My wife has been learning a ton up there. She is without a car, living in a dorm in her 30’s, and on a meal plan. More impressively, she can completely break down a pig on her own already. She is also picking up a ton of “value-added” concepts. These are things you might need to know should one ever decide to open a shop. Here is a photo of the case the students stock and sell as they learn.

It has been a while since I have done one of these updates, so I thought it would be a good time to check in.     

I started the ‘Max’s Back Pocket’ series during the heat of the pandemic lockdown. People were being sent home from work and the stock market appeared to be crashing. It was a great way to keep my thoughts organized while also networking with other bloggers. I kept it up for 16 weeks, doubling my initial commitment of 8 weeks. I am self-aware and know my limits. But I enjoyed the series and certainly found value in checking in regularly with less technical content.

With that, welcome to the 18^th edition of Max’s Back Pocket. I am moving away from Roman numerals this week.

Back From Calgary

After a two week quarantine in Calgary followed by several days of getting my wife set up at school, I flew back to New England on my own. With the borders closed, the international hub of the Calgary airport felt like a ghost town. I was one of two people going through security.

I got back to New England in the early morning hours of September 10^th. It was a full day of travel. I reported back to work bright and early.

I went through our employee health COVID-19 screening processes that morning. When I answered “yes” to the international travel question, I was connected to a nurse to talk through my circumstances. I was approved for work. Evidently, they did not feel my travel itinerary put me in a significant risk category. I can also stay pretty isolated at work if needed. They did offer to provide a COVID-19 test if I was interested, but I opted out.

My Job

Since returning home, I have been absolutely cranking things out at work. Except for an external deadline here and there, I have almost complete autonomy right now. I can manage my department and put up value where I see fit.

I’ll tell you, it is a great feeling and a win for the organization. I launched this blog amid my second EPIC electronic medical record (EMR) implementation. My mom had passed away unexpectedly 8 months prior. At that point, my entire work schedule revolved around deadlines and projects imposed on me by external departments. Mainly our information systems department. At the same time, I was tasked with centralizing the processes of an entire hospital business office. Needless to say, I had a lot going on.

Whining? Yes. But it left a bad taste in my mouth and I literally could not keep up with the work. Things were getting missed, and it was costing the company money. This is a known cost of EMR upgrades (particularly on the financial side), but I don’t like seeing it. I had almost no autonomy and my motivation for retiring early was at an all-time high. I was turning into a burnout scene. The blog was a good way to let off some steam.

It is amazing what a year can do. These days, I am really enjoying everything.

I still talk about pulling back here and there. I even contemplated a 32-hour workweek several months back. But for now, I am going to keep my nose to the grindstone. We have new local leadership that I find quite motivating and everything is going smooth. We are safely and successfully ramping up operations. I also have plenty of my favorite benefit, paid time off, to keep a little flexibility built-in.

Health

My physical health is also reaching new heights. I am lifting weights at least 4-5 days a week with a friend from work. To complement that, I am also running between 20 – 30 minutes after those workouts at increasingly faster intervals. I almost broke a 7/min mile pace for 21 minutes a few days ago. It was on a treadmill, but still not bad.

Mrs. Max OOP was nice enough to carve out leftovers and freeze them for me. She left me about a month of meals before she left. So I have been working those down. In between those meals, I have been making elaborate chopped salads to increase and diversify my vegetable intake.

Sober October

I am also on Day 22 of an experiment that completely eliminates alcohol from my diet. I probably have not gone a week without drinking alcohol in over 15 years. That makes this a significant accomplishment. I very much enjoy drinking, so it will definitely work its way back into my routine. But this has been a nice re-set. I have never slept so well and any indigestion I had has been completely eliminated.

My birthday is on Halloween and I will be rolling into that birthday in the best shape of my life (and a cold drink in hand).

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Here at the intersection of healthcare and personal finance, Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this pandemic inspired idiomatic experiment?

Max’s Back Pocket.

Personal Finance

The folks over at TicTocLife put together a comprehensive analysis of the “rent vs. buy” question. They included a lot of the components that often get missed including taxes, opportunity costs, and maintenance. They also used a real-life case study to help demonstrate the complicated equation. Theory is great, but real-life examples are even better.

After owning a house for four years down in North Carolina, we have been renting the last four here in New England. We downsized a ton to make the equation work, and I wouldn’t change a thing.

We will probably eventually buy again, and I recently moved about $75,000 out of the total stock market in anticipation of a home purchase or other needs. If you plan on needing money in the next five years, equities are not always the best place for it. It was nice to harvest some capital gains as well.

Healthcare

John Lynn asks the question, did COVID-19 create a false telehealth market? He makes a lot of good points here. Evidently, at the height of the pandemic, we were looking at 50-60% adoption of telehealth, but he expects this will settle closer to 10-15%. We are already seeing a pullback in the use of this technology. He goes on to say false markets aren’t necessarily a bad thing, as long as you don’t make long term business decisions based on short term trends.

Here at Max Out of Pocket, we took a detailed look at telehealth billing a while back with Telehealth Billing: Exposed!.

Life

As I mentioned above, I have been really focusing on my physical health. Diet is an important piece of this. Diet and exercise will hopefully save me fists full (or is it fist fulls?) of out-of-pocket costs over time.

When I planned to start eating more chopped salads, I poked around the internet a bit for some ideas. If you left it to Max, I would probably end up with just lettuce and maybe some olive oil.

As it turns out, a couple cooks had a recipe that became my favorite chopped salad last week.

This chopped salad will amaze everyone around the table! Homemade Italian dressing, crisp veggies, and Parmesan cheese combine into one extraordinary salad.

Favorite Chopped Salad

I am less than efficient at grocery shopping and somehow forgot the jarred sliced pepperoncini. But overall, the recipe turned out great and I would highly recommend it. It also was a relatively cheap meal, other than the olive oil. The dressing even has maple syrup in it! I added chicken to make it a main course.

How was your week?

Max

The post Max’s Back Pocket Vol. 18 appeared first on Max Out of Pocket.

I started the ‘Max’s Back Pocket’ series during the peak of the pandemic lockdown. People were being sent home from work and the stock market appeared to be crashing. It seemed like a good way to organize my thoughts during a crazy time while also networking with other bloggers. I kept it up for 16 weeks, which was double my initial commitment of 8 weeks. Overall, I enjoyed it, and it was nice to check in weekly.

But I may re-think the weekly frequency at some point. Initially, I thought I would eventually cut this down to monthly, or even every two weeks on payday. Time will tell, but I don’t anticipate I will eliminate the series altogether. It’s fun. I am just looking for some time to focus on a few other things, so I need to build in some balance. I don’t want to be a professional content curator.

With that, welcome to the 17th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Here at the intersection of healthcare and personal finance, Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this pandemic inspired idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Yesterday was payday, so I made my usual addition to my medical office building portfolio. I have been adding to this portfolio every two weeks for well over a year at this point.

It just so happens I received my quarterly dividend from Physicians Realty Trust yesterday as well. Between the three accounts that I keep my medical office buildings in, it came out to $533.37 in passive income for July.

So I essentially re-invested almost my entire dividend payment right back into Physicians Realty Trust. Those 30 new shares are projected to net me $27.60 in passive income over the next year.

The dividends that hit my individual brokerage account will be taxed this year, the dividends that hit my Traditional IRA are tax-deferred, and the dividends that hit my Roth IRA will never be taxed.

The last I checked my 3-stock medical office building portfolio is worth $65,000 and should kick off about $3,686 in dividends over the next year. Keep in mind, this is part of my “speculative” allocation and most of my portfolio lives in index funds.

$3,686 in passive income annually is nice, but it’s nothing compared to what Bob over at Tawcan has put together over the years. Bob has amassed a dividend portfolio that generates over $2,100 in passive dividends per month. His portfolio is much more diversified and built for the long haul. Check out his June update here.

Bob lives in Vancouver, Canada. Mrs. Max OOP is Canadian and eventually wants to move us back to Canada, so I like to keep an eye on Canadian bloggers.

Finally, I was disappointed to find out a few weeks ago that Kim from The Frugal Engineers closed down her site. She did a nice guest post here on how to pandemic proof your finances several months ago. She is moving on to bigger and better things, but hopefully, we can stay in touch over email.

Healthcare

Things are going really well for me at work right now. The pandemic essentially canceled all meetings that were already pretty useless in the first place. As a result, my productivity has gone through the roof.

I just closed out week one of a two-week remote healthcare conference. It goes from 1-4 pm every day and is quality content. Unfortunately, the conference is not in person this year, so I have not been able to completely unplug and recharge like I did last year. Man, I really liked that hotel.

That said, I have been coming home from work and participating remotely from my couch. I thought getting out of the office would be a good strategy to make sure I pay attention and don’t work/check email during the conference. It has been a nice break from my normal routine.

My new friends over at #HCLDR had their weekly tweet chat on Tuesday. I was unable to attend this week, but they had a dynamic discussion. Thankfully, I was able to check out some of the highlights on Twitter the next day.

Next week they are covering the keys to maintaining virtual care’s momentum. Telehealth is something I have taken some interest in on the finance side of healthcare. We did a deep dive into the billing a few months back so it should be a great discussion. Join us on Tuesday, July 21st if you are interested!

Never Events

Have you ever wondered what Medicare considers a “Never Event” in the hospital? Doing a lab test on the wrong patient is certainly concerning, but it isn’t considered a “Never Event”. It has to be an invasive procedure and something we never want to see happen.

Medicare doesn’t cover “never events”:

A surgical or other invasive procedure done in error including:

1⃣A wrong procedure on the patient
2⃣The correct procedure, wrong body part
3⃣The correct procedure on the wrong patient

See why they call them “never events”?

— Max (@maxoutofpocket) July 15, 2020

That said, even if you have a noninvasive (like maybe a lab test) test performed that was not ordered by your doctor, I would challenge the billing. It’s not necessarily something you would sue over, but at the very least you and your insurance shouldn’t be billed for it.

Life

As I mentioned, Mrs. Max OOP and I have been quite busy. I took back-to-back Fridays off work. I am carefully managing my favorite benefit – paid time off. There is a need to make sure I don’t go over my cap of 281 hours, otherwise, I will stop accumulating time off.

During my little hiatus from writing, we hit up Cape Cod for the first time, checked off another 4,000 footer in New Hampshire, and had family in town for three days. All while staying appropriately socially distanced.

I might have picked up a bad habit on the Cape. It’s called golfing. We golfed twice last year for the first time and now twice this year. My game seems to be improving exponentially and I am finding it slightly addictive. Luckily, I have been borrowing clubs and need to give them back next week, so hopefully, that will nip the habit.

Until then, we have a 3 pm tee-time set for today here in town.

How have you been?

The post Max’s Back Pocket Vol. XVII appeared first on Max Out of Pocket.

Week one of my state’s softer “safer at home advisory” seemed to go pretty well. Although our town has been busy, people appear to be playing by the rules. Of course, we won’t really have material data on if COVID-19 is spreading for a few more weeks. Mrs. Max OOP and I are lucky enough to be in one of the states where cases are on the decline.

With that, welcome to the 16th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Here at the intersection of healthcare and personal finance, Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this pandemic inspired idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Medimentary could probably have a standing spot in the weekly Max’s Back Pocket reel. The mind behind that blog is very quietly sharing some pretty impressive content and ideas about healthcare. Maybe even a bit deeper than some of the stuff we produce here at Max Out of Pocket. This is the kind of blog I tend to gravitate to. Perhaps it is time for Max to set up a “blog roll” and link back to it.

Last week, they touched on The Paradox of Thrift While Choosing Financial Independence. Ah, personal finance and healthcare, my type of blog.

Hopefully, he or she is not getting sick of my long and obnoxious comments. Here are some of my notes on the article.

Here at Max Out of Pocket, we covered one of my favorite employer benefits; paid time off.

Yesterday was payday, which usually triggers some activity in my personal finance world. Some of it happens automatically, such as adding 9.85 hours to my PTO bank. That took my total to a healthy 260 hours.

Sitting on over 6 weeks of vacation is a pretty good place to be.

Healthcare

I have stumbled across some write-ups by Rebecca Pifer at the Healthcare Dive over the last few months. I like her style and it’s to the point. A few articles outlining the operational and financial impact COVID-19 has had on small practices caught my attention. The titles highlight the dire state of things, particularly for independent practitioners.

• Professional services revenue plunged nearly 50% in April as pandemic worsened
• What about us?: Frontline primary care practices fear for survival amid coronavirus

In the first link, Rebecca reviews a study from FAIR Health outlining bleak revenue numbers for professional services across the country. These numbers are daunting, and further demonstrate just how fragile the fee-for-service model is. And they don’t just apply to professional services; hospital systems are seeing similar shortfalls.

Consolidation Into Health Systems

Shrinking revenue figures like this lead right into the next article, written back in March. The provider consolidation into health systems we have seen over the last decade has been stark. Surprisingly, in 2018, over half of physicians (54%) still worked in independent practices. That percentage was higher than I would have thought. Unfortunately, that number will continue to shrink as these revenue numbers chip away at independent practices’ already razor-thin margins.

I have spent most of my career working for large health systems, a consolidation “machine”. Large hospital systems do a lot of great work for their communities and can take some of the financial pressure off physicians and allow them to focus on patient care. But I am also a huge fan of nimble small businesses and their ability to adjust quickly. Independent clinics can provide a level of customer service large systems struggle with. I think over-consolidation will be a problem in the long run.

The article also mentions that lower telehealth reimbursement rates will impact these clinicians. One thing I would add is the administrative burden of setting up the billing, will also be a problem for small practices. I highlighted some billing concepts with Telehealth Billing: Exposed!

I am lucky enough to work for a financially solid health system with a strong balance sheet. We were able to absorb the crashing revenue number we saw in March, April, and May. Unfortunately, that just hasn’t been the norm across the country. Every day, I am seeing more and more hospital systems furlough or layoff employees.

Life

Mrs. Max OOP and I had a two-month obsession with RVs in 2018. Specifically, the Winnebago. We figured we would live in it full time and travel around the country with our two cats. That dream was short-lived, but I still get envious every time I see someone else doing it. Maybe someday we will get there.

Take the folks over at Money Fitness Journey, for example. They gave us a free tour of the inside of their RV. One thing I like about this tour is it is real. The RV actually looks like someone lives in it, not an Instagram post. Oh, and they have two nice-looking dogs. Thanks for sharing this and thank you for your military service, David.

Speaking of PTO and travel, Max will take next Friday off and embark on my first trip to Cape Cod for the weekend with Mrs. Max OOP. We will follow the rules and maintain social distance as required. It will be nice to get out of town and I will reduce my PTO bank by 8 hours.

That’s a wrap. Enjoy the first day of summer!

Is your state opening back up? Are you comfortable going to see your provider?

The post Max’s Back Pocket Vol. XVI appeared first on Max Out of Pocket.

It will be interesting to keep an eye on things. Other states have seemed to stumble a bit with fresh COVID-19 cases popping up as lockdowns lift. The Max Out of Pocket crew is currently hunkered down in a rural area with limited activity, so I am hopeful my community is responsible with the reopening efforts and use our ‘ruralness’ to our advantage. As a vacation town, one concern I have is vacationers from out of state bringing COVID-19 here.

Friday closed out week four of biking to the hospital. This was the first work week I had to deal with rain in the forecast. I woke up Thursday to a light drizzle. I didn’t let that stop me from jumping on the bike. We have rain jackets for a reason. So I logged another 26.7 miles this week between riding to the hospital and the gym. Using the IRS mileage rate, that is another $15.35 back in my pocket this week.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Here at the intersection of healthcare and personal finance, Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this pandemic inspired idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Personal finance. I am lucky enough to call this a hobby. So I am not necessarily trying to fill an entire bank with the proceeds of this little blogging side project.

Liz from Minding My Thirties appears to be in the same place as me at this point. She recently reflected on When is Enough Money – Enough? Her experience with Twitter very much lines up with mine. Outside of the #HCLDR (healthcare leader) group I have been interacting with on Tuesday nights, I have had a hard time keeping up with it. Evidently, I initially liked it.

I’m starting to enjoy this new twitter hobby of mine. I think I am starting to understand the hashtag thing. #amireallyontwitter #yesyouare

— Max (@maxoutofpocket) March 21, 2020

By the next day, I was already starting to show my fatigue, but still enjoying it.

Good morning twitter. This place stays pretty busy. I like it. #sundaymornings

— Max (@maxoutofpocket) March 22, 2020

On a side note, I am pretty pumped I just figured out how to “embed” tweets into my blog posts. I can even center them.

Liz felt “dwarfed” by her internet peers who “seemed to be averaging 20 tweets an hour”. It didn’t take long for me to feel the same way. I almost wonder if some of these “Tweople” (I like that) have actually outsourced their Twitter account or somehow automated it. This feeling also initially killed my vibe, but I have been coming back around to Twitter.

Like Liz, right now I am focused on developing my writing and thought-provoking topics.

Healthcare

Have you ever wanted to know how much rehab costs? I am not talking about physical therapy here. I am talking about the kind of rehab not a lot of people want to talk about. A drug and alcohol rehab stay.

Detox and Rehab

My Quiet FI took a hard look at the cost of his time in rehab back in 2016. For those who don’t know, it’s usually split into two parts:

• Detox
• Rehab

My Quiet FI’s retail price came in at $32,161 for 7 days and 6 nights on the detox side of things. The rehab side was just a few nights inpatient then several weeks outpatient. The rehab side came in at $12,541.

Total Charges = $44,702

Since Quiet FI was insured, he got what I like to call the ‘TJ Maxx sale price’ on detox and rehab. This came in at $12,445 for everything.

Quiet FI Paid With Insurance = $12,445

I would love to understand the breakdown here. How much did Quiet FI’s insurance pay on top of the $12,445? Or, did the entire stay hit their out-of-pocket (deductible)?

Without putting up too much commentary here, I agree with Quiet FI’s concerns. The pricing on this makes absolutely no sense. In fact, it could potentially keep someone out of rehab. The uninsured, in particular, are at risk for the higher pricing. I have talked about “itemized healthcare” here on the blog a few times. This is just another example of it putting a black eye and a potential barrier on a pretty amazing service line that is out there if people need it.

It has been a few years since I worked with this type of insurance reimbursement. It seems like a lot of insurance companies (including Medicare) generally pay a “fixed price per day” for this type of service on the inpatient side (regardless of charge). I am going to go back and look at my notes and one day do a formal write up on it. I recall Medicare’s payment methodology being quite complicated and even considers if you originated in the ER or not in their payment calculation.

Max Goes To The Dentist

On a lighter healthcare note, Max’s first teeth cleaning of 2020 happened this week. Spoiler alert, my retail price for the cleaning came in at $108. I happen to think this pricing is an absolute bargain considering the level of service being provided.

Thankfully, my employer-subsidized insurance will cover that in full. In other words, I left with a clean bill of dental health in more ways than one.

Healthcare Outpacing Inflation

Lastly, I thought I would dust off a classic Dave covered back in 2018 over at Accidental FIRE. Like Max, Dave is a bit of a map nerd. In late 2018, he put together a really nice summary of just how much state and local spending has increased per capita on healthcare. The time period compared was 1992 and 2016 (post-Obama care).

One takeaway I find really interesting from this analysis is New Hampshire and Vermont. Although they are neighbors, New Hampshire came in as one of the states with the lowest increase (26%) where Vermont came in as one of the highest (261%). Dave also does a nice job discussing Medicaid expansion and exactly what that means at the state level.

Life

Speaking of New Hampshire, Mrs. Max OOP and I got out for an early hike today in Northern New Hampshire. It was an earlier start than we have been getting the last few weekends. The trail was nice and empty and we got a ton of great photos. It was a great start to the day.

Let’s end this with a few photos of this morning!

The post Max’s Back Pocket Vol. XV appeared first on Max Out of Pocket.

I finished a huge project at the hospital that has been bogging me down for three weeks. Everything was submitted yesterday. My gym opened back up 6/1/2020 by appointment only. There are lots of new rules in place and they are doing the best they can. Interesting to see a gym with all the cardio equipment roped off with signs saying “do not use”. How’s that for an excuse not to exercise?

Who needs cardio equipment when you have a bike? After fixing my popped bike tire on Sunday, the wheels were back in full force by Monday and I was able to ride into the hospital all 5 days. On the “gym” days I would ride from the hospital down to the gym which is approximately 2.5 miles. That makes my round trip from the house to the hospital to the gym and back to the house about 6.1 miles and puts me at 24.8 miles for the week.

24.8 miles X $0.575 (IRS Mileage Rate) = $14.26 back in my pocket

Covered the cost of my new bike tube. Now I just need to find a way to calculate the health benefits of this little bike commute.

On to the 14th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this ridiculous idiomatic experiment?

Max’s Back Pocket

Personal Finance

I cleaned some skeletons out of my personal finance closet this week. A little motivation prompted me to get some work done on one of our retirement accounts. We have to take the good with the bad when it comes to saving for retirement. The bad usually comes in the form of fees from the account administrator.

I stumbled across a personal finance blog called Ocho Sin Coche. The brain behind that blog kindly reminded me that my “inaction” on one of our old 401(k) accounts was costing us some serious money. 401(k) Fee Drag is definitely a thing and once you leave an employer, it is really time to consider rolling over a 401(k) to an IRA. This is particularly true if your former employer is reaching into your pocket and taking your hard-earned cash.

Mrs. Max OOP has an old 401(k) from some work she did with a grocery store last year. It is worth about $10,000. Recordkeeping Fees, Other Recordkeeping Fees, and Administrative Fees clipped $81.14 of this account since she left that position. Here I am counting bike miles while her previous employer is offsetting all my work. That all came to an end Sunday when I rolled it over to our IRA. I should get a check for about $10,000 in the next few weeks and we will deposit/consolidate it into her Vanguard IRA. Unfortunately, the 401(k) is going to hit us with another $8.50 on our way out the door.

Now what I really want to know, what exactly does Ocho Sin Coche mean? I briefly googled it but didn’t get much back.

Healthcare

Things got interesting this week when I found out the Max Out of Pocket Blog is a 2020 HITMC Award Honoree. Max is up for the individual blog of the year. This award is given to the author of the best healthcare related blog of the past year. The blog must not be affiliated with any company. There will be an event on 6/30/2020 to announce the winner. You can register here if you are interested.

33 Charts

One of the blogs also being recognized is a blog called 33 Charts. I am doing some catch-up on this website; aka scoping out the competition : ). I like what I see. One thing nice is it offers some short reads on several different subjects. In a recent post called Telemedicine and Telehype, the author mentioned that although telehealth has leapfrogged now that some of the regulatory barriers have been removed, we should be cautious.

Our goal is not to figure out how all of our care can be delivered through a screen. Our goal is to figure out how we can use technology to optimize the journey and the experience for our children and their families. In the midst of the telehype it’s important to understand your mission. When you understand where you’re going you can begin to consider where the next tool fits into that mission.

Telemedicine and Telehype – BRYAN VARTABEDIAN, MD

33 Charts has a whole archive dedicated to telemedicine and I will be doing some catch-up on this. Perhaps they will be interested in my take on the billing: Telehealth Billing: Exposed!.

The Healthcare Marketer

The other blog up for nomination is The Healthcare Marketer. The author, Dan Dunlop, recently reflected on 14 Years of Blogging About Healthcare Marketing.

I could only hope Max Out of Pocket is still around in 14 years. Mr. Dunlop has written more than 1,700 posts for the Healthcare Marketer Blog. That equates to 10 posts per month over 14 years. It looks like he lives down in North Carolina, not too far from my previous health system. He is clearly a leader in the industry and has tremendous experience in marketing.

I have a ton to learn from these two blogs.

Final Thoughts

Well, it’s been another productive week around here. Unfortunately, I didn’t get to any podcasts this week. Evidently, there are three new podcasts for me to check out and are also up for an award on June 30th:

• To Care is Human – Jason A Wolf & Tiffany Christensen
• HIT Like a Girl – Joy Rios & Robin Roberts
• This Week in Health IT – Bill Russell

Looks like Max has his work cut out for him. Happy Saturday.

The post Max’s Back Pocket Vol. XIV appeared first on Max Out of Pocket.

As I mentioned last week, I use the IRS valuation to calculate my net pick up from bike riding to work. So that’s another $9.68 back in my pocket for a total of $19.36. My vehicle has not left the house in two weeks.

$2.42 per day X 4 days = $9.68

We will see how next week goes. I have been anxious to get back to the gym and I found out mine opens up Monday by appointment only. A colleague from work and I have been working out for some time, and he scheduled us a slot. The gym is on the other side of town, maybe a few miles, so I will have to decide if I want to schedule the time to bike down there or drive in the days we work out. We will see, maybe I will test out the ride this weekend.

On to Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this idiomatic experiment?

Max’s Back Pocket.

Personal Finance

This was a “non-pay” week for us, so not much going on in our personal finance world. I stumbled across a new blog this week I hadn’t heard of called We Want Guac. Darcy reflects on reaching a $100,000 net worth back in 2019 with What it Means to Have $100,000 in Savings. This was done in her 20’s, and she beat me by a year or two. She mentions that having a six-figure wealth means you have more money than roughly two-thirds of the US population and you are one of the wealthiest people on the planet. If you live in a bubble, it’s easy to forget this type of thing.

She goes on to talk about the security, income, confidence, and the skillset created by putting up a 100k net worth. I would only add that having this type of security could also really help a person through a health crisis. Not having to worry about money during those times is huge.

She also shared a cool little calculator that’s worth playing with. Evidently, their data comes from the 2016 Federal Reserve Survey of Consumer Finance. We don’t own a home, but a lot of my peers do. When I run the same calculation including primary home equity, the calculator suggests my age group has an average net worth of about $34,000. Considering my medical office building portfolio alone eclipsed 50k this year, I am feeling pretty good about everything.

Including primary home equity, most people don’t hit 100k until 50.

Healthcare

Here at Max Out of Pocket, we did an extensive review of How Much Should Molecular Genetic Testing Cost? This was in response to the Dragon Guy’s 9-year cancer update where he let us all know he is still in remission!

I zeroed in on a very specific lab test that is represented by CPT code 81206. It is basically looking for a mutation of a gene often found in patients diagnosed with chronic myelogenous leukemia (CML).

I pulled pricing from Stanford Health Care, Beaumont, and Johnson Memorial Hospital in Indiana. I went through my usual spiel about the “problem gap” which is the difference in reimbursement between the Medicare program and commercial insurance.

Podcast

When I initially launched the Max’s Back Pocket series, I thought I would have a weekly review of a podcast to talk about. Since I live at the intersection of healthcare and personal finance, I am always listening to podcasts that fall into those two categories. Although I have not been doing regular write-ups about them, that doesn’t mean I haven’t been listening.

I found Dr. Zeev Neuwirth’s podcast Creating a New Healthcare way back in July 2019. He really pulled me in with episode #68 featuring an interview with Dr. Stephen Klasko, CEO of Jefferson Health. I probably should have featured that interview at some point, but it wouldn’t do it justice. Just go listen to it. It will fire you up.

When I switched to Google Podcast a few months ago, his show somehow fell off my feed. So I just started catching back up. This last week I listened to his 100th episode.

I wanted to congratulate Dr. Zeev Neuwirth on 100 episodes, excellent work!

Creating a New Healthcare – Episode 100

Creating a New Healthcare – Episode #100: ‘How COVID-19 is Reframing Healthcare in America’ with Sami Inkinen, CEO & Founder of Virta

This story is pretty amazing.

Sami Inkinen sounds like a tremendous person. After dominating the real estate market by co-founding Trulia, he figured he would tackle type 2 diabetes next. Pretty amazing if you ask me. As an extremely healthy triathlete, he had an unexpected encounter with the condition.

His company, Virta, has a unique model for tackling type 2 diabetes. From the sounds of it, a lot of it is nutrition-based. Here is a quote directly from their website.

Virta is a proven treatment to reverse type 2 diabetes. Most of our patients achieve blood sugar control while removing medications like insulin, often in a matter of weeks.

Virta

Virta does a lot of this service through telehealth. By chance, the company’s care delivery model was practically pandemic-proof. It sounds like they take a set of labs when they intake the patient including a comprehensive metabolic panel but everything else is done through regular communication with the provider, mostly remotely.

Even though lab work is needed, they can take care of some of that with at-home testing.

How Do They Get Paid?

Working in billing, finance, and reimbursement, of course, I zero in on the payment model. I listened to this part a few times. Let me tell you, I love how they have this thing set up.

Virta’s economic model is purely outcomes-based. They don’t have to worry about billing codes that represent the extensive research and interaction they have with their patients. Dr. Neuwirth noted that the pandemic has shown how vulnerable the fee-for-service model is. Mr. Inkinen went on to suggest the pandemic has leapfrogged telehealth 3-5 years.

Sami Inkinen emphasized that they have this “bold promise” that their model can reverse type 2 diabetes or put it in remission. He wants to put their money where their mouth is by getting paid for the clinical outcomes that do just that. They only get paid by employers of government payers when outcomes are positive. In other words, they won’t be cranking out “extra” telehealth encounters just to get the fee for the service. This aligns everyone’s interest with that of the patient.

I actually wrote down this quote:

If you get paid for doing something, at some point, somebody is going to be doing more of that something.

Sami Inkinen

I agree, if we make that “something” outcomes instead of services, it certainly does seem to line the economic model up better. I also jotted down this quote by Dr. Neuwirth.

There is no CPT code for caring.

Dr. Neuwirth

I don’t think there is any better way to end this post.

Max

I have no affiliation with Virta or Dr. Neuwirth.

The post Max’s Back Pocket Vol. XIII appeared first on Max Out of Pocket.

I rode my bike in Tuesday through Friday logging a total of 16.8 miles for the week. The IRS puts a value on these miles at about $0.575 per mile in 2020. That comes out to $2.42 every day that I bike.

$0.575 X 4.2 miles = $2.42

This theoretically represents the fixed and variable costs of operating my automobile. Considering the age of my vehicle and the fact that gas prices have tanked, it probably isn’t that high. But I am going to go with it as a form of motivation. So this week, by biking, I put $9.68 back in my pocket. That’s a decent chunk of change!

$2.42 per day X 4 days = $9.68

I had a pretty good streak of biking into work a few years ago when we were living down south. Back then my commute was just over 6 miles and it would take about 30 minutes in the morning, mostly because of the hills. I was rewarded with a nice downhill ride on the way home, though. I would leave really early in the morning to try and beat the heat.

With that, welcome to the 12th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this idiomatic experiment?

Max’s Back Pocket.

Personal Finance

I have been dollar-cost averaging into my medical office building portfolio every two weeks for over a year now. Jim Collins discussed way back in 2014 why he doesn’t like that approach with Stocks — Part XXVII: Why I Don’t Like Dollar Cost Averaging. He sees it as just another form of market timing, and I tend to agree with that thought process when talking about the total stock market index. That said, my medical office building portfolio is just a speculative hobby for me to learn a little bit about REITs. I am somewhat dependent on W2 income to keep that project going. Investing $50,000 all at once just wasn’t in the cards.

That said, since yesterday was payday, I did invest another $750 into the portfolio.

Here at Max Out of Pocket, we reviewed how I got $1,000 in paper I Bonds from my 2018 tax return. I am actually creating a ladder with I Bonds so I can eventually release my $51,436 emergency fund security blanket. I hope to have a post on that sometime in the near future.

Another good one from this week: Courtney from Your Average Dough, discusses Net Worth vs Cash Flow: What’s More Important? Courtney notes that there isn’t necessarily a correlation between income and net worth. She ultimately thinks cash flow is more important than net worth. I would tend to agree.

Healthcare

The mind behind MEDIMENTARY took a look at an old study that asks the question, “Why Are Danes So Smug?” Spoiler alert, it’s not genes, diet, or even climate contributing to Danish happiness. It all comes down to the fact that the Danish are able to live in the moment. They have low expectations about the future and are happiest just living in the present.

Medimentary goes on to compare the governing policies and healthcare philosophies between the United States and Denmark. Since Mrs. Max OOP is Canadian, we have this type of conversation quite regularly comparing Canada to the United States. She even wants us to move to Canada someday.

Evidently, the Danish healthcare system has virtually no cost-sharing for patients. In other words, things like co-payments, deductibles and out-of-pocket maximums wouldn’t exist in that system. Does that mean the Max Out of Pocket blog wouldn’t even exist in a system like that? Maybe. But that would probably be doing us all a favor.

One other thing I found interesting is the Danish model of offering after-hours primary care services including telephonic services. It only took a pandemic for Medicare to loosen up telephone and telehealth options here in the United States. If you need to know how that stuff gets billed, check it out here.

Life

I am looking forward to the long weekend. Hard to believe it is Memorial Day. It looks like the nice weather is following us into the weekend. We grilled out for the first time last week and I am eager to do more of it this weekend. Hoping to keep my biking streak going into the short work week next week too.

Hopefully, we can start looking at some travel plans soon. The folks over at Costa Rica FIRE have some good ideas with 100 Dreams Of Travel Destinations. I hit up 17 out of 100, not too bad. Mrs. Max OOP was born in Australia so hopefully we can check out those three options of their list someday (including New Zealand).

• Montreal, Toronto and Niagara Falls, Canada (Mrs. Max OOP is Canadian)
• Ecuador
• Mexico
• China (two-week trip, even rode the high-speed train)
• Thailand
• Iceland
• Bar Harbour, ME
• Jackson Hole, WY
• Chicago, IL
• Kansas City, MO (work project)
• Las Vegas, NV
• Nashville (lived there)
• New Orleans, LA (3 trips)
• Carolinas Coast (lived two hours from here as well)
• Charleston, SC
• Finger Lakes region (got married very close to here)
• Vermont

Good opportunity to show off a few Iceland photos!

What’s going on in your personal finance world?

The post Max’s Back Pocket Vol. XII appeared first on Max Out of Pocket.

Things started ramping up this week even more than they were last week. Employees at my work are cleared daily now through a questionnaire that asks about various symptoms and activities. We even take our temperature every morning with one of those fancy infrared forehead thermometers. They are really cool and I enjoy screening people.

Every day, more and more “systems” and “processes” are being put in place to help us open the faucet while keeping everyone safe. It is encouraging.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Not much going on in our personal finance lives these days. I forgot to mention that we got our stimulus money way back on April 14th.

Interestingly, our total expenses for April came in at a record low $2,600. That means the stimulus technically covered about 92% of our living expenses in April.

We were not too creative with our stimulus money. But the folks over at All Options Considered know we’re in this together and used their money to help others. Knowing they didn’t need the money, they started giving it away way back in March before the money even hit their account. Pretty awesome.

Apparently, Twitter has a hashtag dedicated to this at #shareyourcheck. Look at that, I’m getting so much better with Twitter.

Here at Max Out of Pocket, I completed the series discussing how the passive income from my medical office building portfolio is getting taxed.

• Tax Treatment Of My REIT Dividends Part 1
• Tax Treatment Of My REIT Dividends Part 2: Non-Dividend Distributions

Healthcare

Speaking of stimulus checks, residents in nursing homes will likely qualify for checks as well. Nursing facilities and families will need to know what to do with the checks when they get them. Is there a risk this stimulus money will put a nursing home resident over the income/asset limit for Medicaid?

Medicaid can be a tricky program to navigate for families of residents living in nursing homes. A lot of state Medicaid programs don’t allow residents to have over $2,500 in assets and still qualify for the Medicaid program. Thankfully, the American Council on Aging put together a nice write-up of how this will work.

Here is the bottom line:

Stimulus checks will not be counted as income and therefore will not impact Medicaid beneficiaries or applicants. However, should the stimulus money not be spent within 12 months, it may be counted as an asset, and therefore could impact eligibility in the year ahead.

Stimulus Check Impact for Medicaid Beneficiaries

This isn’t a green light for the nursing home or assisted living facility to keep it either. The checks should probably just be deposited into their personal needs account and encourage the resident to spend it within the 12 month time period. Maybe they could get a nice new TV for their room?

We have a lot to learn about long term care (LTC) planning here at Max Out of Pocket. I’ve had the pleasure of doing some side projects for a nursing home tied to our health system and have learned a ton about how it works. Frankly, there is a lot to plan around this and it’s just another example of healthcare intersecting personal finance.

Life

On a personal level, I have been thinking for years now that I would eventually go out on my own and start my own healthcare consulting business. It would be a one-man shop. That said, it is just so much easier to work for a W2 employer who provides solid pay and benefits. My main goal for a transition like that would be to build in some additional flexibility into my life.

Thankfully, Dragon Guy started mapping this process out with Contract Work In Early Retirement – Part One: Negotiations. He was lucky enough to dip his toe into this world very quickly after pulling the plug from his W2 employer. It sounds like he learned a lot from the process. Maybe I will get there someday.

I think we are finally getting to warmer weather. Last weekend may have been our last “winter” hike of the year. We got back up to the mountains and there was still a ton of snow on the ground. Maybe this weekend will be our first “spring” hike.

How was your week?

The post Max’s Back Pocket Vol. XI appeared first on Max Out of Pocket.

That said, we did come across this freak thing on a hike last week.

My daily routine has evolved. I have been heading into work a bit later than usual; between 8 – 8:30 am. Typically have a few meetings in the morning. I grab a “to-go” lunch from the cafeteria around 11:30 am. Then, I crank out as much work as I can until about 4:30 pm when I call it a day. Toning down my hours at work has been a focus of mine for the last year or two. By the same token, I have been extremely productive and have closed out several lingering projects that have been on my list.

With that, welcome to the 10th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Yesterday was payday. Both Mrs. Max OOP and I get paid every two weeks and we are on the same payment cycle. That makes every other Friday a good “cash flow” day for us.

When I outlined how much cash we keep in our pocket for a rainy day, I mentioned we have a fidelity cash management account for our day-to-day cash needs. I consider this our ‘operating account’ where our paychecks hit and we pay bills from. It is a nice bucket for me to keep everything organized. The interest rate is currently next to nothing so I do my best to “sweep” this account every Friday and invest everything I can. It generally has just a few thousand dollars in it.

Yesterday, I made another ‘donation’ to the medical office building portfolio with a $1,000 investment in GMRE. I need to keep that project moving. I also invested about $1,000 into the total stock market index.

Our expenses have been lean and fortunately both of our jobs have been stable, and that opens up some room for additional investing. I have been debating on maxing out my 403(b) this year, so I have been putting the minimum in that account.

Speaking of lean, the mind behind Budget Life List touched on 6 Ways to Get Financially Lean During COVID-19. Working for a hospital, my favorite one is number five: lean into your health.

Ensure you’re sleeping at least eight hours, drink a lot of water, eat various colored fruits and vegetables, exercise, and meditate. A way to stay out of the hospital is to work on staying healthy.

Budget Life List

It’s certainly not a guarantee, but following this advice is worth a shot. Hospitals are expensive; I know from experience, if you know what I mean. Do you know what I mean?

Healthcare

We stayed focused on healthcare this week here at Max Out of Pocket. I decided to review the mechanics of telehealth billing with Telehealth Billing: Exposed!. We went over how it works and I think it might come in handy should your insurance decide to waive out-of-pocket costs related to telehealth services. Modifiers and place of service codes will be important.

It’s true, several payers are waiving telehealth out-of-pocket costs for 90 days. Here is Anthem’s press release. Remember, this doesn’t apply to self-insured plans; they have their own rules. That said, I would be pretty surprised if they didn’t follow along.

Waiving any member cost share until June 14, 2020 for telehealth visits, including visits for mental health and select Physical, Occupational and Speech therapies, for our fully insured employer plans, Individual plans, Medicare plans and Medicaid plans, where permissible.

Anthem

In that same press release, Anthem mentions they are relaxing/suspending select authorization requirements so providers can focus on care for patients diagnosed with COVID-19.

The Healthcare Economist briefly covers this in Fighting fraud sensibly in a global pandemic. There is a thought that relaxing some of these processes and regulations will allow unethical providers to engage in “wasteful and fraudulent activities”. While the Healthcare Economist acknowledges this risk, he argues it might be worth the cost.

The authors note that Medicare and Medicaid improper payments totaled in the tens of billions of dollars. Yet even if these figures do rise, increasing access to care in a pandemic is likely well worth the cost.

The Healthcare Economist

Life

I have said it once and I will say it again, I am starting to like this slower pace of life. We really need to start thinking about what part of this pandemic we want to keep and what parts we want to ditch. I feel like people are getting a chance to appreciate the simple things in life again.

But then again, that is easy for me to say. Mrs. Max OOP and I have been saving and investing for years. We were ready to comfortably ride out a pandemic should one pop up. We even still have our jobs. But there are plenty of others that NEED the economy to turn back on so they can get back to work. That said, there is also a lot of good coming out of this. For example, Physician On Fire donated $25,000 to COVID-19 relief. Pretty cool.

Well, that about does it for this Saturday. Here is another picture from that hike last weekend. We will try and stay away from those parts of the forest today and tomorrow.

How is your life going? Find any good hikes?

The post Max’s Back Pocket Vol. X appeared first on Max Out of Pocket.

My state is set to slowly phase-in services starting May 4th. Healthcare is at the top of this list. Treading lightly will be key to our success.

By the same token, I am wondering what parts of our infrastructure have been permanently changed. Are one-way shopping aisles here to stay? Will masking be the new norm as we enter hospitals? Are haircuts a thing of the past? Hopefully, free lunch at my hospital is put into a new policy and procedure.

After a few weeks of adjustment, the Max Out of Pocket crew quickly adapted to the new normal. We have come to enjoy the slower pace of life. We did re-up our meat supply a bit this week after hearing from the Tyson Foods chairman that there may be supply disruptions. Mrs. Max OOP went to the University of Arkansas which isn’t too far from Tyson’s headquarters. She keeps an eye on what they say. We didn’t go crazy or anything, just 5 lbs of beef and a large packet of chicken. You never know. We have been pretty good at spacing out our trip to the store.

With that, welcome to the 9th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got implemented into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this idiomatic experiment?

Max’s Back Pocket.

Personal Finance

If you like personal finance stories with real numbers in them as much as I do, the folks over at Fire On The Plains shared their story in January. They started back in 2009 with nearly $130,000 in student debt. By January 2020, they were on their way to being completely debt-free with only $29,000 left on their mortgage. They also put up some serious salaries, blowing out the 250k mark by the end of 2019. Apparently, there is also a 1959 film called Fires on the Plain.

Got Float?

Mrs. Max Out of Pocket and I sold our house down south when we moved to New England a few years back and have been renting ever since. We have zero debt except for the 25-30 day “float” we hold on our credit card interest-free every month. I have paid this balance in full every month for as long as I can remember. We incur absolutely no interest expense on it. I would venture to say I have never paid a dime to the credit card industry in interest. Here is a look at how our “float” looks as of today.

I suppose our financial pick up on this is pretty immaterial since the interest rate on my cash allocation is so low. I guess in the long term, say maybe 1-lifetime unit, it adds up. It also helps us manage our cash flow and extends our emergency fund by about 20k. Note the $20,000 credit limit; a pretty solid emergency fund should we ever need it.

Careful though, you don’t want to “ride the float“. There is a simple test to know if you have fallen into that trap. The folks over at You Need A Budget do a great job explaining this. Are you riding the credit card float?

Still not sure if this applies to you? Here’s the test to determine if you are trapped in the float: If you can’t pay the credit card in full right now AND meet your current obligations, you’ve got debt. You’ve probably been riding the float.

Are you riding the credit card float?

Healthcare

Here at Max Out of Pocket, we took a break from personal finance this week and checked on our options for telehealth. I basically broke everything down to video/audio visits, phone visits, and email/patient portal visits. I even disclosed the billing codes. Next week I am going to take a closer look at the billing and how it might impact our out-of-pocket cost calculation. Just another example of where healthcare intersects personal finance.

Healthcare can be hard to keep up with. The mind behind the Paradigm Shift of Healthcare is certainly making it easier. I like how they try to keep the politics and policy debates out of their content. In episode 37, they touch on responding to negative payment trends. In this episode, they bring on Dr. Tom Davis. He discusses telehealth, healthcare bailouts, and strategy for operating a small physician practice in the current environment.

Dr. Davis warns that although telehealth removes some of the friction from receiving care, it is not a substitute for an actual visit with your doctor and may further fragment the healthcare market. He also compares the 2008 bank bailout to the current situation in the healthcare market and references a “partnership” between health systems and the government. I personally think that’s a stretch, but I suppose I can at least see his thought process.

He warns that the landscape has changed and small clinicians are not only competing against health systems but also the government. Finally, he says payment trends are shifting incentives for performing procedures and thus moving dollars from primary care to specialty services who commonly perform procedures.

Life

Mrs. Max OOP has been teaching her high school kids from home. It’s not easy, but she has been making it work. Apparently, that is nothing compared to homeschooling your own kids. Joe from Retire by 40 says homeschooling is hell! He is using this spring as a trial run since they have plans to take a trip around the world. This trip would theoretically force them into a home-schooling situation.

I suppose it is time for me to finish my coffee and enjoy the rest of my Saturday. The Max out of Pocket crew doesn’t have a ton planned for this weekend, but I am sure we will figure something out. We got some turkey eggs from a colleague at work, so I suppose that is next on the agenda. I have never had turkey eggs!

How was your week?

The post Max’s Back Pocket Vol. IX appeared first on Max Out of Pocket.