neighbors that their physician is retiring or their doctor's practice was bought out by the local healthcare conglomerate.
My own family physician is my age and is also considering retirement.  His practice was bought out two years ago by the local hospital corporation.  We no longer are visited in an inpatient hospital situation by our family doctor after being processed by admissions.  We are treated by a "hospitalist".  This is a physician employed by the healthcare institution.  They work shifts just like the nurses and in some instances will cover the entire institution in off hours.  I do miss the warm smile of the physician I have know since I was thirty-five.  What has changed this climate?  Most of it comes to regulations and finances resulting from the regulations.  I began to search the media for information on this trend.

I found that the implementation of the electronic medical record, extra personnel to service the claims for payment, and slow payment from government healthcare such as Medicare facilitate a  few of the changes in this landscape.  Practices that do not switch to the new electronic medical records required by the government are docked 2% in payments.  "The cost for purchasing, implementing, and training staff for the new federal software can run $40,000 with additional yearly maintenance costs thereafter. The new software is not designed to integrate with other systems used by medical practices.(Breitbart-California, 2014)."  "Doctors report that electronic systems have cut productivity by about 25 percent. (McSwain, 2014)."  Many of my friends report their physicians now spend as much time in front of the screen as focused on them.  There is still ICD-10 to implement.  It is a coding system required for payment.  It is to  be implemented late this year.  That will require more training and personnel.  Many physicians are hiring "scribes".  That is a person that follows them around with the laptop to facilitate much of this information into the system. That is  another person that must be added to the payroll.  More details are available on the links below.

What I did decided is that physicians financially have little choice but join large practices or be bought by conglomerates to spread the costs around for the implementation of our cumbersome regulations.

There is a trend for concierge services.  That is where one pays upfront and does not file on insurance or medicare.  The costs are often posted in the waiting room and are considerably less than filing insurance.  I recently was in Florida and experienced some irritation in my eye.  I stopped by a concierge practice.  It was a walk-in situation with the costs for all procedures posted in the lobby.  My care was good.  It was quick.  The physician made eye  contact with me.  I even received a follow-up call the next day to check on my progress.  It seems that was what it was like in the 1950's when my mother would take me to the doctor.  No one had insurance other than for hospital stays.

The doctor's office was a one-stop shop.  He even dispensed the medications under most instances.  You did have to have the money to pay. 

Obamacare Killing Off Small Doctor Practices.  (2014) retrieved from

http://www.breitbart.com/Breitbart-California/2014/05/02/Obamacare-Killing-Off-Small-Practice-Docs

Swain, D. (2014).  Obamacare Deals Blow to One Doctor Medicine.  retrieved from

http://www.utsandiego.com/news/2014/Apr/26/obamacare-deals-blow-to-one-doctor-medicine/3/?#article-copy

 

Is it Alaska, Florida or somewhere in between?

I have been thinking about taxes in retirement recently.  I even had a conversation with a friend that is also exploring retirement.  I had even explored my own state of Virginia which offers seniors no tax on the social security benefits and $12.000 cap on benefits beyond the social security before state tax is imposed.  My friend had reported to me that the state she and her husband plan to retire to offers a $41000 cap on social security income, IRA’s and pensions per person.  We had both always felt our only break for state taxes would be to maintain a residence in Florida.  I was somewhat relieved to know that I could maintain my home in Virginia with a somewhat lowered tax rate.  I put this on the table for another day’s exploration.    An article in USA TODAY mobile app caught my eye yesterday, “10 worst states for retirement” (Brody, 2014).  The link is at the bottom of the page if you want to explore this list.  Much has to do with high estate taxes but there are other issues as well. Most appear to be taxes or financial issues.  I thought I might as well explore what is the best state from a tax or financial standpoint to consider for retirement.  I found the list!  In  Kiplinger online,  there is a list published in August, 2013 (“10 Most Tax Friendly States”, 2013.) This link too is available at the end of this blog article.  It does appear from a tax standpoint that Alaska has no state income tax, no sales tax, or no estate tax.  I figured I must check for Florida on the list.  It does have a sales tax but no income or estate tax.  The others listed have many of the mentioned taxes but at a lower rate than others.  I suppose it is not all about the tax but it can  enhance one’s lifestyle with a little more funding available.  Family presence and especially locality of one’s children and grandchildren is important in the consideration of where to settle.  If one is going to be a part- time resident in a particular state to maintain lower tax rates, it would nice if that state had things to offer that were appealing to a preferred lifestyle.  For some that might be weather and for others it might be friends or family.  I hope you explore the links below.  There is some interesting information about the 10 on each list.  Comments are welcome.  I love to know what readers are thinking and considering especially if you follow the links.

“10 Most Tax Friendly States”.( 2013).  Retrieved from http://www.kiplinger.com/slideshow/retirement/T006-S001-10-most-tax-friendly-states-for-retirees/

Brody, J. (2014).  “10  Worst States for Retirement”.  Retrieved from  http://www.usatoday.com/story/money/personalfinance/2014/04/19/retirement-states-taxes/7788891/

Long Term Care (LTC) -Hope you have it.

Long Term Care Policies have been around awhile.  Many of you bought them when the payout did not have a cap on the number of years.  I purchased mine about 7 years ago through a large insurance company and was told that the cap of payment was five years.  I was informed that most people that need long term care, whether in the home or in a facility averaged about 5 years before the person expired.
I just read a study that the current average life span once LTC use begins is 3 years!  What is happening?  I did began to get curious as to what care in different facilities cost both nationwide and locally in central Virginia.  What I did find  is that the cost of  using this care in your home is growing at a much slower rate  versus a long term care facility (Blackwell, 2014).
Would not most of us prefer to be in our own home.  My insurance carrier explained to me that if I received this care in my home from an agency and/or used an elderly day care that I could stretch the monies alloted in these policies to almost double time.  For me that would be 10 years!
If I were paying out of pocket and did not have a policy, what might this service cost in my home?
As recently reported by a Genworth Financial study, "Nationally, the 2014 median hourly cost for the services of a homemaker or home health aide hired from a home care agency is $19 and $19.75, respectively. In Virginia, the median hourly cost of homemaker services is $18 and the median hourly cost of home health aide services is $19. " (Blackwell, 2014).  I am glad I purchased a policy when I did.  I would be without funds quite quickly trying to pay these rates.  I realize the agency gets a percentage of this payment but the hourly rate is about the same as a beginning Registered Nurse!
I am sure those of you that have arranged care for elderly parents are aware of these costs.  Placement in an assisted living facility or a nursing home would be close to double this assessment. The question I am left with is --why is the average life span once one begins long term care declining?  I will have to research this trend.  There will be more to come. Hope you have explored a Long Term Care Policy!

Blackwell, J. (2014).  Genworth Studies Costs of Elder Care.  Retrieved from http://www.newsadvance.com/work_it_lynchburg/news/genworth-studies-costs-of-elder-care/article_fefc9946-c47f-11e3-aea2-001a4bcf6878.html