Archive for February, 2018

Alabama’s Physicians Contribute Billions to State Financial Health

Alabama’s Physicians Contribute Billions to State Financial Health

MONTGOMERY – Alabama’s more than 8,700 patient care physicians fulfill a vital role in the state’s economy by supporting 101,770 jobs and generating $16.7 billion in economic activity, according to a new report released by the Medical Association of the State of Alabama and the American Medical Association.

“Urban or rural, large group or solo practitioner, Alabama’s physicians are major economic engines,” said Medical Association President Jerry Harrison, M.D., of Haleyville. “While we are healers first, this study shows physicians help improve the health of our state as much as the health of our patients.”

The report measured the economic impact of Alabama’s physicians according to four key economic barometers:

  • Jobs: Each physician supported an average of 11.7 jobs, including his/her own, and contributed to a total of 101,770 jobs statewide.
  • Output: Each physician supported an average of $1.9 million in economic output and contributed to a total of $16.7 billion in economic output statewide.
  • Wages and Benefits: Each physician supported an average of $839,103 in total wages and benefits and contributed to a total of $7.3 billion in wages and benefits statewide.
  • Tax Revenues: Each physician supported $64,816 in local and state tax revenues and contributed to a total of $565.4 million in local and state tax revenues statewide.

The report focused on doctors of medicine (M.D.s) and doctors of osteopathy (D.O.s) who are engaged in treating patients as opposed to those who focus on research or teaching. While this new study illustrates that physicians carry tremendous responsibility as skilled healers charged with safeguarding healthy communities, it also shows their positive impact is not confined to the exam room. Physicians are strong economic drivers in their communities by the economic growth, opportunity and prosperity they generate.

The study also noted that in comparison to other industries, patient care physicians contribute as much or more to Alabama’s economy than higher education, nursing and community care facilities, legal services and home health care.

View the full report and an interactive map of the United States here: https://www.physicianseconomicimpact.org/.

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Keep the Medical Association in Your Facebook News Feed

Keep the Medical Association in Your Facebook News Feed

Facebook changed its news feed algorithm to prioritize content from friends, family and groups so you are less likely to see public content from businesses, brands and news media now than before the first of the year. Facebook justified the change for “people’s well-being” and suggesting that businesses will have to work harder to get their members’ attention.

So, what can you do to keep the Medical Association in your Facebook news feed?

Desktop Computers

Go to the Medical Association Facebook page and make sure you have “liked” the page. Hover over “Following” and select “See first” from the drop-down menu.

 

Also switch “Events, Suggested Live Videos” to “On,” and you’re all set!

Phone and Tablet Users

On your smartphone or tablet, go to the Medical Association Facebook page and click “Like.”

Then select “Follow” or “Following;” click it and turn “Get Notifications” to the on position. Don’t forget to Like and Share our posts with your friends and family!

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State Committee of Public Health Appoints New State Health Officer

State Committee of Public Health Appoints New State Health Officer

The State Committee of Public Health has appointed Dr. Scott Harris as Alabama’s 12th state health officer, effective Feb. 21.

“I feel honored and privileged that the State Committee of Public Health granted me this opportunity to address the state’s health care needs and challenges,” Dr. Harris said.

Dr. Harris brings a wide range of knowledge and extensive experience that includes more than 19 years in private practice to his position. A graduate of Harding University in Arkansas, he attended medical school at the University of Alabama at Birmingham School of Medicine and served his residency and internship at Carraway Methodist Medical Center before returning to UAB to complete a fellowship in infectious diseases. In 2017, he was awarded a master’s degree in public health from the UAB School of Public Health with a concentration in health policy.

Dr. Harris practiced infectious disease medicine at Decatur General Hospital and Parkway Medical Center. He served on the Medical Executive Committee, medicine department chairman and director of multiple committees including infection control, pharmacy and therapeutics, and the surgical care improvement project. He is past chairman and current member of the Decatur Morgan Hospital Foundation.

In 2005, he became medical director at the Decatur-Morgan Community Free Clinic. The non-profit clinic offers health care and dental care at no charge to low income, medically uninsured local residents. The clinic relies heavily on volunteers, including community members. Dr. Harris also has served on many international medical missions to Central America, South America and Africa.

In 2015, Dr. Harris joined the Alabama Department of Public Health as area health officer for seven North Alabama counties. For the past six months, he has served as acting state health officer and currently co-chairs the Alabama Opioid Overdose and Addiction Council.

The Talladega native is a fellow of the American College of Physicians, Infectious Disease Society of America, and a credentialed HIV specialist, American Academy of HIV Medicine.

The ADPH employs approximately 3,000 and has an annual budget of $694 million.

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FDA Classifies Kratom as Opioid

FDA Classifies Kratom as Opioid

The U.S. Food and Drug Administration has officially classified the plant kratom, originally seen as an opioid alternative, as an opioid itself, stating that compounds in kratom act like prescription-strength opioids.

Found in Malaysia, the leaves of the kratom plant are traditionally crushed and made into a tea to treat pain as well as heroin or morphine dependence and possibly reduce withdrawal cravings. According to the American Kratom Association, there are 3 million to 5 million kratom users in the U.S. The supplement can be found in head shops and gas stations sold as powders, pills, capsules and energy drinks.

FDA scientists analyzed the chemical structures of the 25 most common compounds in kratom and concluded that all of the compounds share structural characteristics with controlled opioid compounds, such as morphine derivatives. They also found that compounds in kratom bind strongly to mu-opioid receptors, comparable to opioid drugs.

The scientific data and event reports have “clearly revealed” compounds in kratom make it “not just a plant — it’s an opioid,” said FDA Commissioner Scott Gottlieb, M.D., “and it’s an opioid that’s associated with novel risks because of the variability in how it’s being formulated, sold, and used recreationally and by those who are seeking to self-medicate for pain or who use kratom to treat opioid withdrawal symptoms.”

The FDA announced the voluntary destruction and recall of all kratom-based products manufactured nationwide under the brand names Botany Bay, Enhance Your Life and Divinity by Divinity Products Distribution. The FDA encourages all companies currently involved in the sale of products containing kratom intended for human consumption to take their products off the market and submit any necessary evidence to the FDA.

“The extensive scientific data we’ve evaluated about kratom provides conclusive evidence that compounds contained in kratom are opioids and are expected to have similar addictive effects as well as risks of abuse, overdose and, in some cases, death,” said Dr. Gottlieb. “To protect the public health, we’ll continue to affirm the risks associated with kratom, warn consumers against its use and take aggressive enforcement action against kratom-containing products.”

The FDA recommends consumers not use any kratom products and dispose of any products currently in their possession. “At this time, there’s no evidence to indicate that kratom is safe or effective for any medical use,” said Dr. Gottlieb.

The FDA has received 44 reports of deaths associated with the use of kratom. Additionally, the FDA and the U.S. Centers for Disease Control and Prevention are carefully monitoring an active nationwide outbreak across 20 states of a rare type of salmonella associated with kratom products.

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HIPAA Guidance for Mass Shootings and Other Tragic and Emergency Situations

HIPAA Guidance for Mass Shootings and Other Tragic and Emergency Situations

In the aftermath of one of the deadliest school shootings in U.S. history, many health care organizations are revisiting their HIPAA policies and procedures to determine exactly what information they are allowed to share and to whom they may share information. 

FAMILY AND FRIENDS

A health care entity may share a patient’s location, general condition or death with a patient’s family, guardian, or friend who is involved in the patient’s care or who may be responsible for payment of the patient’s treatment. This may occur in a variety of circumstances including, but not limited to, the following:

  • If the patient is present and able to consent to the disclosure, the health care provider must obtain the patient’s consent, provide the patient with the opportunity to object to the disclosure, or based on the professional judgment of the health care professional, they may reasonably conclude that the individual would not object to the disclosure being made.
  • If the patient is not present or unable to consent due to incapacity or emergency, the health care professional may in the exercise of professional judgment determine whether the disclosure to the family, friend or guardian is in the best interest of the patient.
  • If the patient is deceased, the health care provider may disclose information about the patient to the family member, friend or guardian unless the health care professional is specifically aware that the patient expressed that the disclosure not be made prior to their death.
  • Health care providers may also share information about a patient with police, media outlets or the general public when attempting to identify, locate or notify family members, guardians or personal representatives of a patient. Information that may be shared include the patient’s location, general health status or death.
  • PHI may be shared with disaster relief organizations that are legally responsible for assisting with disasters if doing so will assist in the notification of family members or other individuals responsible for the patient’s care. [1]

MEDIA OUTLETS

Hospitals and health care entities may share general information about a patient with media outlets in an effort to identify, locate or notify individuals responsible for the patient’s care. However, if the request is initiated by the media, you must consider the following:

  • If the patient is conscious and does not specifically object, limited facility directory information may be shared as long as the requestor identifies the patient by name. This information includes whether the patient is indeed seeking treatment at the facility, whether they are in critical or stable condition, and whether they sought treatment and are now released.
  • If the patient is unable to consent, the health care provider can determine based on their professional judgment whether notifying the media or general public of the patient’s status or death is in the best interest of the patient.

Specific information about a patient’s care, such as x-rays, tests performed and test results, or details of a patient’s diagnosis may not be disclosed without either the patient’s authorization or the authorization of their personal representative.

LAW ENFORCEMENT

Health care entities can provide information to law enforcement with a signed HIPAA authorization from the patient or the patient’s personal representative. However, there are instances in which PHI may be shared with law enforcement without patient consent. Those instances include:

  • When the health care professional reasonably believes that the report would prevent or lessen a serious and imminent threat to the health or safety of an individual or the public;
  • The entity believes in good faith that it is sharing information that may be evidence of a crime that occurred on the premises of the entity;
  • Alerting law enforcement of the death of an individual when there is a suspicion that the death resulted from criminal conduct;
  • When responding to an off-site medical emergency, as necessary to alert law enforcement to criminal activity;
  • When it is required by law to make reports to law enforcement, like in instances of treating gunshot or stab wounds;
  • In compliance with court orders, warrants, subpoenas or summons;
  • In response to a request by law enforcement to identify or locate a suspect, fugitive, material witness or missing person (the information must be limited to basic demographic and identifying information about the person); and
  • Instances of child abuse or neglect reporting when the entity receiving the report is officially authorized by law to receive the report[2].

WHAT ABOUT THE SUSPECT?

When law enforcement needs assistance with identifying and locating a suspect, fugitive or material witness to a crime, health care entities are encouraged to cooperate with these requests.  However, those disclosures must be limited to the following information:

  • Name and Address,
  • Date and Place of Birth,
  • Social Security Number,
  • ABO Blood Type and RH Factor,
  • Type of Injury,
  • Date and Time of Treatment,
  • Date and Time of Death, and
  • Description of Distinguishing Physical Characteristics[3] (Ex. Tattoos, mustache, beard).

Any additional disclosures about a suspect’s medical information, such as DNA tests or body fluid analysis, can only be disclosed upon the presentation of a signed authorization, court order, warrant or documented administrative request.

WHAT IS A HIPAA WAIVER, AND WHEN DOES IT APPLY?

There is no lack of confusion regarding what a HIPAA waiver is and when it may be utilized. Waivers of HIPAA sanctions and penalties occur when the President declares an emergency or disaster and the Secretary of the Department of Health and Human Services (HHS) waives provisions of the Privacy Rule during the emergency or disaster.

If the Secretary issues such a waiver, it only applies:

  • In the emergency area and for the emergency period identified in the public health emergency declaration;
  • To hospitals that have instituted a disaster protocol. The waiver would only apply to patients at such hospital; and
  • For up to 72 hours from the time the hospital implements its disaster protocol.[4] Once the limited waiver terminates, health care entities are required to comply with the HIPAA Privacy Rule.

It is important to know under what circumstances you can disclose information and to whom those disclosures can be offered. Failure to understand these requirements may place you at risk for HIPAA violations and sanctions. If you have specific questions about disclosures of PHI, please contact a health care compliance professional.

[1] 45 CFR 164.510(b)

[2] 45 CFR 164.512

[3] 45 CFR 164.512(f)(2)

[4] 45 CFR 164.510(b)(4)

Article contributed by Samarria Dunson, J.D., CHC, CHPCattorney/principal of The Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Ala. The Dunson Group, LLC, is an official partner with the Medical Association.

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Tips for Preserving Tax Deductions in 2018

Tips for Preserving Tax Deductions in 2018

Starting this year, the Tax Cuts and Jobs Act limits an individual’s or a couple’s federal tax deduction for state and local taxes (SALT) to $10,000. SALT deductions include deductions on state and local income, sales and property taxes. High-income earners, such as physicians, frequently have a SALT deduction far exceeding the new $10,000 cap and will, therefore, be negatively impacted by this change.

To illustrate, if you paid $9,000 in property tax and $22,000 in State of Alabama income taxes in 2017, you would have received a $31,000 deduction on your Federal return. In 2018, that deduction would be capped at $10,000. Consequently, the taxpayer will lose $21,000 of deductions. Fortunately for Alabamians, there is a way to help mitigate this adverse tax change in 2018.

The Alabama Accountability Act (AAA) provides an opportunity to preserve your state tax deduction through donations to a Scholarship Granting Organization (SGO). This Act, passed by the Alabama Legislature in 2015, enables Alabama residents to use up to half of their state income tax burden (limited to $50,000) to support approved schools in our state which serve an economically disadvantaged student population. The AAA donation provides state income tax credits (a dollar for dollar reduction in Alabama tax liability) to donors who contribute to a state-approved SGO operating within Alabama. This payment is treated as if you paid Alabama taxes, but for federal purposes, your donation will be reported as a charitable contribution. Otherwise, as described above, the state tax payment would be reported on your federal return as a SALT deduction subject to the $10,000 cap and provide no tax benefit to you.

Let’s update the illustration above to demonstrate the AAA donation benefit. You pay one half of the $22,000 state of Alabama income tax directly to the state as usual. You pay the remaining half of the $22,000 state of Alabama tax liability with an AAA donation ($11,000). The $11,000 AAA donation counts as a state tax payment on the Alabama tax return. However, on the federal tax return, the $11,000 AAA donation is deducted as a charitable contribution and escapes the $10,000 SALT deduction cap. The AAA donation preserves an $11,000 tax deduction which, at top federal tax brackets, is roughly $4,000 in federal income tax dollars.

It is important to emphasize the state allocates $30,000,000 annually for the AAA tax credit program. We expect the 2018 allotment to be reserved quickly, given the significant tax benefit the AAA provides. Therefore, we encourage you to act quickly, if interested, before the opportunity is gone. Based on the current AAA usage rate, we anticipate the $30,000,000 allotment for 2018 could be exhausted by the end of April or earlier.

If you wish to take advantage of this program, there is a two-step process:

1) Reserve your credit on the Alabama Department of Revenue web portal, My Alabama Taxes (MAT); and

2) Write your check for that amount and send it to the Scholarship Granting Organization (SGO) as noted below.

  • Have your 2016 Alabama 1040 with you since you will need your state adjusted gross income to set up your account with the Alabama Department of Revenue.
  • Follow the steps on this website https://myalabamataxes.alabama.gov to create your MAT account, if you do not already have an account.
  • Once that is completed, follow the steps online to reserve your tax credit with the state by clicking on “Report a donation to an SGO” on the right side of the web page.
  • Fill in your personal information and make a selection of an “SGO.”
  • Once you have filled in your personal information, you will then write a check for the amount you reserved to the SGO you selected.

This SGO contribution benefits deserving schools, counts as a payment of your Alabama personal income tax and enables you to gain federal tax deduction for a cost that will be otherwise non-deductible. We encourage immediate action on this mutually beneficial step. If you need help, contact one of our Warren Averett Healthcare Consulting team members.

Article contributed by Sae Evans, Maddox Casey and Jim Stroud, Members, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

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The Tax Cuts and Jobs Act: How Will It Affect YOU?

The Tax Cuts and Jobs Act: How Will It Affect YOU?

The new tax reform law — commonly referred to as the “Tax Cuts and Jobs Act” (TCJA) — is the most significant tax legislation in decades. Although the law was passed only a few weeks ago, the impact on the economy and business outlook seems undeniable as the stock market rally continues and both individuals and businesses appear the most optimistic in quite some time.

Tax reform was originally sold to us as simplification. In fact, you would be able to file your taxes on a postcard, right? Although some aspects of tax law have been simplified, other new provisions such as the 20 percent Qualified Business Income Deduction are very complex, despite appearing straightforward at first glance.

The law significantly impacts both individuals and businesses. Let’s start with a basic overview of what’s covered in the new law. (Except where noted, these changes are effective for tax years beginning after Dec. 31, 2017.)

INDIVIDUAL PROVISIONS

The new law makes small reductions to income tax rates for most individual tax brackets, and it significantly increases individual AMT and estate tax exemptions. But there’s also some bad news for individuals: the TCJA eliminates or limits many tax breaks. In addition, much of the tax relief for individual taxpayers will be available only temporarily.

Here are some of the key changes. Except where noted, these changes will sunset after 2025:

Individual Tax Rates

The majority of physicians will notice tax savings due to an overall reduction in tax rates. Please see the summary comparing tax rates and income brackets pre- and post-TCJA later in this section.

Physicians will notice not only have the tax rates been reduced, but the upper thresholds of most income brackets have also increased, resulting in more of your income being taxed at lesser rates.

For instance, under the new brackets, the 24 percent bracket extends all the way up to taxable income of $315,000, whereas under the old law, the 25 percent bracket only went up to taxable income of $156,150. For a married filing joint taxpayer with taxable income of $315,000, this results in tax savings of almost $15,000.

Standard vs. Itemized Deductions / Personal Exemptions / Limitations

Every taxpayer has the choice whether to itemize deductions on Schedule A of their 1040 (mortgage interest, charitable contributions, property taxes, state and local taxes, etc.) or take the allowable standard deduction.

Under the new law, the standard deduction nearly doubles as follows:

  • $24,000 for married individuals filing a joint return
  • $18,000 for head-of-household
  • $12,000 for all other individuals

Even with the increased standard deduction, I anticipate it will still be advantageous for most physicians to continue itemizing their deductions as most will exceed the increased thresholds above.

Prior limitations on itemized deductions, known as the Pease limitation (named after Rep. Donald Pease), have now been repealed. Under the Pease limitation, many physicians found their itemized deductions limited because their taxable income exceeded the amount allowed for full deductions. As a result of tax reform, these limitations no longer apply.

Although the benefits noted above are positive, there are some “take-aways” that should be noted, such as:

  • Personal exemptions of $4,050 have been eliminated;
  • Elimination of the deduction for interest on home equity debt;
  • Mortgage interest deduction limited to interest on debt up to $750,000 for new loans (previously $1,000,000). Taxpayers can continue to deduct interest on primary and secondary/vacation home;
  • New $10,000 limit ($5,000 if single) on the deduction for state and local income/property taxes; and
  • Elimination of moving expense deduction.

Since passage of the law, I have had several phone calls and emails from individuals worried that they are losing the ability to deduct charitable contributions. Please note that charitable deductions remain fully deductible under the new law. In fact, taxpayers are able to contribute more under the new law – up to 60 percent of their adjusted gross income as opposed to 50 percent previously. There is one exception, an admittedly BIG exception. Donors are no longer able to deduct 80 percent of the amount paid for the right to purchase tickets for athletic events (i.e. Tide Pride, Tigers Unlimited).

Estate Tax

Although the Estate Tax was not repealed under the TCJA, its impact was significantly reduced through increased gift and estate exemption amounts. Previously, the estate and gift tax exclusion was $5,490,000 in 2017, but under the new law will double to $11,200,000 in 2018 (including inflation). The increased exemption amounts are set to expire Jan. 1, 2026. This creates significant planning opportunities for physicians to transfer wealth using the increased exemption.

Alternative Minimum Tax (AMT)

AMT is a “supplemental” tax that hits many physicians. It essentially taxes those whom the IRS believes are taking too many deductions under the standard income tax system. For instance, under AMT, no deductions are allowed for state and local taxes, real estate and personal taxes, etc.

Many were hopeful AMT would be repealed in its entirety, but that did not happen. Instead, the exemption amount was raised significantly, thereby subjecting fewer individuals to AMT. It’s very likely that if you were subject to AMT tax in the past, you may not be going forward in 2018.

Affordable Care Act

During the final days of the bill’s negotiation process between the House and the Senate, a provision was added for the repeal of the individual mandate called for under the healthcare reform bill. Many took this to mean that the Patient Protection and Affordable Care Act was gone; however, that is not the case. The tax reform bill merely removed the penalty associated with the mandate for individuals to obtain health insurance. PPACA is still very much in play.

There was no change to the 3.8 percent net investment income nor the additional .9 percent payroll tax on high-wage earners. In addition, large employers (generally those with 50 or more FTE’s) are still required to provide affordable minimum essential health care coverage to full-time employees. Those employers are also still required to complete Form’s 1094 and 1095 annually to report the details of healthcare coverage provided to employees.

Alimony

Under the TCJA, individuals will no longer be allowed to deduct payments for alimony or separate maintenance payments. Likewise, the recipient of those payments will no longer include payments in their income. This is generally effective for divorce or separation agreements executed after Dec. 31, 2018. Current rules (i.e. alimony deduction) continue to apply to already-existing divorces and separations, as well as divorces and separations that are executed before 2019.

BUSINESS PROVISIONS

In addition to the individual provisions noted above, the TCJA also has many provisions which will impact businesses both large and small. In general, the law significantly reduces the income tax rate for corporations and eliminates the corporate alternative minimum tax (AMT). It also provides a large new tax deduction for owners of pass-through entities and makes major changes related to the taxation of foreign income. But it also reduces or eliminates many business tax breaks.

Following are some of the key business-related changes:

Corporate Tax Rate Reduction

Under the old law, corporations were subject to graduated tax rates that topped out at 35 percent. Personal service corporations, which include physician practices, were taxed at a flat 35 percent. The TCJA reduced the corporate tax rate to a flat 21 percent rate. Although the tax rate reduction is a positive, most physician practices organized as C Corporations bonus out income at year-end to avoid paying corporate tax at all, making this somewhat irrelevant.

20 Percent Qualified Business Income Pass-Through Deduction

But what if your practice isn’t organized as a C Corporation? It doesn’t seem fair that one entity type receives a reduction in tax rates while others do not. To compensate for this, Congress created an entirely new 20 percent qualified business income (QBI) deduction for owners of flow-through entities (such as partnerships, LLCs and S corporations) and sole proprietorships through 2025. This new deduction is commonly referred to as the “pass-through deduction,” as income from these entities passes through to owners and is included on the individual 1040 income tax return.

Qualified business income is essentially the net income of the practice after physician salaries. It excludes any investment-related items, such as interest, dividends, or capital gains or losses from the sale of property. The deduction is 20 percent of the QBI and is a reduction in taxable income on Form 1040.

What appears rather straightforward at first, quickly becomes complex and illogical with a strict or literal reading of the law. In some cases, the amount calculated for the 20 percent deduction varies among entity types with all else being equal, which doesn’t appear the outcome Congress intended. These ambiguities will most likely be addressed in later regulations and technical corrections that will provide further details on interpretation and application of the law. This will be a key area to monitor for the remainder of 2018.

In addition, the 20 percent deduction is subject to a tangled web of limitations and phase-outs. Service-related entities (i.e. physician practices) are also subject to even more limitations that, depending on income level, quickly eliminate the 20 percent deduction.

Let’s first examine the limits applicable to both service and non-service businesses alike. The 20 percent qualified business income deduction is limited by the greater of:

  • 50 percent of W2 wages paid by the qualifying business, or
  • 25 percent of W2 wages paid plus 2.5 percent of unadjusted basis of all qualified property.

The 20 percent deduction is reduced if an individual’s taxable income as shown on their 1040 exceeds $157,500 if filing single or $315,000 if filing jointly. For service-related businesses such as a physician practice, the 20 percent deduction is completely lost once the physician’s individual taxable income exceeds $207,500 if filing single or $415,000 if filing jointly. Phase out begins at $157,500 filing single and $315,000 filing jointly.

To illustrate, assume Dr. A is a solo practitioner who files a joint return. Her practice is organized as a single-member LLC. The qualified business income as reported on Schedule C of Dr. A’s 1040 is $240,000 after $195,000 in wages paid to her staff. Dr. A and her husband’s taxable income for the year is $295,000.

In this example, Dr. A’s tentative 20 percent deduction is $48,000 ($240,000 QBI * 20 percent). Since this amount is less than 50 percent of wages ($195,000 * 50 percent = $97,500), the deduction is not reduced. Also, since Dr. A’s overall taxable income is less than $315,000, she is able to take the full deduction of $48,000.

This is perhaps the most complex area of the tax reform law. This is an area which will merit monitoring in the coming months as the IRS provides additional guidance on the implementation of this provision of the law.

Depreciation Deductions

For physician practices, several favorable changes were made to the existing rules regarding depreciation. Most notably, equipment purchased after Sept. 27, 2017, and before Jan. 1, 2023 (in most cases) can by fully expensed or deducted in the year of purchase rather than depreciating over the equipment’s useful life. Previously, this “bonus” depreciation was limited to 50 percent of the asset’s cost, but has now been increased to 100 percent. In addition, the equipment no longer has to be original use or new property — used property also qualifies for the deduction.

In addition to bonus depreciation, the provisions of Code Section 179 were also modified to allow for more property types to qualify for immediate write-off, including subsequent improvements to commercial property such as roofs, heating and A/C systems, fire protection, alarm and security systems.

Other Business Impacts

In addition to the major overhauls noted above, there were several other impacts to businesses, including but not limited to:

  • Repeal of the 20 percent corporate Alternative Minimum Tax
  • New limits on net operating loss deductions
  • Elimination of the Section 199 deduction
  • Like-kind exchanges now limited to real estate only
  • New tax credit for employer-paid family and medical leave — only through 2019
  • New limitations on excessive employee compensation
  • New limitations on deductions for employee fringe benefits, such as entertainment and, in certain circumstances, meals and transportation

Summary

The TCJA will have a significant impact on business and individuals. These items highlight the major provisions of the law that are most impactful to physicians. The new tax law is certainly broad-reaching and complicated.

Article contributed by Mark Baker, Principal, Jackson Thornton CPAs and Consultants. Jackson Thornton is a Preferred Partner of the Medical Association.

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Bipartisan Budget Act Boosts Health Programs

Bipartisan Budget Act Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, the Bipartisan Budget Act of 2018 is officially one for the record books. The week leading up to the final vote was far from smooth with Sen. Nancy Pelosi impressively filibustering on the floor of the U.S. Senate for eight hours to Rep. Rand Paul blocking the final vote late Thursday night/early Friday morning and forcing a six-hour government shutdown before allowing the final vote to be taken.

Now that President Trump has signed the Bipartisan Budget Act of 2018 here’s what you need to know:

Technical Amendments to MACRA. Makes several changes to the Medicare Access and CHIP Reauthorization Act (MACRA) that the medical community has been strongly advocating for, including:

  • Excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;
  • Eliminates improvement scoring for the cost performance category for the third, fourth and fifth years of MIPS;
  • Allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS;
  • Requires CMS to update on CMS’ website by Dec. 31 of each year, information on resource use measures including measures under development, the time-frame for such development, potential future resource use measure topics, a description of stakeholder engagement and the percent of expenditures under Medicare Part A and B that are covered by resource use measures.
  • Allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
  • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback regarding the extent to which models meet criteria and an explanation of the basis for the feedback.

Physician fee schedule update (in lieu of Misvalued Codes). Reduces the Physician Fee Schedule conversion factor for 2019 from 0.5 percent to 0.25 percent. This is more favorable language than, and is in lieu of, the language in the House bill that would extend the “misvalued codes” provision for one additional year. The AMA estimated, based on the recommendations of the AMA / Specialty Society Relative Value Scale Update Committee (RUC), that the misvalued code provision in the House bill would have reduced the statutory 0.5 percent payment update in 2019 by 0.45 percent. Rejection of the misvalued code policy is an important outcome for future budget saving exercises. On a bipartisan basis, policymakers have recognized that the misvalued code “budget dial” is tapped out and should be shelved.

IPAB. Permanently repeals the Independent Payment Advisory Board. IPAB was a 15-member government agency created in 2010 by the Affordable Care Act for achieving specified savings in Medicare without affecting coverage or quality.

Children’s Health Insurance Program (CHIP). CHIP is extended for an additional four years beyond the previous Continuing Resolution’s six-year extension, with appropriations made through 2027.

Community Health Centers. Funding for community health centers is reauthorized for two years at a level of $3.8 billion for FY 2018 and $4 billion for FY 2019.

Medicare payment cap for therapy services. Permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018.

National Health Service Corps. Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education. Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling annual funding for this program.

Geographic Practice Cost Indices (GPCI) floor. Extends the work GPCI floor for two additional years through Jan. 1, 2020.

Reducing EHR Significant Hardship. Removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

Closing the Donut Hole for Seniors. Closes the Medicare Part D prescription drug “donut hole” sooner than under current law by increasing the discounted price manufacturers provide from 50 percent to 70 percent.

Emergency Medicaid Funds for Puerto Rico and the U.S. Virgin Islands. Puerto Rico’s Medicaid caps for 2018 – 2019 are increased by an additional $4.8 billion. The Virgin Islands’ caps are increased over the same time period by $142.5 million. Also, 100 percent federal cost sharing for Medicaid is provided for both territories through Sept. 30, 2019.

Prevention and Public Health Fund (PPHF). The Senate bill reduces funding for the PPHF by $1.35 billion between FY 2018 – 2027.

Other Select Budget Agreement Provisions:

Note: there is an agreement to include these funds in the Omnibus before the March 23 deadline.

  • $6 billion in funding for the opioid crisis and for mental health
  • $4 billion to rebuild and improve VA Hospitals and clinics
  • $2 billion for NIH research (above CURES Act increases)

Click here if you would like to see how Alabama’s Congressional Delegation voted.

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State of Alabama Files Lawsuit Against Purdue Pharma

State of Alabama Files Lawsuit Against Purdue Pharma

MONTGOMERY – The State of Alabama has joined other states in filing a complaint against opioid manufacturer Purdue Pharma, LP, one of the largest opioid manufacturers in the country. The complaint alleges Purdue’s marketing of these drugs contributed to the creation of the opioid epidemic in Alabama.

The lawsuit comes on the heels of a report by the Alabama Opioid Overdose and Addiction Council, appointed by Gov. Kay Ivey in mid-2017 to devise solutions to the state’s opioid crisis.

That report found at least 30,000 Alabama residents over the age of 17 are dependent on heroin or prescription painkillers. The council also found the drug overdose death rate in Alabama also increased 82 percent from 2006 to 2014. During that period, 5,128 people died from overdoses. In the U.S, more than 42,000 overdose deaths in 2016 involved opioids, according to the Centers for Disease Control and Prevention.

The lawsuit alleges that marketers persuaded physicians that prescription painkillers were not addictive, according to Alabama Attorney General Steve Marshall.

“The lies that they were told and trained in over the years whether it be that there was no dosage too high of an opioid … or even this concept of a pseudo-addiction that if somebody appeared in an office demonstrating signs of addiction that just meant that they needed more pain medication,” AG Marshall said.

Purdue denies the allegations, writing in a statement that its drugs are approved by the Food and Drug Administration and make up only 2 percent of all opioids prescribed.

Purdue Pharma manufactures, markets and sells prescription opioid pain medications, including the brand name drugs OxyContin, MS Contin, Dilaudid/Dilaudid HP, Butrans, Hysingla ER and Targiniq ER, as well as generic opioids. OxyContin constitutes roughly 30 percent of the entire market for analgesic drugs (painkillers). Purdue’s drugs compose a majority of the extended release market, for use with chronic non-cancer pain patients, which is the most dangerous method of use. Prescription opioids constitute the largest component of the opioid epidemic, both in quantity and damage caused.

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Physician Groups Issue Joint Statement in Support of Raising Alabama’s Legal Tobacco Age to 21

Physician Groups Issue Joint Statement in Support of Raising Alabama’s Legal Tobacco Age to 21

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MONTGOMERY — The Medical Association of the State of Alabama, the Alabama Chapter-American Academy of Pediatrics, the American College of Cardiology-Alabama Chapter, the Alabama Dermatology Society, and the Alabama Academy of Family Physicians have joined in support of legislation that would raise Alabama’s legal tobacco age from 19 to 21.

“Research has shown our children are at the greatest risk of becoming smokers because they begin to experiment with cigarettes around the age of 18,” said Medical Association President Jerry Harrison, M.D. “Smoking remains one of the most preventable causes of heart disease by making the heart work harder and raising the blood pressure, which can trigger a stroke. So, raising Alabama’s legal tobacco age limit by a couple of years in order to add years to our children’s lives only makes sense.”

A study published last year in the journal Pediatrics showed raising the minimum tobacco purchase age to 21 would likely have significant public health benefits, including 249,000 fewer premature deaths and 45,000 fewer lung cancer deaths for those born between 2010 and 2019. The study also showed that younger adolescents were more likely to support the initiative, and past research has shown that up to 75 percent of adults favor the higher purchase age for tobacco products.

“This legislation is one of the most effective actions Alabama can make to ensure the health and safety of our children,” said Susan Walley, M.D., FAAP, member of the AL-AAP Executive Board and the Executive Committee of the American Academy of Pediatrics Section on Tobacco Control. “Any tobacco use in children and adolescents is not safe. Adolescents are more likely to become addicted to nicotine, even with experimental use, which has a ‘gateway effect’ to other substances of abuse. Once adolescents start using tobacco products, whether from electronic cigarettes or traditional combustible cigarettes or cigars, they risk a lifelong habit that kills one-in-three smokers from a multitude of diseases.”

According to the Alabama Dermatology Society, smoking is bad for the skin in multiple ways – ill effects that can begin in the teenage years. In addition to causing premature skin aging and wrinkles, smoking nearly doubles one’s risk of developing psoriasis. Even more worrisome, studies show smokers boost their risk for developing squamous cell carcinoma of the skin by 52 percent. Squamous cell carcinoma is the second most common form of skin cancer, and, while often treatable, can have deadly consequences.

A bill sponsored by Rep. Chris Pringle (R-Mobile) – HB 47 – would raise the age from 19 to 21 for anyone in Alabama looking to purchase, use, or possess tobacco products in Alabama. This proposed legislation includes any tobacco, tobacco product or alternative nicotine product. Our organizations fully support the passage of this legislation for the lives of Alabama’s children.

For more information or comment, please contact:

Lori M. Quiller, APR, Medical Association of the State of Alabama, (334) 954-2580

Linda Lee, APR, Alabama Chapter-American Academy of Pediatrics, (334) 954-2543

Christina Smith, American College of Cardiology-Alabama Chapter, and Alabama Dermatology Society, (205) 972-8510

Jeff Arrington, Alabama Academy of Family Physicians, (334) 954-2570

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