Archive for June, 2018

The New Tax Laws: The Sky is Not Falling on America’s Nonprofits

The New Tax Laws: The Sky is Not Falling on America’s Nonprofits
By: Jim Lyons, Senior Partner Pride Philanthropy

There has been much conversation and consternation about the potential impact on nonprofits and charitable giving as a result of the tax law changes that were passed in late 2017. While the new law will impact different people in different ways, we are not anticipating any significant impact on charitable giving as a result of the changes in tax laws. In reality, there have been several changes that allow for expanded deductions for America’s most generous donors.
The one area that has been the greatest concern in the charitable world is the impact of raising the standard deduction to $24,000 for those who do not itemize their deductions. The concern here is for those who do not itemize, there’s no longer as great an incentive to make a gift as that gift would no longer be deductible. Historically 80% of our gift gifts come from those who do itemize. Another statistic to consider is that 75% of all money given away in the country comes from 4% of our donors. This means we still need to focus our efforts on the high net worth individuals who can make a significant gift to a nonprofit organization.

What is most important in the new tax law are those areas that were left unchanged. There have been no changes to the text deductibility of gift annuities and certain types of trusts and no changes in the treatment gifts of appreciated assets. This will be a considerable factor for the Baby Boomer generation as they consider gifts late in life. There have been no changes to the IRA Rollover Provision which allows for individuals 70 1/2 and older to make a gift up to $100,000 directly from their IRAs.

There’s additionally been some concern about raising the exemption on estate taxes from $5.49 million for individuals to $11.2 million. The fact is that those levels of estates represent less than 1/10 of 1% of all the estates that are probated in the country. These high net worth individuals typically have sophisticated estate plans which include provisions for multiple charitable organizations and the tax considerations are less important than leaving a legacy to a community or an organization.

There has been a myriad of articles written the past few months about the tax law changes, and this article is not intended to be tax advice. You need to consult your own CPA and or/tax attorney for advice regarding your specific circumstances. The main takeaway for nonprofit
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charitable organizations are to not be overly concerned about the changes and become less than positive about the future of giving. There may be special situations where the tax deductibility is impacted, but we are not anticipating any significant overall impact to giving. Studies have shown tax deductibility is way down the list of considerations when someone makes a gift and is far outweighed by 1) the person who asks, 2) others involved with the charity, 3) the charity’s reputation as being a quality organization and a good steward of their resources, 4) a specific interest in healthcare, education, the arts, etc., and finally followed by tax considerations, which primarily affect structure and timing of payments.

When we look historically at tax law changes, we have seen several since 1969 and each time there is great concern about what it will do to giving. We have not seen any measurable impact from any of those changes. The biggest driver of giving is the economy and the stock market. Giving tracks at about 2% of GDP and has for decades. The market also moves in the trend with the S&P 500, although not anywhere near to the level of volatility of the stock market. We have only seen giving go down in two years in the last 60 years and that was in ’08 and ’09 when the stock market saw historical drops. People
give because they think they can make an impact on an organization and/or a community. My advice to donors is to keep giving because you do make a difference and my advice to nonprofits is keep asking and positively presenting your mission and how you change lives.

For more information about the Georgia Healthy Family Alliance Capital Campaign – http://www.georgiahealthyfamilyalliance.org/

Pride philanthropy is a consultant for the GHFA Capital Campaign.

 

Naloxone: More than Just a Rescue for Opioid Overdose

Naloxone: More than Just a Rescue for Opioid Overdose

Michael Crooks, PharmD., Medication Safety Lead – Alliant Quality, Georgia’s Medicare Quality Improvement Organization

The Surgeon General Takes a Stand: In April 2018, Dr. Jerome Adams gave voice to the call for broad availability of the opioid overdose reversal agent naloxone in a recent advisory statement calling for more Americans to keep the medicine on-hand.  Naloxone can temporarily reverse the effects of opioid overexposure, including respiratory depression, by blocking the activity of opioids at receptors in our central nervous system.

The Surgeon’s General statement was clear: more people should carry and learn to use the medicine – not just opioid users.  Beyond those prescribed high doses of opioids and those misusing opioids, including heroin or fentanyl, the recommendation identifies friends and family members of opioid users along with health care providers and community members who encounter at-risk opioid users.

Opioid Prescribers and Dispensers Should be Naloxone Prescribers and Dispensers: Putting naloxone in the hands of every person included in this recommendation may be impractical – the cost alone for such a supply is prohibitive.  Prescribers should, however, consider which of their opioid-using patients ought to be prescribed or counseled on the use of naloxone. Recommendations vary by care setting or specialty, but generally identify dose, duration, drug combinations and personal factors that can increase risk of opioid related harm.

Georgia Law accommodates several means of increasing access to naloxone by defining prescribing protocols and curtailing personal liability through the Medical Amnesty Law and implementing a standing order for pharmacies to initiate dispensing without a patient-specific prescription.

Naloxone is just a part of the opioid risk conversation: Recommending naloxone to patients can be beneficial, even if the medicine is not dispensed.  A study in several primary care clinics showed reduction in opioid-related hospitalizations and emergency department use for individuals counseled on the use of naloxone versus those who were not.  This improvement was independent of patients actually filling the naloxone prescription and occurred without significant change in the dose of opioids used.  Patients, family members and caregivers are too often under informed on the risks of medication use, and a conversation about the possible benefit of another medicine as a “rescue” really brings the point home: opioids can be dangerous, even deadly.

Initiative Creates Efficiencies and Incentives for Preceptors; An Interview with Preceptor Expansion Initiative Chair, Annie Rutter, MD

Initiative Creates Efficiencies and Incentives for Preceptors; An Interview with Preceptor Expansion Initiative Chair, Annie Rutter, MD

By Mary Theobald, MBA, Vice President, Society of Teachers of Family Medicine

Mary: Tell us a little about yourself.

Annie: My name is Annie Rutter and I’m a family doc and I work in upstate New York where I’m the clerkship director for family medicine. That’s what I do as my day job. I’ve also been working with STFM on a couple of different initiatives — most recently with the Preceptor Expansion Initiative.

What’s the Preceptor Expansion Initiative?

So, this is an interdisciplinary approach to increase the pool of community-based preceptors. When we look at where most physicians practice after they graduate from residency, it’s in community settings. Right now, most of our medical education takes place in tertiary medical centers. We don’t have enough sites for students to train in community settings. So, this initiative was taken on by multiple organizations, with the Society of Teachers of Family Medicine as the leader, to gain insight and to increase the number of physicians, nurse practitioners, and physician assistants in the community providing ambulatory education.

Why is there a shortage of community-based preceptors?

There are a lot of demands put on community physician’s day to day. Sometimes, they’re not able to — or they don’t feel like they’re able to — take on students. This initiative will help them get rewarded for their work and also help them realize that this is work they can do. There are also more medical schools — both MD and DO — in the United States and in the Caribbean and other parts of the world that are using the United States physicians as community faculty. And then certainly the demand increases when you add in other health professions who rely on community-based preceptors to teach the skills they need in an ambulatory setting.

What about the fact that an increasing number of community physicians are employed rather than solo practitioners?

Yeah, I mean that’s part of the hypothesis. There’s certainly a trend across the United States for more and more community-based and private practices to be part of bigger hospital or health care systems — to be employed. That comes with competing demands, created by systems or just the health care system more broadly. Where solo practitioners were making the decisions about whether or not they could or wanted to take a student, that decision is now sometimes taken out of their hands and raised up to the systems level. And when compensation is based on productivity, and there’s a perception that a student slows you down, then it’s certainly viewed as a burden to teach. That can be a huge barrier to getting students into community settings.

You’ve noted that clinical practices have a lot on their plates. Isn’t taking on a student going to add more to that already full plate?

If we train our students well before they get into the clinical setting, they can be a huge asset to a practice. Students can do a lot more than what many think they can do. Students can help with quality improvement projects and other practice-based initiatives. With the new CMS documentation changes, students can document patient visits. The preceptor, who of course has to see the patient and repeat the pertinent parts of the physical and the history, can confirm what the student wrote. The tedious task of re-typing doesn’t have to take place any more.

I think many of us, because of how we were trained, think students need to work one-on-one with a doctor and that students need to see every patient that comes in the door. If a student only sees several patients in a day and does the full visit from start to finish, including all the follow-up — the documentation, all of those pieces— they’ll learn what it’s like to take care of patients. Students aren’t as efficient as trained attending faculty physicians, so they’re not expected to do that same workload.

The reality is that students get a lot out of varied experiences in a practice — spending time with different types of providers, like pharmacists, medical assistants, case managers, nurse practitioners, physician assistants, all sorts of folks who are part of the care team. There’s value in learning from all health care team members.

Will the Preceptor Expansion Initiative help students be better prepared for clinical rotations?

Yeah, so there are a couple of things that this project is specifically focusing on. One of them is standardized onboarding of students, and this takes on a couple of facets. One is the logistics of onboarding: Does the student have a login to your EMR? Does the student have all of the proper HIPAA and other training and paperwork, so he can contribute and begin learning right away?

The second piece of that onboarding is making sure the preceptor knows what the student has already learned, such as documentation skills, physical exam skills, history taking, and maybe even specific procedures. So, again, when student comes in on day one, the preceptor can utilize the student’s skills for improved and efficient patient care. And so those two pieces, the logistics and the clinical preparation, will help ease the transition of students into clinical settings.

I would say the other thing the Preceptor Expansion Initiative is working on is figuring out efficient workflows for when there are multiple learners in an environment. So, for example, if a practice was able to host a medical student and a pharmacy student, the practice could use the workflow models to get ideas on how to incorporate both types of students — who have different skill sets — into one clinical practice setting to provide value for the patients, the preceptor, and the students.

What are some of the positive things you hear from preceptors?

Some of the most positive feedback I get is related to giving back to the profession. A lot of preceptors say, “You know, I take students because someone took me and taught me how to do this.” They enjoy getting to know the students and sharing their wisdom –, not just clinical wisdom, which is important, but also mentorship. Things like how to decide where to go for residency, work life balance, etcetera. Preceptors can share what it’s like working in private practice or working for a hospital system or doing procedures in the office. I think sharing this knowledge is one of the things preceptors really enjoy. The other thing so many preceptors tell me is that students teach them a lot.

What if a physician wants to precept, but no one has ever asked?

So, there’s a lot of different ways to get involved. One of the first ways is to talk to your state chapter. Many of the Academy chapters can connect preceptors with medical schools. Or, if you have a medical school in your community, reach out directly to the Department of Family Medicine or to their office of medical education.

What if someone wants to precept and there are policies within their practice or system that won’t allow them to do that? Any suggestions for advocating for change?

I think one way is to have a good relationship with your administration, whether that’s your practice manager or a larger hospital systems director, and to talk to them directly. Systems need physicians, so hopefully they’ll want to keep you happy. Another avenue is to connect with other providers who might be interested in teaching. Band together and talk to your administration. And still another way might be go ahead and contact a medical school, because some of the folks there may be able to build a bridge with the administration at your health system to negotiate how this might work and to dispel myths.

Some people think a commitment means they need to take a medical student every day for the entire academic year. Many schools are able to negotiate it so a preceptor works with students part of the time — maybe at certain times of the year or when the demand is great. There are a lot of different models out there. It’s important to explore those options before closing the door.

Is there anything else you think we should talk about?

I sometimes hear that family docs don’t teach because they’re not sure they’d be a good teacher. Faculty development is a requirement for medical schools, and that includes community-based faculty. Schools work with community-based faculty to get them prepared to have students in their offices by teaching them what is expected and also providing tips on effective teaching. Community based physicians are extremely smart. They’re taking care of patients, they’re working hard every day, and they have a lot of wisdom to share with students about the day-to-day clinical presentations of patients.

For more information about precepting in Georgia and receiving a state tax incentive – click here:  https://www.augusta.edu/ahec/ptip/

Register Now!! June CME Webinar on “I’m growing up, now what?” The process of Transitioning to Adult Services: Unique Health Care Challenges for Youth with Intellectual/Developmental Disabilities – June 6, 12:00 pm – 1:00 pm

Through a partnership with the Georgia Department of Public Health, GAFP is offering a webinar on Health Care Transition. This month’s webinar will be held on June 6th at 12:00 pm and will feature a presentation by Andrea Videlefsky, MD – Medical Co-Director, Adult Disability Medical Home, Inc. and Jeffrey M. Reznik, MD, Urban Family Practice. From this webinar, you’ll learn what unique challenges Georgia’s youth with developmental disabilities are facing and how to create an emergency plan.

CME Webinar Objectives:

  • Forming a medical home within the framework of your insurance plan
  • Identifying what you need when leaving the pediatrician (medical summary, immunization records, medication history, etc.)
  • Identifying other transitional issues (what happens after school?)
  • Creating a viable emergency plan
  • Establishing long term goals that effect access to legal, health and service options

Please click the link to register for the June 6th webinar.

https://attendee.gotowebinar.com/register/9126395501911416579

Can’t Listen Live?  Register anyway – and we’ll send you the recording once it’s posted on our website.