2012 woa spring news woa... · 2015-10-28 · 2012 howard steel lecturer p. 4 multimedia education...

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Brian Jewett and his Program Committee have put together up to 28.75 hours of cut- ting edge education while still allowing time in the afternoons to “smell the roses.” With the London Summer Games starting shortly after our meeting ends, I’m sure there will be great interest in Rudolf Hoellrich, MD’s symposium on “Care of the Athlete,” includ- ing views on concussions, stress fractures, and plasma-rich protein injections Val Lew- is, MD will moderate the “Tumor Update” symposium, covering the management of skeletal metastases Bill Maloney, MD will oversee the “Total Joints: Back to Basics” symposium with discussions on infected joints, instability, and venous thrombo-em- bolism prevention David Lowenberg, MD will lead the discussion at the “Common Fractures in the Elderly-Current State of the Art” symposium. David’s panel will look at distal radius, proximal humeral, hip, and spinal compression fractures. Ken Butters, MD and his symposium colleagues will tell us about the “Elbow – Cradle to Grave,” including pediatric and adult fractures and advanced imaging Last but not least, Steve Ladies and Gentlemen, Lush parks, gorgeous plants and wildlife, your choice of relaxing or challenging hiking trails, an active volcano and the highest point in Ore- gon beckoning to be climbed, lakes and streams for canoeing and fishing, average June high temperatures in the mid 70s, the Columbia River and its gorge where the ad- venturous can sail and windsurf, great din- ing, avant-garde brewpubs. Sound like paradise? Well it is, but now we call it Portland, OR, “The City of Roses.” More than that, it’s the site of the 76 th Annual Meeting of the West- ern Orthopaedic Association. To match the grandeur and majesty of our host city, we’re planning an outstanding and enjoyable edu- cational experience for you and your family. Our home base will be the Hilton Portland and Executive Tower. Its central location is ideal for sightseeing, shopping, and enjoying great dining, sports, and a myriad of cultural events. www.woa-assn.org Spring 2012 Volume 14 Number 2 President’s Message Peter J. Mandell, MD News Western Orthopaedic Association Ross, MD and his expert panel will conclude our 2012 six-symposium cycle with the latest on the “Foot and Ankle,” including ten- donopathies and midfoot injuries. We’re honored to welcome John Tongue, MD, AAOS President and a native Orego- nian, to deliver the AAOS report at our meet- ing. I am delighted that my Presidential Guest Speaker, Kevin Bozic, MD, the current Chair of the AAOS Council on Research and Quality, will be with us as well. Our Howard Steel Lecturer is Bruce Paton, MD, who will tell us about “Doctors in the Wilderness” in the early days of America and Oregon. In addition to our symposia, we will have a wide selection of original research papers, young investigator award papers, resident I N S I D E 2012 Award Winners p. 2 2012 Program Chair’s Message p. 3 2012 Scientific Program Highlights p. 3 2011 Presidential Guest Speaker p. 4 2012 Howard Steel Lecturer p. 4 Multimedia Education Sessions p. 4 Upcoming WOA Meetings p. 4 Money Matters p. 5 Chapter Connection p. 7 Practice Management Advisor p. 7 The WOA has been working extremely hard to bring a very valuable benefit to its mem- bers and all attendees at the WOA Annual Meeting. The SAE (Self Assessment Exami- nation) Team, chaired by Dr. Nitin Bhatia, and including Drs. Brian Jewett, Valerae Lewis, William Maloney, and Richard Haynes, has prepared a program that will provide 10 SAEs that are required for every doctor’s MOC (Maintenance of Certifica- tion). The SAE program is embedded in the WOA Annual Meeting, which allows you, the physician, to attend the meeting and receive a possible 28.75 CMEs and at the same time receive your 10 SAEs. The development process is a lengthy one requiring a significant amount of manpower and time. The WOA program is now being reviewed by the American Board of Ortho- paedic Surgeons (ABOS) for SAE approval and we are hopeful that we will receive ap- proval soon. So come to the WOA meeting prepared to satisfy your MOC requirements; the cost is significantly less for WOA mem- bers than other programs. Due to our format, you can earn your 10 SAEs at the same time you are earning the valuable CMEs. Self Assessment Exam Available at Annual Meeting WOA’s 76th Annual Meeting June 13-16, 2012 Hilton Portland Portland, OR

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Page 1: 2012 WOA Spring News woa... · 2015-10-28 · 2012 Howard Steel Lecturer p. 4 Multimedia Education Sessions p. 4 Upcoming WOA Meetings p. 4 Money Matters p. 5 Chapter Connection p

Brian Jewett and his Program Committeehave put together up to 28.75 hours of cut-ting edge education while still allowing timein the afternoons to “smell the roses.” Withthe London Summer Games starting shortlyafter our meeting ends, I’m sure there will begreat interest in Rudolf Hoellrich, MD’ssymposium on “Care of the Athlete,” includ-ing views on concussions, stress fractures,and plasma-rich protein injections Val Lew-is, MD will moderate the “Tumor Update”symposium, covering the management ofskeletal metastases Bill Maloney, MD willoversee the “Total Joints: Back to Basics”symposium with discussions on infectedjoints, instability, and venous thrombo-em-bolism prevention David Lowenberg, MDwill lead the discussion at the “CommonFractures in the Elderly-Current State of theArt” symposium. David’s panel will look atdistal radius, proximal humeral, hip, andspinal compression fractures. Ken Butters,MD and his symposium colleagues will tellus about the “Elbow – Cradle to Grave,”including pediatric and adult fractures andadvanced imaging Last but not least, Steve

Ladies and Gentlemen,

Lush parks, gorgeous plants andwildlife, your choice of relaxingor challenging hiking trails, an

active volcano and the highest point in Ore-gon beckoning to be climbed, lakes andstreams for canoeing and fishing, averageJune high temperatures in the mid 70s, theColumbia River and its gorge where the ad-venturous can sail and windsurf, great din-ing, avant-garde brewpubs. Sound likeparadise?

Well it is, but now we call it Portland, OR,“The City of Roses.” More than that, it’s thesite of the 76th Annual Meeting of the West-ern Orthopaedic Association. To match thegrandeur and majesty of our host city, we’replanning an outstanding and enjoyable edu-cational experience for you and your family.Our home base will be the Hilton Portlandand Executive Tower. Its central location isideal for sightseeing, shopping, and enjoyinggreat dining, sports, and a myriad of culturalevents.

www.woa-assn.orgSpring 2012 Volume 14 Number 2

President’s MessagePeter J. Mandell, MD

NewsWestern Orthopaedic Association

Ross, MD and his expert panel will concludeour 2012 six-symposium cycle with the lateston the “Foot and Ankle,” including ten-donopathies and midfoot injuries.

We’re honored to welcome John Tongue,MD, AAOS President and a native Orego-nian, to deliver the AAOS report at our meet-ing. I am delighted that my PresidentialGuest Speaker, Kevin Bozic, MD, the currentChair of the AAOS Council on Research andQuality, will be with us as well. Our HowardSteel Lecturer is Bruce Paton, MD, who willtell us about “Doctors in the Wilderness” inthe early days of America and Oregon.

In addition to our symposia, we will have awide selection of original research papers,young investigator award papers, resident

I N S I D E

2012 Award Winners p. 2

2012 Program Chair’s Message p. 3

2012 Scientific Program Highlights p. 3

2011 Presidential Guest Speaker p. 4

2012 Howard Steel Lecturer p. 4

Multimedia Education Sessions p. 4

Upcoming WOA Meetings p. 4

Money Matters p. 5

Chapter Connection p. 7

Practice Management Advisor p. 7

The WOA has been working extremely hardto bring a very valuable benefit to its mem-bers and all attendees at the WOA AnnualMeeting. The SAE (Self Assessment Exami-nation) Team, chaired by Dr. Nitin Bhatia,and including Drs. Brian Jewett, ValeraeLewis, William Maloney, and RichardHaynes, has prepared a program that willprovide 10 SAEs that are required for everydoctor’s MOC (Maintenance of Certifica-tion). The SAE program is embedded in theWOA Annual Meeting, which allows you,the physician, to attend the meeting andreceive a possible 28.75 CMEs and at thesame time receive your 10 SAEs.

The development process is a lengthy onerequiring a significant amount of manpowerand time. The WOA program is now beingreviewed by the American Board of Ortho-paedic Surgeons (ABOS) for SAE approvaland we are hopeful that we will receive ap-proval soon. So come to the WOA meetingprepared to satisfy your MOC requirements;the cost is significantly less for WOA mem-bers than other programs. Due to our format,you can earn your 10 SAEs at the same timeyou are earning the valuable CMEs.

Self Assessment Exam Available at Annual Meeting

WOA’s 76th Annual MeetingJune 13-16, 2012Hilton PortlandPortland, OR

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Western Orthopaedic Association News

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award papers, and instructional course lec-tures. There will be scientific posters andmultimedia education sessions.

We won’t lack social events either. Attendeeswill have an opportunity to take a tour of theNike headquarters, sign up for an epicurean’swalk to taste Portland’s fine food and drink,and enjoy a half-day excursion to the Colum-bia Gorge and Waterfalls. Our Friday eveningGala Dinner will feature entertainment from

Dave Anderson, a nationally touring comedi-an who has appeared on numerous TV showsand written for Jay Leno.

Please join us in Portland, June 13-16, 2012,for a great educational experience and sum-mer fun as well.

Sincerely,Pete and Jeanne Mandell

President’s Message continuedWOA 2011-2012 Board of

Directors

Peter J. Mandell, MD

Ellen M. Raney, MD

Valerae O. Lewis, MD

Theodore L. Stringer, MD

Kim L. Furry, MD

David D. Teuscher, MD

Jeffrey M. Nakano, MD

Richard J. Barry, MD

William J. Maloney III, MD

Kevin L. Smith, MD

Nitin N. Bhatia, MD

Omer A. Ilahi, MD

Steven J. Morgan, MD

Lisa A. Taitsman, MD

Lawrence R. Housman, MD

Paul C. Collins, MD

Robert Slater, Jr., MD

Brian A. Jewett, MD

Congratulations to the following 2012 WOAResident/Fellow Award Recipients. Theaward papers will be presented during theScientific Program on Thursday 11:35 am –12:44 pm.

The Lloyd Taylor, Vernon Thompson, Haroldand Nancy Willingham, Sanford and DarleneAnzel, and Resident Award Winners will beannounced Friday evening.

Incidence and Morbidity of ConcomitantSpine Fractures in Combat Related Amputees

Blockade of Matrix Metalloproteinase-3 afterTraumatic Nerve Injury Offers a Novel Treat-ment for Improving Functional Recovery

The Effect of Pedicle Screw Hubbing on Pull-out Strength in the Thoracic Spine

Arthroscopic Basic Task Performance inShoulder Simulator Model Correlates withClinical Shoulder Arthroscopy Experience

Daptomycin and Tigecycline Have a BroaderEffective Dose Range Than Vancomycin asProphylaxis Against a Surgical Implant Staph-ylococcus Aureus Infection

2012 Award Recipients

A Biomechanical Comparison of Plate Fixa-tion and Calcium Phosphate Cement for Dis-tal Femoral Metaphyseal Defects

Change in Physical Activity One Year afterLumbar Decompression With or WithoutFusion, Is it Correlated to Self-Reported Out-come Scores?

WOA has added three new awards this yearfor Young Investigators. Congratulations tothe following 2012 WOA Young InvestigatorAward Recipients. The award papers will bepresented during the Scientific Program onFriday 8:30 am – 9:00 pm.

Functional Assessment of Acute Local VersusDistal Transplantation of Human NeuralStem Cells Following Spinal Cord Injury

Surgical Treatment of Insertional AchillesTendinopathy With or Without Flexor Hal-lucis Longus Tendon Transfer: A Prospective,Randomized, Controlled Trial

Evaluation of Akt/mTOR Activity in MuscleAtrophy and Fatty Infiltration after RotatorCuff Tears in a Rat Model

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2012 Program Chair’s MessageI was honored when the WOABoard and President Pete Man-dell asked for my help in devel-oping this year’s WOA AnnualMeeting’s Scientific Program.The Program Committee has

been hard at work creating a dynamic andinteresting program.

With 2012 being an Olympic year, we beginthe program on Thursday with our SportsMedicine Symposium ,where distinguished faculty will discuss top-ics on stress fractures, concussions, and PRPinjections. Following that, our Tumor facultywill be discussing bone and soft tissue tu-mors, what to look for and updates on man-agement of skeletal metastases. Thursdaywill also have concurrent paper topics onsports medicine and tumor.

Friday is a busy day for the scientific pro-gram. In addition to the new Young Investi-gator Award papers, the Total JointSymposium will review topics on thrombo-embolism controversies, instability manage-ment, infections, and complications withnew bearings. We have a special lecture onosteoporosis coupled with our Trauma Sym-posium on management of osteoporotic frac-

tures. We also have an exciting PracticeManagement Symposium covering emergingtopics on physician hospital relationshipsand ACOs.

On Saturday, we have Symposia on currenttopics on foot and ankle maladies, and diffi-cult adult and pediatric elbow problems. Po-dium papers will be presented on topics fromfoot and ankle, pediatrics, spine, and upperextremity.

The Program Committee would like to inviteyou to bring challenging, troubling, or other-wise interesting cases to discuss at three earlymorning sessions. Thursday morning beforethe General Session we will have a panel todiscuss sports medicine cases, specificallyfocused on stress fractures and concussions,and on Friday morning we will be discussingtopics on arthroplasty, and on Saturday wewill have a panel reviewing elbow cases. Besure to come with cases or topics for whichyou would like expert help.

In addition to the scientific program, Dr.Pete Mandell has invited Dr. Kevin Bozicfrom UCSF to speak as the Presidential GuestSpeaker. Dr. John Tongue will address theWOA with updates from the AAOS. Our

Howard Steel Lecturer, Dr. Bruce C. Patonwill be presenting his talk “

”, a topic relevant tothe history of Portland, Oregon and generalmedicine.

Our Portland meeting is shaping up to be oneof the best in years. The Program Committeeand many distinguished faculty are excited topresent the scientific program to you thisyear, while the WOA Board is equally antic-ipating a fun, interactive social program. Welook forward to seeing you in Portland!

Sincerely,Brian A. Jewett, MD

2012 Program Committee

The Western Orthopaedic Associationgratefully acknowledges the followingorthopaedic surgeons for their contri-butions to the development of the sci-entific program.

Brian A. Jewett, MD, ChairNitin N. Bhatia, MD, FACSMichael P. Dohm, MDJames P. Duffey, MDMelvyn A. Harrington, MDBryan S. Moon, MDSteven J. Morgan, MD

Thursday – June 14, 2012GENERAL SESSION I – Clinical Case Presenta-tion ReviewSYMPOSIUM I – Care of the AthleteCONCURRENT GENERAL SESSION II – Tumor &Basic ScienceCONCURRENT GENERAL SESSION III – SportsMedicineGENERAL SESSION IV – Howard Steel LectureBruce C. Paton, MD, “Lewis and Clark: BetterThan Most Doctors”SYMPOSIUM II – Tumor UpdateGENERAL SESSION V - Resident Award PapersGENERAL SESSION VI – Recredentialing Up-dates: MOC and MOL & BOC ReportPOSTERS (Open daily to all participants before and afterthe Scientific Program.)

MULTIMEDIA EDUCATION SESSION (Following PosterSession)

Friday – June 15, 2012GENERAL SESSION VII – Clinical Case Presenta-tions ReviewSYMPOSIUM III – Total Joints: Back to BasicsGENERAL SESSION VIII – Young InvestigatorAward PapersGENERAL SESSION IX – Special LectureSusan Bukata, MD “Osteoporosis: Orthopae-dic Knowledge and Management”SYMPOSIUM IV – Common Fractures in the El-derly-Current State of the ArtGENERAL SESSION X – AAOS Report and Presi-dential Guest Speaker, Kevin Bozic, MDSYMPOSIUM V – Practice ManagementCONCURRENT GENERAL SESSION XI – TraumaCONCURRENT GENERAL SESSION XII – Total JointPOSTERS (Open daily to all participants before and afterthe Scientific Program.)

MULTIMEDIA EDUCATION SESSION (Following PosterSession)

EXHIBITOR AND POSTER PRESENTATION RECEPTION

Saturday – June 16, 2012GENERAL SESSION XIII – Case Presentations Re-viewSYMPOSIUM VI - Elbow – Cradle to GraveGENERAL SESSION XIV – Advocacy Update IICONCURRENT GENERAL SESSION XV – Upper Ex-tremityCONCURRENT GENERAL SESSION XVI – Foot &Ankle/Practice ManagementSYMPOSIUM VII – Foot & AnkleGENERAL SESSION XVII – OREF Update & Presi-dential AddressCONCURRENT GENERAL SESSION XVIII – Pediat-ricsCONCURRENT GENERAL SESSION XIX – SpinePOSTERS (Open daily to all participants before and afterthe Scientific Program.)

MULTIMEDIA EDUCATION SESSION (Following PosterSession)

2012 Scientific Program Highlights

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Western Orthopaedic Association News

It is a great pleasure for WOA tohave Dr. Kevin J. Bozic as the 2012Presidential Guest Speaker for theAnnual Meeting to be held inPortland, Oregon. Dr. Bozic is an

orthopaedic surgeon who specializes incomplex hip and knee replacement with anemphasis on minimally invasive techniques.He has extensive experience in all aspects ofjoint replacement and arthritis management.In research, his interests are in health carepolicy, health care technology assessment,cost-effectiveness analysis, and the impact ofcare delivery reform on cost and quality.

Dr. Bozic is a graduate of the University ofCalifornia, San Francisco School of Medicine

and the Harvard combined orthopaedicresidency program. He completed afellowship in musculoskeletal traumatologyat Massachusetts General Hospital, anaffiliate of Harvard Medical School, as well astraining in adult reconstructive surgery atRush Medical College in Chicago. Inaddition, he earned a master’s degree inbusiness administration at Harvard BusinessSchool. He is an active member of the boardof directors of the American Academy ofOrthopaedic Surgeons and has been involvedin numerous regional and national healthpolicy initiatives including the MedicareEvidence Development and CoverageAnalysis Committee.

2012 Presidential Guest SpeakerKevin J. Bozic, MD, MBA

Upcoming WOA Meetings

July 31 - August 3, 2013Resort at Squaw Creek

Lake Tahoe, CA

June 13-16, 2012The Hilton Portland

Portland, OR

2012 Howard Steel LecturerBruce C. Paton, MD

WOA is pleased to have BrucePaton, MD as this year’s HowardSteel Lecturer. Dr. Paton was bornin India, where his father was adoctor in the Indian Medical Ser-

vice, and lived there for six years. He waseducated in Scotland and received his medi-cal degree from the University of Edinburgh.He also served in the military as a Lieutenantin the Royal Marines, serving in the 41st and45th Commandos in Europe and Hong Kong.

After graduating from medical school, Dr.Paton spent a year at the Church of ScotlandHospital at Chogoria, Kenya. During thattime, he was the doctor on the first OutwardBound School course ever held in Africa. Themain purpose of the course was to climbKilimanjaro, which he successfully accom-plished with his group.

Returning to Edinburgh he trained first incardiology, then in surgery, and finally im-migrated to the United States in 1958 as aresearch fellow at the University of Colora-

do. During the next 21 years he rose throughthe academic ranks, becoming a professorand Chief of the Cardiac Surgical Service.During his last year at the school he was theActing Dean. Dr. Paton went into the privatepractice of cardiovascular surgery for thenext 16 years and finally retired in 1995 asEmeritus Clinical Professor of Surgery.

His outside interests of climbing, bird-watching, painting, and photography beganwhen he was a boy in Scotland and havecontinued ever since. These interests got himinvolved in the Colorado Outward BoundSchool, in which he served as Chairman ofthe Board, and the Denver Audubon Society,and the Wilderness Medical Society, servingas President for both organizations.

Dr. Paton has an extensive medical bibliogra-phy of 200 papers and contributions to 15books. Apart from writing about heart sur-gery, he has done research and written aboutfrostbite and hypothermia, two topics verypertinent to the Lewis and Clark expedition.

He has traveled in every continent of theworld, and except in Antarctica, he has usu-ally hiked, climbed, and slept in tents ratherthan visiting the capital cities and sleeping incomfortable hotels. He was the doctor lectur-er and leader on six trips for Mountain Travelto Africa, Chile, Alaska, the Alps, and Nepal.His interest in expeditions and history gothim interested in Lewis and Clark. His book,“Lewis and Clark: Doctors in the Wilderness”was published in 2001 and has received com-plimentary reviews as a highly readable ac-count of the medical problems encounteredby the expedition and how they might behandled now. The book covers the medicalpreparations for the expedition and the stateof medicine in 1800 and discusses such con-troversial subjects as the death of Sgt. Floyd,the illness of Sacagawea, and Lewis’ gunshotwound.

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Multimedia Education SessionsThe WOA will provide a multimedia education session following the Scientific Program on Thursday, Friday, and Saturday, June 14-16. A com-prehensive selection of AAOS DVDs will be available for your review. These DVDs will highlight surgical procedures and current concepts in or-thopaedics. Registered attendees should find these DVDs informative and helpful in their practice.

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Will You Conquer the Cash Crunch in Retirement? How to Meetthe #1 Financial Challenge Facing Baby Boomers…and AvoidCommon Pitfalls

David Mandell, JD, MBA and Dinah Bird, Ph.D., CFP®, CIMA

When selling almost anyasset, you will pay capital gains taxes atboth the federal and state level. Thesetaxes can eat up 25% of the gains. Fordistributions from a qualified retirementplan or IRA, the tax bite can be as highas 45%! Relying solely or significantly onliquidation strategy means being subjectto these taxes and to the risk that suchrates will increase. Given that federalcapital gains tax rates are at the lowest intheir history, being subject to future taxincrease is not a risk to overlook.

A laddered bond portfolio is a strategy com-monly used by retirees whereby an investorpurchases a group of bonds with differentmaturities, attempting to match cash flowswith the demand for cash. One bond mightmature in one year, another in three years,and the remaining bonds might mature infive-plus years. Each bond represents a differ-ent rung on the ladder.

As inflation goes up,the bonds in the laddered portfolio donot keep up with buying power. Thebonds and their interest may pay thesame, but the investor can purchase few-er goods with the same amount of mon-ey.

As rates rise, theprices of a fixed rate bond will fall, andvice versa. Although bond laddering is atried and true approach, consider theproblems of allocating a substantialamount of money to a laddered portfolioin light of today’s interest rate environ-ment and a seven-year treasury paying2.875%!

Interms of dividend-paying stocks, divi-dend pay outs are based on a percentageof the stock’s price. As the stock marketfluctuates, so does the yield from thestock. The stock dividend will go down

dollar-wise if the market takes a downturn -- just when the dividend is mostneeded.

The life annuity (not to be confused with thevariable annuity) is designed by actuaries topay interest and principal back to you overyour lifetime. Essentially, you write an insur-ance company a check today and they payyou monthly, quarterly, or annually for therest of your life (or the longer of your life andyour spouse’s). The benefits of this strategyinclude:

1. The amount the insurance compa-ny pays you is “fixed” and will notdecrease if the stock market crashesor if interest rates fall.

2. Even if you outlive your life expec-tancy, the insurance company con-tinues to pay you or your spouse foras long as you are alive.

However, as interest rates have been at his-toric lows for a number of years, annuitypayment rates are also extremely low. Thismakes their internal rate of return (IRR) verypoor. As with any insurance product, thestrength of the insurance company is also arisk. Since you may want payments for de-cades in the future, only the strongest carriersshould be considered.

Finally, the inflation risk to this techniquealso weakens its attractiveness. If inflationrepeats itself like the early 1980s with theprime rate at 21% or even a reasonable 8%,then a 3% annual check from the annuity(not uncommon in today’s market) is not asattractive. For these reasons, a life annuitycan be part of a balanced cash income strate-gy, but it typically should not be heavilyrelied upon.

Abby is on the brink of retirement at 62.Abby has social security, a $1.2 million homenear her four grandchildren, a 4% life annui-

Those of you born between 1946 and 1964are part of the 77-million strong Baby Boom-er generation – one that is now contemplat-ing retirement. If you were born before 1946,you may already be retired or seriously con-sidering it. If you fit into either of thesegroups, the following issue will be paramountfor all of your financial decisions movingforward: “How do I take the wealth I havesaved and efficiently turn it into cash incometo sustain me during retirement?” No won-der, as the quote above makes clear, manysoon-to-be retirees are worried about run-ning out of money in their retirement.

In this article, we will discuss problems withthe solutions retirees typically rely on to gen-erate cash income in their retirement andsuggest alternatives which may be safer andmore efficient.

“Conventional wisdom” suggests that finan-cial planning for retirement should includevarious investment strategies for generatingcash to live on. Let’s examine the leadingstrategies for generating cash and the signifi-cant risks inherent in each of them:

This technique is used in almost all retirees’planning. It simply means periodically sellingassets to generate cash to live on – whetherthose assets are in IRAs, personally-held se-curities and investments, real estate, the fam-ily home, business, etc. The problems withperiodic liquidation are:

Timing the saleof an asset can be tricky, as many retireescan attest to in the aftermath of the stockmarket crash of 2008. The investmentyou are selling may be discounted 30 to50 percent at the time you need to sell.Being stuck in a “liquidation only” strat-egy in market downturns can be danger-ous.

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Western Orthopaedic Association News

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ty on a $500,000 policy, and an impressive50/50 investment portfolio of stocks andbonds valued at $3 million that is a combina-tion of her IRAs, 401(k)s and savings. Abbyenjoys semi-annual vacations with hergrandchildren but otherwise expects to easilylive on $200,000 income per year during herretirement. She is in good health and, due toher family history, expects to live until theage of 90. Abby divorced many years ago andhas no alimony liabilities. She has a long termcare insurance policy that will pay her$10,000 annually. All is looking good forAbby’s retirement.

Abby’s practice was bought out two yearsago, and she has decided to retire five yearsearlier than planned. She considers this a safedecision, as she has a paid-off home, an annu-ity, long term care insurance and a $3 million50/50 stock/bond portfolio. Despite retiringearlier than anticipated, she has planned welland is better positioned than 99% of Ameri-cans at retirement.

Abby decides to keep her house to avoidselling at a loss. She forgoes a reversiblemortgage because the “fees are outrageous.”Current inflation is benign at 1.7%, which isa nice advantage. She has the cushion of longterm care if needed. Abby is living within her$200,000 per year budget.

Abby meets her $200,000 annual cash needsby these income streams:

1. Social Security = $30,000.002. Annuity payments (4% of $500,000) =

$20,000.003. Dividend payments from her 50% in

stocks (2.00%) = $30.000.004. Interest payments from her 50% bond

ladder of 1-10 years, Which has ablended yield of (3.00%) = $45,000.00

Total in flows = $125,000.00

Abby’s two largest drains on her annual in-come are:

1. Income tax ($50,000.00)2. Property tax on her home

($30,000.00) Total out flows = (80,000.00)

Netting out the outflows from the income,leaves a shortfall of $155,000 of cash.

Abby will need to liquidate stocks and bondsin her investment portfolio to make up theshortfall of $155,000 for taxes and cash.Chances are very high she will have to liqui-date some of her stock when the market isdown due to normal stock market fluctua-tions. Consequently, Abby will have to selleven more stock to generate the appropriateamount of cash needed. Plus, there is a highprobability that inflation will cause the priceof her bonds to decrease as she liquidatesthem for cash.

Abby’s investments will most likely sus-tain her for the 28-year time horizon and herportfolio will be depleted before her death.Abby may very well experience the numberone fear of retirees -- running out of moneyin retirement!

The Alternative Income solution can helpAbby overcome this challenge. Instead ofliquidating her portfolio of stocks and bondsfor cash each year, Abby can add alternativecash income to her bond portfolio. By doingso, she will boost her income, provide aninflation hedge, and liquidate less of herstocks/bonds, allowing her portfolio to grow.An alternative income strategy will help ex-tend the life of her investment portfolio soshe will have investments for as long as shelives.

“Traditional” investments are consideredstocks, bonds, currency, or hard assets, suchas real estate. An “alternative cash incomestrategy” is one that involves combinations ofsuch assets to create a unique portfolio de-signed to generate cash income.

One Alternative Income Strategy provides adiversified cash flow stream from hard assetsthat are in the form of an investment securitycalled a Real Estate Investment Trust or RE-IT. The advantages of using REITs for form-ing a foundation of a cash-focused retirementstrategy are:

1. According to the law, at least 90% ofthe cash flow streams generated fromproperties in the REITs must bepassed to the owner/investor of theREIT.

2. REITs can be an inflation hedge; asinflation increases, the property rentsusually increase as does the value ofthe property.

3. REITs typically offer a low correla-tion to the U.S. stock market, whichmeans that REITs help decrease vola-tility.

A REIT-based Alternative Income Strategybasically works like this:

An investor buys into an REIT portfolio,which will generate about 6.5% income tosupplement the money needed for expenses.Consequently, fewer securities are needed tobe sold out of the retiree’s portfolio, whichshould generate more growth in their invest-ments. Adding REITs as an alternative in-come to a portfolio has the potential toaugment conventional strategies by enhanc-ing cash flows and extending the life of theretiree’s investment portfolio.

Generating income throughout retirement isa significant challenge. Common techniques,including asset liquidating, bonds, dividend-paying stocks and life annuities, all havesignificant risks associated with them. There-fore, the use of alternative income tech-niques is often recommended to augmenttraditional techniques.

Your financial needs are complex and theauthors welcome your questions. You maycontact them at (877) 656-4362 or throughtheir website www.ojmgroup.com.

SPECIAL OFFER: For a free trial of the “CashIncome Calculator,” please call (877) 656-4362.

Money Matters continued

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w w w . w o a - a s s n . o r g / S p r i n g 2 0 1 2 / V o l u m e 1 4 / N u m b e r 2

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Whenever possible, have your front deskstaff collect patient copays, deductibles, andprepays at the time of service. Make payingup front easier for patients by accepting debitand credit card -- and possibly even online --payments.

Since coding errors are the source of mostdenied claims, training staff to focus on accu-racy in coding should be a priority. In addi-tion, the submission of “clean” claims withina certain number of days after a service isrendered should be a goal of your staff.

Review your accounts receivable. You’llprobably discover that, for certain accounts,your practice loses money every time it gen-erates statements, considering labor costs,postage costs, and envelopes. Write off ac-counts that are not worth pursuing becausethey are either too old or are for smallamounts. And consider writing off other ac-counts that seemingly never will be paidbecause your office failed to send the bill ina timely manner or because the patient didnot obtain the correct referral for the servic-es your practice provided.

We can help your practice implement proce-dures that can reduce the number of uncol-lected bills. Please contact us for moreinformation.

is provided bySomerset’s Health Care Team for our clientsand other interested persons upon request.Since technical information is presented ingeneralized fashion, no final conclusion onthese topics should be made without furtherreview. For additional information on theissues discussed, please contact a member ofour Health Care Team. This document is notintended or written to be used, and cannot beused, for the purpose of avoiding tax penal-ties that may be imposed on the taxpayer.

Unpaid claims are a fact of life for manymedical practices. Unfortunately, the longerpatient bills remain uncollected, the less val-uable the receivable becomes to the practice.Keeping the percentage of unpaid patientbills to a minimum should be a priority for allphysicians.

Your practice can take a variety of stepstoward greater profitability, including speed-ing up collections and minimizing the denialof claims. It should also focus on cleaning upand writing off old claims.

Your practice should have procedures inplace that generate up-to-date informationon the status of each outstanding account.Your accounting staff should have a reportthat includes the date each bill was sent, thecurrent balance, and the number of days de-linquent.

Using the information on that list, your staffshould contact delinquent patients on a pre-determined schedule. However, you shouldalso consider sending out fewer notices be-fore past due accounts are sent to a collectionagency.

Smarter Accounts Receivable Management

The Arizona Orthopaedic Society is pleasedto announce that they will host their AnnualMeeting, June 8 - 9, 2012 in the Phoenix/Scottsdale area.

The meeting will begin with a family-friend-ly opening night reception on Friday, June 8.On Saturday, June 9, they will celebrate theArizona Orthopaedic Residents with a resi-dent paper competition, in addition to invit-ing several speakers to address currentsocio-economic issues of interest. That eve-ning, everyone will enjoy an Arizona Dia-mondbacks baseball game in a party suite.

Look for registration information onlinesoon at www.azortho.org. Hotel rooms willbe available for attendees on both Friday andSaturday nights.

For more information or questions, contactPatrice at [email protected].

The 79th Northern California OrthopaedicSociety (formerly NCCWOA) Annual Meet-ing will be held June 1 - 3, 2012 at the CarmelValley Ranch Hotel in Carmel, California.

To view the registration brochure and thecomplete Clinical & Scientific Program,please visit www.norcalortho.com or formore information, contact Karmi A. Fergu-son at [email protected] orcall (707) 297-6576.

We want to include your Chapter news in the Chapter Connection. If your

local WOA Chapter has a meeting, event, orannouncement, please email information [email protected].

Statements and opinions expressed in the advertisements and information regarding products or services herein are those of the author(s) and do not necessarily reflectthose of the Publisher or the Association. The Publisher and the Association do not assume any responsibility or liability for such material and do not endorse,guarantee or warrant any product or service advertised in this newsletter.

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110 West Rd, Suite 227Towson, MD 21204E-mail: [email protected]: www.woa-assn.org

Member Incentive

Refer and sponsor new memberand receive 1/2 off the registration

fee for the next annual meeting.

Refer and sponsor new mem-bers and the registration fee for the

next meeting is waived.

Do You Know a Qualified MD or DOOrthopaedic Colleague Who Is Not a WOA Member?

Apply formembership

online at

or call

and ask foran application.

The Benefits of Being a Member:

10. WOA newsletter9. Awards and scientific recognition8. Diverse annual meeting content7. Substantial discounts to other regional

society meetings6. Annual meeting discount for members5. Free subscription to the

4. Meeting registration fee waived for newmembers’ first year

3. Eligibility to participate in Ortho-Preferred®,a professional liability insurance programexclusively for orthopaedic surgeons

2. 10 SAEs incorporated in the Annual Meetingprogram content

1. 24 FREE CME credits through the

FreeMeeting

Registration!

Completion of an accredited residency program and privileges topractice as an orthopaedist in a local hospital are the

requirements for both MD and DO candidates.