March 2019

(Part 2 reviewed the concierge practice statistics and models commonly used)

Innovation Model:

Without a doubt, beginning your new medical practice using a concierge model avoids having to accumulate a large herd of patients and then converting them to a "direct primary care practice" later on. The big disadvantage is that the startup of a medical practice requires money, usually a fairly good bundle. Just picture the lender's face when you explain to him that you have no job and that you have a left-over debt of $ 150,000 from your education — and are asking for another $ 50,000 to get started on top of the other debt. Thank God you have a rich uncle to help you financially.

Of course, you'll have that same problem with the bank no matter how you begin your practice. You could join an HMO, gather the money up, then start your private practice. Maybe there's a group practice you can join already already employing a "retainer-based" method of practice, and go from there.

Transformational Model:

So, you've been in practice 15 years already. It must be disturbing for you to see the decrease in income earned by doctors (8% decrease average over the past 10 years according to the AMA studies, among others). Then you wise-up and ask yourself if you know for sure whatever your practice is growing …….. you know, the number of patients joining minus the number leaving monthly. Or, have not you done that? Or ……. maybe start now?

Most doctors see what's happening now in the world of medical practice-and it is not good. Choices for medical practice practitioners have not changed, really. But, the consequences of those choices now are very different, and are important to know about for medical practice business reasons.

Transforming you practice is not easy. Some follow the hybrid model to transition and some flat set a date to stop your regular practice and begin their concuracy practice. We'll talk about the issues related to that
move in another article.

Private Practice Group Model:

Luckily, there are a good number of medical group practices who have come together in a concern practice in this country, which you may choose to join. In addition, with the gradual dissatisfaction with the health care system and the gradual increase in numbers of patients looking for alternatives, the concurrency practitioners, already solo or in a group, will be looking for doctors of a like mind to join them. Practice overhead will be reduced proportionally by adding a new doctor to the staff. Retiring doctors leave openings for new doctors.

Solo primary practice physicians in private practice, especially in rural areas, are disappearing. But if they join together in group practice, this attrition would be far less common.

Commercial Model:

Concierge Choice Physicians (CCP), a medical practice consulting company, is one of the few groups who offer a turnkey solution to doctors who sign up for their assistance and joint venture. This company splits the annual patient concierge subscription fee with the doctor and also provides all the marketing services paid for by the subscription fee arrangement. CCP has special interest in working with the Hybrid Model.

Other doctors have created joint ventures with large businesses which refer large numbers of their employee patients to the concierge physician practice in return for providing office space, equipment, supplies, and other necessities. The employees pay the annual subscription fee to the doctor and the company has saved thousands of dollars spent on large health insurance plans which are much more costly and administratively complex.

Be creative and create your own special joint ventures. I know! I'm getting to that next.

The where and how elements of concierge medical practice:

The most common reason that a practice practice fails is lack of income. The lack of income to sustain the practice comes when a practice practice is not able to recruit enough patients. Success requires about 300 patients, per physician, enrolled, at least. As with any regular medical practice, you do not make money or earn an income without patients. But, you already know this.

The topic brings us back to what is critically important and what most physicians neglect before starting a medical practice-Demographics.

Considerations to face head-on if you want a successful concierge practice:

• Big enough population to attract enough patients: I have not seen any studies concerning this issue, but, my belief is that you should have no serious problem launching a practice in any urban area of ​​one million population-where you will be the only concurse physician for that population. This criteria has to be modified by the affluence of the area, local industries and businesses, availability of educational and recreational facilities, and the average income of the population, among others.

Because of the scarcity in the present day (2010) of numbers of concierge physicians, the competition for patients should not be an issue in this population for the next decade.

• Professional Competition: Contacting various resources available on the Internet which provide such information is easy to find. For example, in February 2010 an informal one-year summary of findings related to the concierge medicine marketplace was released.

Over Over 66% of current US concierge physicians in practice are internal

medicine specialists.

Second Second in rank are family physicians.

Sin Since early 2009, there has been a steep rise in numbers of concierge dental and pediatric

practices-understandable, because they are primarily office based practices with large volumes

of patients.

One should not leave out the increasing numbers of plastic surgeons using this same game plan. As the antagonism between doctors and government interference in health care increases, the high probability of physicians opting out of commercial health insurance programs and government Medicare and Medicaid will happen. It's reported now that 30% of doctors have already stopped seeing Medicare / Medicaid patients. Does that send you a message?

Keywords = concierge medical practice, retainer based practice, concierge group practice, concise physician practice, medical practice business, direct primary care practice, medical practice practitioners

Source by Curtis G. Graham

The current most popular candle being sold today is the Glade Scented Candles. Some think this is simply because it is also the most widely advertised candle on the market. I, for one, do not make this assumption.

Glade produces a variety of candle types with an excellent selection of scents. They are available at most local stores that sell candles. When you combine a high quality product with a reasonable price and local availability you find that you have a winner.

Glade flameless candles are a wonderful item to use if you have pets or small children in your home, because they use battery power to operate. They are designed to flicker like a real candle as they freshen the air. This safety feature is very popular for people that want the look and scent without the hazard of a real flame. Glade flameless spotted candle unit and two refills can be had for only $ 8.95, a very attractive price, especially if you can also buy more refills and keep using the base unit. The flameless feature also allows people to have the Glade spotted candle to use at work without having to worry about setting off the smoke or fire alarm.

Glade spotted candle will liquefy and burn very efficiently because of its unique cotton and metal wick and a warming plate. The scent last longer than most other decorated candles of a similar type. This is something consumers quickly notice and appreciate. They show their appreciation with repeat purchases.

Glade spotted candle with a holly evergreen fragrance is almost a collector's item. It is no longer made and since consumers really like it they are more than willing to acquire it for more than the retail price ($ 9.95 for the holder and 2 refills) even if there is only one refill available. There is some speculation that special scents that are only produced for short times in seasonal scents and then discontinued may actually develop into a collectors line of candles from Glade.

The simple fact is that if you like decorated candles you would do well to check out the Glade Scented Candles. For style, value, and a long lasting scent you will be very pleased. Just go to your local store, select the scent that you like best and bring the candle or candles home.

Glade-Scented-Candles-Are-a-Hit&id=1536105″>Source by Simon Harris

Hemorrhoids can be a painful story that hinders many activities and pleasures of life. When the condition is medically advanced, it may require the intervention of a professional. But the good news is that the solution does not always have to be surgery. There are non-surgical hemorrhoids treatment processes to treat the pain and ease the patient from the grip of this ailment too.

Injecting the Vein

This is a simple procedure of injecting the swollen vein. The blood flow is curved, usually using rubber bands and this will cause the collected blood and mucus to be safely released, most probably using the process of suction. The procedure does not cause much pain and is usually used to treat grade 2 and grade 3 hemorrhoids.

Infrared Photocoagulation

The main principle remains the same as that of the previous procedure. A laser beam or an infrared photocoagulation is used to stop the blood flow to a particular area. Thus, the hemorrhoid dies without blood flow and is safely taken out. The disadvantage with this process is that in case of multiple hemorrhoids, only one can be treated at once. It takes a gap of around a fortnight for it to heal and become safe for the next one to be treated or removed. One disadvantage of this treatment is that the laser may cause damage to the cells that are around the targeted area though it is said to be effective than the previous one.

These are currently the main procedures that treat this condition without requiring a surgery. They are usually less painful than the surgical procedure and quite effective too. To choose between the two one must research well, talk to medical professionals and, if possible, people who have undergone the treatment. This will help in creating clear ideas using facts so that the best option can be chosen.

What to Look For When Going for Non-Surgical Hemorrhoids Treatment

• Not all doctors know exactly what and how to go about with these treatments as they are relatively new. It is essential to choose a professional who is well trained in these, and preferably experienced as well.

• Consider choosing a good reputed hospital as well. The area where the treatment will be performed is a sensitive one and choosing a place without enough medical facilities may end up in unnecessary complications.

• Usually, most people experience a mild case of hemorrhoids that goes away with proper care and a few home remedies. Only after consultation with a doctor should one opt for the treatments.

• After the treatment is over, follow up should be religiously done and the advice given by the doctor must be strictly followed. The wound will be healing, and this stage requires high levels of care.

For some, surgery may really be the better option. Whatever it is, a medical expert can always make well informed decisions on what is right. It is recommended to take a second opinion when in doubt.

Source by Charles Cameron

The labeling of America's children with mental illness has facilitated an overall "system" that dictates a number of medical decisions that may devastate their lives in the future. This new "system" has occurring influence over the health decisions affecting America's children and this unpreceded increase in children being diagnosed with psychiatric conditions and the prescribing of psychotropic drugs can be traced to collaborative efforts of the drug industry, organized psychiatry, and government agencies. The use of psychotropic drugs in America's children is referred to as "off -labeling" because the drugs have not been approved by the FDA for use in children. This has become more and more controversial and with several pending lawssuits may become quite costly for the drug companies. For pill makers, the battle is worth fighting. In Meagan Barnett's article "The New Pill Pushers" (2004, April) an estimated 23 percent of prescriptions are written for off-label use. This is obviously the reason the big pharmaceutical companies think it is worth the fight and why they are willing to set aside the millions of dollars to settle these suits. According to Dr. Lawrence Diller MD., Pediatrician, in the article "Mental Health Screening: A PhrMA Friendly Remedy for Societal Problems" by Vera Sharav, (2005, December) "No other society prescribes psychotropic medications to children the way we do." The use of off-labeling or unlicensed psychotropic drugs in America's children is actually uncontrolled experimentation providing no factual information or understanding of the effects of these drugs. It is time to raise some very serious questions about this ever increasing practice in America.
The President's New Freedom Commission now recommends screening the entire population for mental illness. This means that 52 million school children will be tested using TeenScreen, which will create a tremendous increase in the number of children labeled with psychiatric illness; adding to the growing number of children taking these mind altering drugs. Eugenicists blamed genes or "bad blood" now psychiatry, induced by the creative marketing of a 10 billion dollar a year pharmaceutical industry, blames a "chemical imbalance" "Mental Health Screening: A PhRMA Friendly Remedy for Societal Problems" by Vera Sharav, ( 2005, December). Even after 30 years there is still no valid research and simply no scientific way to actually prove that a child's behavior problems are the result of a chemical imbalance. Brownlee, S (2006). Is not it time to begin to question the true basis for this practice of unproven biological-genetic theories of "bad behavior" being mental illness? Is the drug industry's marketing strategy about a "chemical imbalance" fact or fiction? The wonder of it all is how the media has been instrumental in promulgating the theory of this "chemical imbalance", when challenged by Jonathan Leo and Jeffrey R. Lacasse in their article, "The Media and the Chemical Imbalance Theory of Depression", the press either did not provide any citations or referred the authors to interesting articles on research. Not a single citation was provided that was direct proof of any chemical imbalance. The only real proof is that the theory of a "chemical imbalance" is just that, a theory, an unproven "idea" that allows the drug industry to promote their psychotropic remedies at a cost we may not know for years to come. "Who will bear the responsibility? … for the hormones likely to follow from mental health screening when children are wrongly labeled as having a mental illness? … for depriving children of a normal child? … for exposure 91%, that's 9 out of 10 children referred for mental health services to psychoactive drugs? … Who will restore children's damaged brains? Who will restore the wondrous magical world of childhood? " (Vera Sharav, President AHRP, 2005).

Adults have studies about the drugs, they know the potential side effects, and they have a voice in making the decision whether or not to take them and also to use them in conjunction with other methods of therapy that will help adjust the thinking process. Children, especially those who are under state care, often referred to as CINA (pronounced: china; child in need of assistance) have no voice. The state makes the decisions for them. Often even family are invented from being part of the solution. Of course if they are unfortunately placed in residential treatment facilities; additional support often comes in the form of restraints and sedation. Judges sitting on the bench of our family court systems are ordering that a child take a medication that has not even been approved by the FDA, schools and teachers are making the decision that unless a child is put on medication they will not be able to attend school. "Medicating Aliah" by Rob Waters provides us with a stark realization of just how powerful this "system" has become. Thirteen year old Aliah Gleason was a B and C student in seventh grade. She had some problems, mostly with her attitude. School officials determined that she had "oppositional disorder" but her parents disagreed, considering her simply a teen that would outgrow her attitude problems. After a mental health screening was conducted, Aliah's parents received a letter from the school. Initially it determined Aliah did not have any real problems but then the Gleasons received a phone call. They were told that Aliah had scored high on a rating rating and needed further evaluation; reluctantly the Gleasons agreed. Six weeks later a child protection worker went to Aliah's school, interviewed her and told Mr. Gleason to take Aliah to the Austin State Mental Hospital. He refused; Aliah was placed in emergency custody, driven by the police to the state mental hospital. She and her parents were separated for the next five months. Aliah ended up spending a total of nine months in state psychiatric hospitals and treatment facilities. While in state care she was in restraints more than 26 times and medicated-against her will and without her parent's consent-with at least 12 different psychiatric drugs, many of them at the same time – polypharmacy in action. The Texas Medication Algorithm Project is funded and in part developed by Jansen pharmaceutical company, the maker of Risperdal. Shon, Steven MD (2006, December). This is only one example of the uncontrolled experiment of America's children.

What role does the FDA play in determining the off-labeled use of psychotropic medicines in America's children; virtual none. The medical industry discusses how to use these powerful mind altering drugs on America's children. DosReis S. et al. (2006). The American Medical Association and the FDA are allowing the off-labeling use of these mind altering drugs in children as young as three years of age; the foster care system is rife with this type of treatment for mental illness, also referred to as SED (serious emotional disorder). Is it possible that the massive and powerful drug industry has paved a "myth" on America with this so called "chemical imbalance" creating a ten billion dollar a year industry? The tobacco industry did. Even more alarming is the practice of Polypharmacy; children being given multiple drugs in the same class of medication, which should be avoided according to Dr.Bellonci (2008, May). Dr. Bellonci offers a clear picture of what steps are necessary in beginning a transformation of the system, "A child taking more than three psychotropic medications should prompt an explanation from the prescribing clinician and may warrant a review by a consultant to the child welfare system. there is a recommendation that a child take more than one medication from the same class of medicines it should be supported by an explanation from the doctor and even a review by the child welfare system ". Dr. Bellonci, a consultant to the State of Tennessee's child welfare system was addressing the House Ways and Means Committee and discussing his concerns regarding policies and procedures relating to psychotropic medication and behavior management. We can not allow the FDA to relegate the decision of the use of off-labeling drugs to the prescribers; we must demand a much more serious look at the unpresented use of this type of drug and that demand is way over due, Caplan P, Cohen E. (2007).

The FDA must immediately put their focus on fact and not fiction. Bosley S. (2004). The idea of ​​a "chemical imbalance" must be validated with sufficient data to warrant this type of marketing and use of these psychotropic drugs in children. The transformation of the child welfare system must start with complete financial disclosure from any doctor prescribing this type of medication. This marketing is now being challenged in a lawsuit under the "False Claims Act" a little (Barnett, 2004) known and seldom used law that was established to protect the government from Medicaid and Medicare fraud. This is not where the issues of whether or not a drug company can promote the use of a dangerous drug like Neurotin for anything other than what it has been sanctioned for by the FDA belongs. Neurotin is approved by the FDA for one purpose; to treat epileptic seizures. When in fact the pharmaceutical company that makes Neurotin Parke-Davis, now part of Pfizer) has been promoting it not just for that purpose but in the children diagnosed as "bi-polar", or having attention deficit disorders.

There are very valid uses for many of these drugs but not in America's children, not without the foundation the must be demanded when considering the possible consequences and certainly not the uncontrolled experiment with these mind altering drugs on America's most precious commodity, children.

Source by Sharon Lambert

Homestays allow travelers a stopover with all facilities, comfort (for any time duration they plan to stay) and discover the high and low of Uttarakhand at an affordable price. Experience the unique feeling while interacting with individuals of different tradition and culture while lodging into a homestay in Uttarakhand.

Many families in Uttarakhand, staying in remote villages, have opened their home to welcome tourists. You may find a homestay at beautiful remote at hilly locations surrounded by picturesque sceneries that are often seen painted on a canvas. You can witness the beauty of this place by visiting homestays in Nainital, Bhimtal or other hilly destinies of Uttarakhand.

The hilly destination of Nainital is one of the most visited destinations of India. This quiet valley is famous for its centrally located lake. To regain your lost peace, Nainital promises a perfect recluse to the visitors surrounded by the majestic mountains and the sparkling Naini Lake.

As Nainital is a popular hill station in Uttarakhand, it is crowded through the year. Finding a comfortable lodging may not be easy. You can be subjected to lots of noise when opting to stay in the city. To relax, select to lodge into homestays that are found in the far-flung places away from the city.

Built on the slopes of the mountains, a homestay in Nainital is surrounded by orchards, farms and colorful flowery areas. These places provide shelter for many bird species, seen fluttering with their sweet chirpy- chirps intoxicating the misty atmosphere. This celestial sphere is a delight to both your eyes and ears, releasing the feeling of bliss. You can go trekking or indulge in bird watching at these peaceful getaways.

Home-cooked vegetarian and non-vegetarian meals are served in a village style with the host family. Vegetarian grown locally are used to make various delicious Indian and local cuisine. Fruits are also freshly plucked and served to the guests.

The rooms of a homestay in Nainital are clean, spacious and tastefully furnished with wooden furniture. Each room has a modern attached bath with a geyser and a shower. Privacy is the foremost priority that a guest can enjoy. The rooms are provided with a TV, DVDs and an air-conditioner / heater. If the weather is too cold, you can also find a seat near a fireplace with burning logs to keep you warm. Spend your day idling on the bed or go trekking to lighten your mood. Enjoy the feeling of peace and luxury.

The places of visit that one can enjoy when in Nainital are:

– Sit by the lakeside or get a boating experience amidst serene beauty. At night, the lights from the surrounding hotel play a magical rhythm on the water of Lake Naini.

– When in Nainital watch the sun disappear behind the mountains, at Hanuman Garhi.

– This is one of the most enchanting views that must not be missed.

– Naini Peak is the highest point in Nainital. A trekking expedition, through the Pine and Deodar forest, to this peak offers a delightful experience.

– Bargain at the Tibetan Market or at the shops on the Mall Road to get your heart's desire. These shopping venues are the ladies delight.

– Visit the well maintained Nainital Zoo to see some of the most beautiful species of animals and birds.

For some adventure and fun crawl into the interconnected natural caves at the Eco Cave Garden. These caves resemble the habitats of a tiger, panther, bat, squirrel, ape and flying fox.

There is a rock climbing spot at Barah Patthar that welcomes enthusiasts to reach the top of the mountain. You can also enroll in the 7 days camp to learn rock climbing, trail biking and river crossing.

The mountain regions of Uttarakhand have always held the interest of the tourists who lookout for opportunities to mingle with the locals. These places are rich in cultural heritage and natural habitats which the communities protect while offering you a healthy homestay in Uttarakhand. These recognized homestays will give you an utmost pleasure to make your journey a pleasant and memorable experience.

Source by Leena Dutta

Dental implants have certainly come a long way, and most of them only take an hour to install in your mouth! For people who have been using denture adhesive and are sick of the constant denture care that comes along with adhesive dentures, denture implants are definitely for you!

Lets first talk about the benefits of the old style false teeth, adhesive dentures. These dentures look nice, but fit in your mouth like a mouth guard which completely covers your palate. An adhesive has to be applied to your gums and dentures to hold the dentures into place. The biggest benefit to this denture type is that when you smile they usually look great, and they allow you to chew small food. The biggest drawbacks of course is that the adhesive is messy, uncomfortable, and expensive as you have to purchase it weekly. Another huge drawback is that you can’t eat the foods you want to eat. Unless its mushy small food, you can’t chew it without your dentures dislodging from the adhesive and causing uncomfortable movement and embarrassing moments while eating. Also with the palate covered, you can’t even taste some of the food you choose to eat with these types of dentures.

Well, no need to fear because implant dentures are here. There are several things that can be categorized in the benefit of denture implants category. The first thing is that the dentures are smaller and more light weight. They don’t cover the palate as they just include the teeth and gum line as part of the dentures. The dentures snap into place on the implants which make the teeth extremely sturdy and makes the idea of biting into an apple a reality. There are no messy adhesives to clean up or buy as all you have to do is simply snap the denture out of place and clean it like a normal denture with a dentist friendly cleaning solvent. Another great benefit is that you will be able to taste food again! You will be amazed at how much of a difference it makes to have your denture implants expose your palate which will help you enjoy food like you used to.

As you can see the benefits of denture implants are many and rightly so! Denture implants are changing the way people view life without real teeth and making the transition to dentures much more natural and easy. If you want to start enjoying these wonderful benefits simple make an appointment with your dentist to discuss the different implant types and installation options. Stop suffering with adhesive dentures and make the switch today!

Source by N. Swanson

The primary purposes of a Special Needs Trust ("SNT") for a disabled person is to prevent the waste of assets and to provide the proper care of those assets. The public benefits of Social Security Income and state-paid medical care are provided on a needs basis to those who can not earn income for them due due to a disability. Money distributed directly to a disabled person reduces these public benefits on a dollar for dollar basis. A properly prepared and administrated SNT is a legitimate and valid tool under Social Security rules and laws.

Protect payment of medical expenses (Medi-Cal) Medi-Cal is California's version of the federally funded Medicaid program. The program provides medical benefits for the medically needy. No qualification for Medi-Cal is required for the disabled receiving Social Security Income. If income is less than Medi-Cal limits, Medi-Cal services are available at no cost. Typically the only source of income to the disabled is SSI. SSI income received by the disabled is less than Medi-Cal limits. So a disabled person receiving SSI also receives free medical care under the Medi-Cal program.

Income in excess of Medi-Cal income limits require share of cost (SOC) of medical expenditure. One goal of special needs trust is to provide benefits to the disabled without those benefits being counted as income. So no cash disbursements can be made to the disabled in order to reserve free medical care.

Protect receipt of social security income (SSI) SSI is intended to provide funds for food, clothing, and shelter for the aged (over age 65), disabled, or blind recipient. An individual receives less than $ 1,000 per month. Any money received by an SSI beneficiary is considered income to the beneficiary, and reduces SSI benefits on a dollar-for-dollar basis. Payments made to third parties for food or shelter is considered payment in-kind and results in about 33 cents loss or reduction of SSI benefits for each dollar space.

Payments to third parties for goods and services that are not food or shelter will not result in any reduction of SSI benefit. These payments are key to improving the quality of life of a disabled person. Examples of permitted expenses are:

• purchase of a home, telephone, TV cable, dental expenses, eye glasses, transportation expenses (including purchase of vehicle, maintenance, gasoline), furniture, movies and vacations.

The trustee of a special needs trust must be aware of the fine distinction between non-food and shelter items. The devil can be in the details. A movie is a permitted expenditure, but popcorn bought for the movie is not. Thanksgiving dinner is an exception to the food prohibition as is discarded food. The discarded food is an example of how much attention has been made on this matter.

In addition to managing the assets of the trust, a trustee can provide a connection to the community and prevent isolation. Public charities authorized to act as trustees can provide community support and make appropriate expenses. Theses trustees also address a major concern of parents, "what will happen to our disabled child when we are gone."

These organizations pool the assets of multiple special needs trusts for management, but each individual has a separate trust account. Disbursements are made from the individual accounts They also provide community resources such as help in finding suitable housing, providing medication education, life skills tutoring, social activities and friendship.

Two examples of such non-profits are the San Diego Special Needs Trust Foundation, serving San Diego Only, and Proxy Parent Foundation Proxy Parent Foundation, serving all of California. San Diego Special Needs Trust Foundation's web address is . Proxy Parent Foundation Proxy Parent Foundation's web address is .

There are costs for these services. At one organization there is an enrollment fee of $ 1,000, an annual administration fee of 1.5% with a $ 1,500 annual minimum charge and an annual Bank investment fee of 1%. Tax returns, if required, are an additional cost.

Requirement of Payback Provision Funding By a Third Party: A special needs trust established by someone other than the recipient of public benefits with assets related to someone other than the recipient is not required, in order to avoid the trust assets being considered available resources to the beneficiary, to contain the payback provisions of 42 USCA 1396p (d) (4) (A).

Funding By the Disabled: A disabled individual, under age 65, may establish a trust with his or her own assets. This trust must have payback provisions. The provisions require upon death of the disable for the trustee to pay back to the State of California the cost of all state provided medical care.

Special Needs Trust for the Elderly

Key Issues: Is it needed as a matter of public policy? The practicality of transferring assets does it improve the quality of life of the elderly?

Social Security Income and Medicaid are for the needy. The concept behind a special needs trust for the elderly is to meet the no asset requirement to receive public benefits by "spending down" or transferring assets out of the elder's control. A basic moral question to ask is "should a person who can afford medical care receive medical care intended for the poor." If the answer is no, then a special needs trust should be avoided.

Putting aside the moral issue. Just how practical is such a trust. Assets must be transferred out of the elder's control. Who can be trusted with those assets. What are the gift tax implications in a transfer.

Specifically how does one transfer retirement accounts. A change in control of a retirement account is a taxable event and taxed at the prevailing income tax rates. An elder is allowed to retain retirement assets as they are not assets counted to qualify. But the income will flow to the elder and dollar for dollar reduce the public benefits. The elder will also receive social security income with more reduction of public benefits.

Finally what are we trying to accomplish here. Mainly it is to have the State of California pay for the cost of living at a skilled nursing facility. As a rule, most people stay at nursing home for about two years. The sad fact is people just do not live that long after entering a nursing home. Assume the cost of respectable home is $ 10,000 per month. The savings is $ 240,000.

Nursing homes paid for by the State are not upscale operations. They are bare-bones minimum arrangements to meet the most basic of needs. This is while the children enjoy the assets of their elderly parent.

An elder's quality of life is not improved with this type of living condition. Special needs trust for the elderly just do not make sense due to loss of control, limited benefit and public policy.

Source by Mark Bidwell

Misalignment of the teeth is a news, especially in the dental niche. Every day millions of people from various parts of the globe are opting for suitable treatment procedures to correct the misalignment of their teeth. 6 month smile treatment can be included in the group – it is labeled as one of the most effective manners to get your teeth aligned. The added advantage of the procedure is that the treatment is affordable by anyone, unlike expensive treatment options like Invisalign. In the rest of the passage, I will be outlining certain aspects of this innovative procedure.

6 month smile treatment is noted to follow the utilization of metal braces to align the teeth. In fact, this is being done by most of the dentists all over the world. The teeth set is altered by the tensional forces attributed to the teeth by these metallic braces. There is something that must be noted – the tensional force imparted by these braces might diminish with the passage of weeks. Here, it is mandatory to visit the dentist at regular intervals – they will ensure that the correctness is always maintained.

Many misconceptions are prevalent in the niche – the popular one being the following – this specific treatment procedure may inconvenience. In fact, Invisalign experts are advertising this one "disadvantage". Considering the effective savings in the costs (that is borne by you), I should severely negate that statement. If you do not want to experience discomfort be prepared to spend money extravagantly, else opt the 6 month smile procedure. Once the teeth have been aligned correctly, something termed as a retainer must be worn for a certain duration – the retainer will ensure that the teeth remain in the new and altered position.

Dental procedures are costly – it is better to discuss the effective treatment costs with the dentist before enrolling for a suitable treatment program. For the same procedure, the rates may vary among the dentists. There are various factors that will decide the overall cost of the 6 month smile procedure. Hidden charges are quite common in the niche; Ensure that the dentist does not resort to such procedures. Transparency in the billing is a much-desired feature that must be noted on a dentist, along with his skill set. If you look forward to treating the misalignment, it is imperative that you should do your homework!

Did you know that the average number of appointments plays a pivotal role in balancing the overall treatment costs? Instead of paying the entire amount in a single go, some of the reputed clinics are noted to charge the patients on a monthly basis. The entire due will have to be paid within six months or one year. Such payment options will work out to be feasible for the patient. Certain dentists are recognized to charge separately for the retainer – it will be wise to stick with those who include it with the initial offering. Premium treatment always comes with an associated price-tag!

Source by Jamie Gram

Ontario, Canada, home to 40% of Canada's population, has some of the top-rated tourist attractions in the world. Ontario has breathtaking views and sights through all four seasons. The province has several lakes, various architectural wonders, and is both the national and cosmopolitan capital of Canada. Here are top 10 tourist attractions in Ontario.

1. Parliament Hill

Designed with large archways, copper adorned turrets, and Gothic revival gargoyles, Parliament is another top destination in Canada. One of the main features of Parliament Hill is the Center Block, the main building of the Canadian Parliament. In the middle of the Center Block is the iconic Peace Tower. The clock and bell tower stands slightly over 300 feet and is covered with stone carvings of gargoyles. The Center Block was developed in the mid-19th century and was one of the first homes of the Canadian government.

2. CN Tower

The CN Tower is the most iconic sight in Canada. It's a marvel of 1970's engineering and it always ranks as one of the top places to visit in every Canada travel guide. It has the appearance of a gigantic hypodermic needle but its main role is to act as a communications tower. It is one of the highest free standing structures in the world that stretches to a height of 1,815 feet.

3. Killarney Provincial Park

Killarney is also referred to as the "crown jewel of Ontario parks", with one of the highest rated kayaking destinations in the world. At Killarney, people can spend days exploring the well-over 50 lakes and network of trails that provide spectacular vistas of the lakes and Georgian Bay.

4. Elgin & Winter Garden Theater

This is a restored work of art that is regarded as one of the last fully functional Edwardian double-decker theaters. The Winter Garden was initially developed as the flagship for a vaudeville chain that never got started while the downstairs was converted into a movie house. Tours of the theater run on Thursdays and Fridays.

5. Royal Ontario Museum

The Royal Ontario Museum celebrated its centennial in 2014 and is regarded as one of the largest natural history museums in North America. With the addition of "The Crystal" entrance on Bloor St. in 2007, the museum building combines the traditional heritage buildings with modern architecture with great effect (and controversial). It is a memorable destination to visit with friends.

6. 1000 Islands Tower

Found in the isle of Ivy Lea, approximately 20 kilometers from a place known as Gananoque, lies the 1000 Islands Tower. This 130-meter-high observation tower provides exceptional views of the archipelago from two open locations and has exceptional exhibits about the glass enclosed deck design. Although it's an historical site, it has an elevator for convenience.

7. National Gallery of Canada

This location is more than just a tourist destination, it's also a work of art. It has a unique ensemble of glass spires and pink granite which complement the copper topped towers of nearby Parliament. The interior section features vaulted galleries, a Canadian art exhibition, and various other notable American traditional forms of art.

8. Canadian Canoe Museum

Exhibiting one of the largest collections of kayaks and canoes, this museum is also a top-rated travel destination. It has an exceptional display of 150 canoes and it also documents the long history of water navigation that occurred in the country. This occurred in the 17th to 19th century, when North America was one of the top canoe destinies.

9. Boldt Castle

This lavish, traditional North American castle is located in the middle of St. Louis. Lawrence. The Boldt castle was developed by George C. Boldt, who was one of the developers of the notable Waldorf Astoria hotel in New York City. Several thousand tourists pass by this location each year to enjoy the scenic structures.

10. Ripley's Aquarium

This aquarium is located in Ontario and is one of the three aquariums owned by the Ripley Entertainment network. The aquarium holds 1.5 million gallons of water and exhibits marine life from all over the world. It is organized into nine galleries, showing a variety of fish, sea animals and marine habitats.

Source by Bob Tom

Factoring is when a business sells its receivables for a service or product delivered to another business. Many people in the healthcare industry think that medical receivables can not be factored because the "customer" is a person and not a business. But medical receivables can be factored because in most cases, your payment comes from Medicare, Medicaid, Blue Cross / Blue Shield, Aetna, etc. In other words, the payment is coming to you from a business, so the receivables CAN be factored.

In the past, healthcare professionals could depend on efficient operations to keep
their cash flowing, but that often is not enough now. Increased costs and longer
times for insurance companies and Medicare to pay the bills are making it
impossible for them to keep their practices running smoothly.

Most factoring companies do not factor medical receivables, but there are several
that specialize in this niche. They fully understand that accounts that are paid by
third party payors take more due diligence and more things have to be looked at
than with "regular" factoring. They know these receivables are filed and paid
different by different states and then have elaborate payment methods and
computations. There are government and insurance regulations, delayed
reimbursements, HMOs, contractual allowances, multiple payors and many more
challenges that are only found in the healthcare industry. The factors who specialize
in your industry know all the lingo and terminology and will immediately understand
your needs.

The healthcare businesses that will most easily be approved for factoring are: Acute
Egypt Rehab or Specialty Hospitals, Physicians, Surgery or Imaging Centers, Dialysis or
Urgent Care or Rehab Centers, Ambulance companies, Medical Labs, DME / HME,
Osteopaths, Oral Surgeons, Pharmacies, Home Health Care and Workers Comp
Healthcare Providers and some Chiropractor groups.

There are certain types of health related businesses that might be more difficult to
factor, mostly because the net collectable value from the private insurance
companies or government is too small each month for a factor to be interested.
These are small chiropractors, dentists, cosmetic surgeons and Lasik doctors (often
not covered by insurance) and some nursing homes because of credit problems.

Medical receivable factoring companies all have different minimum monthly net
collectable amounts, so ask your broker for the one that will be able to help your
business. Some work with amounts as small as $ 35,000- $ 50,000, others have a
minimum of $ 200,000.

Once your account is set up with the factor, you will receive up to 85% of the
invoices within hours of turning them in each week. When the bills are finally paid,
you will receive the rest of the amount owed, minus a small fee. The fee depends on
many things and will probably range somewhere between 2% and 6%.

You will lose all the stress of not knowing when you will be paid for the work you
are doing. You'll be able to pay all your vendors and staff on time, you'll be able to
keep up with all your bills. You will even be able to hire more staff or buy more
equipment, because you'll know you can accept more business.

There have been instances when a medical business has been on the brink of
bankruptcy and decided to try factoring as a last ditch effort and it saved them.
They were able to turn everything around and are thriving now.

Factoring should be considered as a tool for growth and management, not as a last
resort to save your business. Without your practice has very expensive equipment or
diagnostic devices, your largest asset is its accounts receivable and these assets
can be used to keep your business running smoothly and growing.

Source by Donna Poisl

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