QUALITY CONTROL

A key administrative division in our company is the Quality Control Division. In actual fact, our company operates on an organizational system that divides up any business into 7 different Divisions. A previous blog article has gone through, in a summary form, what each of those divisions are. In future articles I will detail each of those areas more closely and how they apply and can be used in any health care practice. In any case, as stated above, one of those divisions is the Quality Control Division. Any business, whether a health care office, a restaurant, a car dealership, IBM, etc. must have a Quality Control area of the company that inspects the products that are coming out and determine whether the products meet the quality standard expected and, if not, see that both the product and the product producer are properly corrected. This is a routine activity in our company.

I recently asked one of our quality control staff to summarize a recent client completion and thought I'd pass along this summary report to give any reader any idea of what we do with our clients. I hope you enjoy it.

SUMMARY REPORT ON A RECENT CLIENT COMPLETION
Prior to coming to us, this client was aware of problem areas but he wasn’t confident that he had recognized the actual source of the trouble. The solutions he tried to implement were not resulting in the changes he wanted. He was overloaded with administrative duties, scheduling was inefficient and he was not monitoring his expenses closely which was creating financial problems.

After carefully examining and evaluating information about the practice, his consultant created a step-by-step plan tailored for him. One of the first areas addressed was his recall program. The consultant recognized that there was a “gold mine” that had not been tapped due to inefficiency and staff problems. A recall program was established which yielded results right away.

The second problem that was confronted was the doctor’s lack of case presentation skills. With more patients beginning to come in, it became vital for him to develop skills that would allow him to deliver all the treatment they needed. The consultant had the doctor do a specialized training program which teaches effective treatment plan presentation After working with the consultant for three months the practice’s gross income rose from an average of $50,000 per month to an average of $80,000 per month, with no increase in the amount of time worked.

While these situations were being handled, the doctor had his office manager take part in management training at Silkin. Since the doctor had been overloaded with administrative duties when he originally came to us, the increase in business would have created more work without a trained Office Manager. With training, the Office Manager was able to take over the day-today management of the practice. She implemented job descriptions for each position, got office policies in use, managed staff and ensured the scheduling was done correctly and efficiently. This reduced stress in the practice and greatly facilitated the doctor.

All of this client’s staff members have participated in Silkin training seminars and now perform as a cohesive, efficient team. The statistics of the practice remain in a higher range and the growth pattern has continued. He now spends less time in the practice and enjoys working without the stress he once had.

Based upon quality control interviews with the client and his staff we verified that he is a very, very happy client for the following reasons:

a) his office is now well organized and efficient;

b) he has a well trained Office Manager in place that handles the day to day administrative duties;

c) he is working significantly less hours;

d) has much less stress; and e) his personal income has greatly increased.

We welcome any comments. You can do so by clicking on the "comments" link below.

Larry Silver
President, Silkin Management Group


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The Baucus Healthcare Plan: What Small-Business Owners Need to Know

Every day I get in my email inbox something called the “NFIB Smartbrief”. NFIB is the acronym for National Federation of Independent Businesses. This is the organization that champions small businesses throughout the U.S. and in every single state through extensive lobbying efforts. It is an organization totally dedicated to helping the small business owner.  The NFIB Smartbrief contains links to timely articles concerning any important and relevant news that effect small businesses.  It is a great way to stay on top of news that can effect us all as small business owners.

The clients of Silkin Management Group are all small business owners, and it is therefore important to me to stay abreast of the news about the issues that are most relevant to our clients.  As I’m sure any reader knows, the healthcare legislation that is changing daily while winding its way through Congress will significantly effect small businesses. And, as Silkin clients are both small businesses and health care providers, anything having to do with this legislation is important to stay on top of. Today, while reading the Smartbrief, I found a very good article summarizing the latest potential effects that the legislation, in its existing form, will have on small business. I therefore thought it would be of benefit to our readers to provide that article, published on line by U.S. News and World Reports and written by Mathew Bandyk.  The article is reproduced below or you can link to it by clicking here: The Baucus Healthcare Plan.

I hope this article helps you see the latest that is going on with the healthcare legislation.  Comments on this are welcomed by clicking on the comments link at the end of this blog.

Larry Silver
President, Silkin Management Group

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The Baucus Healthcare Plan: What Small-Business Owners Need to Know

What business owners should look out for as healthcare reform moves ahead

By Matthew Bandyk

In the battle to pass some form of healthcare reform, small business is a major player.  Earlier this year, Congress proposed reform bills that would put in place heavy fines on businesses that fail to provide healthcare for their employees, with the exception of those that have just a few employees. Small-business political associations in Washington quickly denounced these provisions as too burdensome for too many businesses. Now, what's on the table for healthcare reform has changed. In early September, the SenateFinance Committee put forth a new healthcare bill that removes those penalties on businesses. Instead, it offers carrots to employers that provide healthcare, while keeping a few sticks. The bill, associated with its main sponsor, Democratic Sen. Max Baucus of Montana, seeks to expand insurance coverage through the creation of nonprofit insurance exchanges at the state level. These exchanges, under recent amendments Baucus accepted, will be open to small businesses with up to 100 employees.

Although the Senate is currently debating numerous amendments to the bill, many of the most relevant pieces that apply to small business don't seem to be points of contention. One thing is for sure: Many elements of the bill will have a profound impact on how employers seek out and pay for insurance for their employees.  4 Conundrums That Impede HealthcareReform.

Here are, from the perspective of small-business owners, some of the most important pieces of the current plan to reform healthcare.

Tax credits.

The new carrots in the bill are in the form of tax credits for employers that provide their employees health insurance. But not every employer can cash in on these incentives. Only businesses with 25 or fewer employees would qualify. However, about 92 percent of small businesses with employees fall into this category, according to the SBA. There's one further qualification: The average wage of all of the business's employees must be no greater than $40,000. Most business owners will want to pay attention to how much these credits could save them, and when. In 2011 and 2012, the bill would allow employers to deduct from their taxes an amount equal to the dollar amount the employer contributes for each employee's coverage, multiplied by a certain percentage. This percentage would be based on the amount of the employee's total premium contributed by the employer, or the average premium in the employer's state.

Starting in 2013, the state insurance exchanges kick in, and the credit applies only to businesses that purchase insurance through those exchanges. So would these write-offs revolutionize the way small businesses provide employee healthcare? Bill Rys, tax counsel for the National Federation of Independent Businesses, says expectations shouldn't be too high. The size and length of the credit—just four years—aren't high enough for businesses that are strapped for cash to suddenly consider buying healthcare. But the credit could make a difference for business owners "on the cusp"—those unsure if they can afford employee coverage. "It does provide some immediate cost relief," he says. The relief is especially large for the smallest businesses.

Businesses with fewer than 10 employees and less than $20,000 in average wages get to keep the tax credit in full. For larger businesses, it begins to phase out starting in 2013.  But there are also some potential problems. If a business owner starts paying employees more and the average wage surpasses the $40,000 mark, the business could no longer be eligible for the credit. That wage requirement could make employers reluctant to give out raises. Rys says that this is a real concern, but he's not too worried. There isn't much incentive for employers to keep average wages down for the same reason that the tax credits won't have small businesses rushing out to buy health insurance. The length of the credits is just too short. "The concern would be greater if the credit were longer, but the credit is for only two years before the exchange starts," Rys says.

Tax penalties.

Although no employer will be automatically punished for not providing coverage, there are still some fines in the bill that apply to firms with 50 or more employees—only 4 percent of all businesses that hire. But for businesses included in that 4 percent, the tax penalties can be hefty. That's because the bill provides subsidies for individuals and families who make up to 300 percent of the federal poverty level to help them buy insurance through the state health exchanges. Employers that don't provide coverage will have to pay a tax penalty for each employee who receives these subsidies. This has been dubbed the "free rider" provision because it is intended to deter employers from "free riding" off the new health insurance exchanges. The penalty is either the average cost of subsidies that year multiplied by the number of employees receiving subsidies or $400 per employee—whichever number is lower. But business owners won't be told what they owe. They'll have to crunch the numbers themselves to determine if they owe the full amount or the minimum, says Judith Solomon, senior fellow at the Center on Budget and Policy Priorities. There are many administrative burdens that could come with this provision. For example, a business owner would have to keep track of which employees qualify for subsidies, if they suddenly become qualified, or if they drop out of the exchange altogether. Some business that want to avoid the penalty can expect disputes with the tax man—it will be up to them to inform the IRS that some former  employees who received health insurance subsidies were laid off or no longer work there, says Solomon.

Another complicating factor of the "free rider" provision for employers is that it might make them think twice about whom they hire. "It does distort the hiring decisions in the direction of employers who don't need coverage," says Solomon. A business owner might be inclined to look for potential employees who already get health insurance through their spouse, for example, in order to avoid dealing with the tax penalty. Choosing to hire or not hire someone on that basis could land a business owner in legal trouble.

Insurance taxes.

One of the most controversial aspects of the Baucus bill is that, if passed, it would be partially funded by an excise tax on health insurance companies. In 2013, a 35 percent tax would kick in on insurance policies in which premiums are above $8,000 for single people and above $21,000 for families. It might not seem as if a tax on insurance companies would have much to do with small businesses, especially considering that few small businesses have the type of gold-plated, "Cadillac" health insurance plans to which the tax applies. But Keith Ashmus, the chair of the National Small Business Association, says these taxes could be passed down to all employer health insurance plans—not just the gold-plated ones—in the form of higher premiums. "The tax will be part of the entire cost structure of the insurer," he says. "[So] the trigger will be a high-cost plan by company Y, but the impact will be felt by everyone." The good news is that as the Senate has negotiated aspects of the bill this week, Baucus appears to be willing to ease the impact of the excise tax—but not eliminate it.

Some Ideas on Finding Good Staff

Our research staff does hundreds of interviews every week with practice owners all over the country. This research helps us know the areas of interest of doctors who read or will read this our on-line journal, Solutions Magazine.

One of the highest areas of interest, is "How do I find GOOD staff?" Here are some tips regarding one specific area of finding staff.

We have seen great success with temp agencies and private job placement agencies. There are several reasons why working with these types of companies can be advantageous: a) the cost of promoting, screening, interviewing is borne by the agency, b) the time needed to promote, screen, interview, hire, etc., is primarily taken up by the agency and not your office, and c) most agencies usually have a guarantee of some sort of the person working out and recourse if the person does not work out.

Below are some suggestions on how to best work with these types of companies.

1. Meet with the representative of the placement agency that is most local to your office. Invite them to visit your office to get a feel for the office and the kind of culture that you have specific to your office. Let the representative know about the qualifications of the employee that you are looking for. Be as specific as you can. Show them the job description of the position you are trying to fill so they have a good understanding of what type of person you need. Make the requirements as clear as possible - for example if you are looking for a receptionist, you need someone with excellent communication skills. As this representative is going to go to work for you to find the best candidate for your office, get her/him the best information you can on what you need and want.

2. Discuss with the representative the fees and benefits involved in hiring an employee through them. Most companies offer a 90-day program that has a variety of benefits. The employee works in your office but remains an employee of the temp agency or placement agency. During this trial period, an hourly fee is paid to the company that is just slightly greater than what you would normally pay a direct hire. The benefit to you is that you are not paying the taxes, fees and accounting normally associated with hiring and paying an employee. You are also not covering health insurance. For most employers, this option works out quite well. During this trial period, you have a resource for addressing performance concerns with the agency and determining if the person will work out.

3. Ask to interview the prospects that they send you prior to hiring them. Take the time to interview them just like you would a direct hire. The most obvious benefit to you at this time is that the prospect has already been screened by the agency and is qualified to work in your office. All you have to do is decide if this is the kind of person you want to work with in your office.

Be willing to interview several prospects before selecting the right one for your practice. Just because they are qualified does not mean that they will fit well with your team. Your greatest enemy at this point is any desperation you may feel to get someone hired right away. Remember that hiring the wrong person for your office can become a bigger problem and waste more time and money for you and your staff than taking a little more time to find the right fit. We have a variety of testing procedures that we use with our clients to help in this final evaluation process.
Silkin Management Group has been in business for over 25 years, delivering practice management consulting and training to over 4000 health care offices throughout the United States and Canada. For further information on Silkin visit our website at the Silkin Management Group Home Page.

I invite you to share any thoughts through our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

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ARE YOU A LEADER AT YOUR PRACTICE?

If you're having difficulty getting plans executed, then the information below may be helpful.

It is very important for the owner of a practice to maintain excellent communication with his/her staff and to provide active and visible leadership. Following are some key points for the executive:

Communication of Goals:

Determine what the purpose (Mission Statement) of your practice is and communicate it to your staff. Let them know what the goals for the office are and keep them informed of the projects you intend to implement to achieve those goals. The better informed your staff is and the greater understanding they have of such matters, the more likely they will be working in mutual motion with you.

Communication Tools:

There are some very basic communications devices to implement in the practice. These tools can be kept in place by your Office Manager, but must be reinforced by you as the senior executive. Some of these tools are: written requests or proposals (as opposed to verbal requests), written office communications, written policies and use of an effective communication relay system.

It is important that written communications are responded to swiftly. When people do not hear back on their communications within a reasonable period of time, they become less willing to communicate and as a result, the business can have more problems on its hands.

Staff Meetings:

It is also vital that staff meetings are held minimally once per month, but ideally once per week. This is one of the most valuable opportunities available to you for educating staff, setting goals and targets and handling problem areas that can be addressed by the staff as a whole. The communication lines within the business will strengthen considerably too.

The Owner and his Office Manager should continually strive to establish strong coordination and leadership for the staff. Any problems or disagreements between the Owner and Office Manager should always be sorted out OUTSIDE of the staff meeting and should never be addressed in the presence of any staff.

Staff meetings run most effectively if the Owner and Office Manager meet prior to the staff meeting to plan and coordinate those matters to be addressed with the staff. This should include items such as production goals for the office, coordination needed between staff members concerning patients or other matters, education on office policy or technical matters, etc.

Setting Goals and Targets:

When targeting your weekly and monthly quotas, it is advisable to plan ahead prior to your staff meeting and really confront how much production you did the week/month prior and how much can realistically be produced within the upcoming week/month (bearing in mind that you should target toward expansion). Really take a look at what CAN be done, then go over it together and with the rest of your staff at the staff meeting.

Each week you should bring relevant production graphs to the meeting and keep the staff informed as to how the group is doing in approaching the goals.

Group Member Responsibility:

The more each staff member takes responsibility for the office as a whole, the better your office will do. It is very helpful to have each staff person come to the staff meeting prepared to contribute. This is something to be backed by the Owner so that the staff realizes the importance and complies with the Office Manager's orders. The goal of the executive should be to encourage and show the staff how to become more and more responsible and able to contribute to the creativity, growth and expansion of the practice.

Policy:

To create stability for the practice and to keep the lines straight, it is very important that you continue to implement written policies. There should be written policy to govern all activities in the practice.

When you write a policy, place the original in a binder marked "Policies." The Office Manager would then distribute a copy to each relevant staff person, indicating to the staff that they are to read the policy and route a note to the Office Manager reporting that they had done so. Their copy of the policy would be placed in their "job description" manuals, under General Staff Section.

The Office Manager can be very helpful in policy development, but she needs to know exactly what your policies are. She can write the policies and submit them to you for final approval. She can and should suggest to you areas in which policy is needed. Staff should also be encouraged to propose policy via the Office Manager.

Silkin Management Group has been in business for over 25 years, delivering practice management consulting and training to over 4000 health care offices throughout the United States and Canada. For further information on Silkin visit our website at: Silkin Management Group Home Page.

I invite you to share any thoughts through our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

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ECONOMIC WOES LEAD TO EMPLOYMENT DISHONESTY

I received the following article from one of our attorneys that I thought was very informative and something that would be useful for anyone who runs a small business, which would certainly include health care practices. Some months ago I posted an article on our blog concerning steps to take to protect against employee embezzlement, and I thought that this article would add useful information to that subject. I hope you enjoy it.

As usual, I invite you to share any thoughts through our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

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ECONOMIC WOES LEAD TO EMPLOYMENT DISHONESTY

False Sense of Security

Employee dishonesty can take many forms. No one seems to be exempt, and tough economic times only make matters worse. Although embezzlement can happen at all levels, we have encountered a number of situations in small to medium sized companies where employees were trusted and often thought of as family. When embezzlement is discovered, there is not only the reality of economic loss, but a real feeling of betrayal. After discovery, your oppositions may be limited. The key is to establish and diligently adhere to a system of checks and balances, to minimize opportunities.

Establish Procedures

The first step is to meet with your certified public accountant, or attorney, to establish the correct procedure for your business. This alone can be difficult, because in many instances your loved and trusted bookkeeper will feel like he or she isn’t trusted. Although the feeling is understandable, you can explain that it is something that must be done because (a) it is the correct business practice; and (b) it will confirm the great job your bookkeeper is currently doing. Furthermore, should your bookkeeper become ill or otherwise unable to perform his or her duties, the procedures will already be in place for the replacement. Don’t get talked out of this step, or you could be talking to us, or someone like us, under more strenuous circumstances.

Follow Your Procedures

Establishing procedures won’t help you unless you are willing to follow the established guidelines. It takes a little effort, but nothing equivalent to the forensic work associated with discovering and determining the amount of embezzlement. Where there is embezzlement, seldom is it limited to one method of stealing. Don’t stop looking after you’ve discovered one source of theft. It is like peeling an onion. In one of our cases, the CPA said he was aware of fifty ways to embezzle money, and forty-eight had been employed.

Remedies

How you react when you discover your loss may have a significant impact on the extent of your recovery. Your emotions will run from anger, to embarrassment, how will you recover your loss. Although our advice is sought with regards to each of the above, our primary focus is usually on how to recover your money.

Acting fast is a proven key. As the victim you have a great deal of leverage. The fear of prosecution is a great motivator. Your initial reaction is to call the police and “throw away the key.” While this knee jerk reaction is understandable, it is seldom a motivation for repayment. Although criminal prosecutions can result in “civil compromises,” these are frequently less rewarding than can otherwise be accomplished.

Strike fast and tie up assets. Locate property and collect what you can. If there is a spouse or significant other, don’t overlook their involvement. If significant amounts were stolen, there is a good likelihood they were at suspicious of what was going on.

Call your insurance carrier. If you don’t have employee dishonesty coverage, get it. Make sure your limits are reasonable. You would be amazed at how much can go missing. We have been involved in cases for small to medium companies where the amounts exceeded $1,000,000.

The banks and credit card companies may be a source of recovery. Under the right circumstances, there can be liability for forgery, negligence and credit card fraud. Third party sources of recovery should not be overlooked, as the embezzlers may not have been a good steward of your money. Insurance claims and claims against banks and credit card companies normally require you to prosecute, but by the time you get to this stage, you normally have little to lose.

If you do not have a procedure of checks and balances, contact your professional today.

Written by:
Bitts & Hahs, Attorneys at Law
4949 SW Meadows Rd., Suite 260
Lake Oswego, OR 97035
503-228-5626
http://www.bittner-hahs.com

MORE KEY MARKETING ACTIONS

Silkin Management Group has helped accomplish significant growth for thousands of practices using marketing procedures that really work based upon results. As a follow up to our June 26 blog, here is another list of key marketing actions for a health care practice.

Our tailor made marketing programs include some of the basic techniques mentioned in these tips, but also include the "how to's" of each tip with template examples of most ideas presented. Our consultants develop surveys and questionnaires that health care practitioners all over the country have used to drive more new patients into their practices – and keep them coming back. As the number of patients increase, Silkin continues to provide management and organizational consulting that supports stable growth. This is accomplished by offering specialized administrative training for doctors and their staffs, job descriptions, office policies, organizational charts and much, much more.

Key Marketing Actions:

1. Research your market.
2. Create surveys for existing patients/clients.
3. Create surveys for potential new patients/clients.
4. Conduct surveys with both publics.
5. Tabulate survey results.
6. Categorize internal versus external marketing efforts.
7. Create a promotional calendar.
8. Reactivate past clients.
9. Prospect for new clients.
10. Create a referral campaign.
11. Begin new resident contact campaign.
12. Create/refine letters and promotional items for the practice (welcome letter, thank you letter, educational material, financial information, reactivation letter, etc.)
13. Address the appearance of the practice.
14. Upgrade practice signage.
15. Hold an open house for the practice.
16. Utilize web-based marketing and contact management.
17. Upgrade logo on business cards, letterhead, web site, etc.
18. Use newsletters for existing patients, referral resources and potential new patients/clients.
19. Create a practice brochure to educate, outline expectations and improve patient/client interaction.

I invite you to share any thoughts through our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

Silkin Management Group Home Page
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A Helpful Resource for Employee Legal Questions

As an employer and a manager, it is very important that you understand the importance and value of keeping up to date on the ever -changing laws and rules concerning dealing with employees.

In fact just today, the Supreme Court came out with a very, very important ruling concerning Title VII of the Civil Rights Act which covers anti-discrimination in dealing with employee interactions such as hiring, firing, sexual harassment, etc. You can read about this ruling in the following New York Times article: Supreme Court Finds Bias Against White Firefighters

As an example of this issue, some time ago my company was presented with a concern of an employee that wanted to take maternity leave from work as afforded to her by the Federal Medical Leave Act. Having some familiarity with the act, we were about to point out to her that the FMLA only applied to those companies with 50 employees or more. As our company, at that time, employed only 40 employees, we thought that we were exempt from this rule. With good foresight, though, we told her that we would check out the rules and get back to her the next day. We were very glad that we did this.

The Federal Medical Leave Act does indeed apply to employers with 50 or more employees. (For further information on the FMLA visit http://www.dol.gov/compliance/laws/comp-fmla.htm.) Had we just left the matter at that, and not looked into it further we could have made a grave error had we not granted the proper leave which would have created an unfortunate problem for my company and our employee. What we discovered was that our state also has a medical leave act that had very specific requirements of a company our size that we were required to comply with. Had we not taken the time to really look into the issue and not just work from one source we could have made a costly mistake.

As mentioned above, it is very important for any employer to stay up to date on the relevant laws, rules and regulations concerning dealing with employees. What is important to note is that each state has different laws in addition to the various Federal laws and regulations. Therefore it is vital for you to have a resource to investigate what your state’s parameters are. We therefore did some further research and can now give anyone reading this blog the exact website that you can go to find your states labor department. From reading through the site you can find the relevant laws and rules that will apply to a variety of employee situations and decisions you often make, similar to the example I gave above.

Below you will find, listed by state all of the sites in one easy to use location.

Alabama: http://dir.alabama.gov/
Alaska: http://www.labor.state.ak.us/
Arizona: http://www.ica.state.az.us/
Arkansas: http://www.arkansas.gov/labor/
California: http://www.labor.ca.gov
Colorado: http://www.coworkforce.com/
Connecticut: http://www.ctdol.state.ct.us/
Delaware: http://www.delawareworks.com/
District of Columbia: http://does.ci.washington.dc.us/does/site/default.asp
Florida: http://www.floridajobs.org/
Georgia: http://www.dol.state.ga.us/
Hawaii: http://hawaii.gov/labor
Idaho: http://labor.idaho.gov/dnn/Default.aspx?alias=labor.idaho.gov/dnn/idl
Illinois: http://www.state.il.us/agency/idol/
Indiana: http://www.in.gov/dol/
Iowa: http://www.iowaworkforce.org/labor/
Kansas: http://www.dol.ks.gov/index.html
Kentucky: http://labor.ky.gov/
Louisiana: http://www.ldol.state.la.us/
Maine: http://www.state.me.us/labor/
Maryland: http://www.dllr.state.md.us/
Massachusetts: http://www.mass.gov/?pageID=elwdagencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions+(EOLWD)&L3=Department+of+Labor&sid=Elwd
Michigan: http://www.michigan.gov/dleg
Minnesota: http://www.dli.mn.gov/main.asp
Mississippi: http://www.mdes.ms.gov/wps/portal#null
Missouri: http://www.dolir.mo.gov/
Montana: http://dli.mt.gov/
Nebraska: http://www.dol.state.ne.us/
Nevada: http://www.laborcommissioner.com/
New Hampshire: http://www.labor.state.nh.us/
New Jersey: http://lwd.dol.state.nj.us/labor/index.shtml
New Mexico: http://www.dws.state.nm.us/
New York: http://www.labor.state.ny.us/
North Carolina: http://www.nclabor.com/
North Dakota: http://www.nd.gov/labor/
Ohio: http://ohio.gov/working/
Oklahoma: http://www.ok.gov/odol/
Oregon: http://www.boli.state.or.us/
Pennsylvania: http://www.dli.state.pa.us/
Rhode Island: http://www.dlt.ri.gov/
South Carolina: http://www.llr.state.sc.us/
South Dakota: http://dol.sd.gov/
Tennessee: http://www.state.tn.us/labor-wfd/
Texas: http://www.twc.state.tx.us/
Utah: http://laborcommission.utah.gov/
Vermont: http://www.labor.vermont.gov/
Virginia: http://www.doli.virginia.gov/
Washington: http://www.lni.wa.gov/
West Virginia: http://www.wvlabor.org/home.html
Wisconsin: http://www.dwd.state.wi.us/
Wyoming: http://wydoe.state.wy.us/



I hope you find your state’s web site just as valuable and informative as we have with our state. As always, if you have a specific concern with a legal problem, or if you have a specific legal question, always consult a licensed and board certified attorney in your state.


Larry Silver
President, Silkin Management Group

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Marketing Tips

Collect and tabulate information such as age, occupation, gender, income and location from your current patient records to get a profile of your typical patients. Then tailor your promotion and public relation events to target this majority group

Conduct a Referral Survey to find out if your patients are referring. Discover why they do or do not feel comfortable referring others to your practice. The information you get will help you generate more referrals and give you more control over your internal marketing.

A Quality Control Survey of patients gives you feedback regarding whether or not you’re meeting their expectations and what, if anything, you can do to improve your service to them. Patients appreciate being asked if they are happy with the level of care and service they’re receiving and will be happy that you care enough to ask.

Design a series of questions you can ask of potential patients to find out what they need and want – find out such things as what services they are interested in receiving, what they value most in a health care provider and what has disappointed them in previous practices. Enclose this survey in your new resident letters and use the information you get back to help you write and design ads, brochures and other promotional items.

When surveying by mail, encourage response by enclosing a postage-paid return envelope or reply card. If needed, mailing lists can be purchased to target specific groups you want to attract.

Use phone surveys to get back in touch with inactive patients. Ask them questions designed to find out what you and your staff can do to reactivate them. They will appreciate the personal contact and you’ll have an opportunity to interest them in returning to your practice for services.

Set aside time to work with your staff on getting referrals from patients. The best way to get referrals is simply to ASK FOR THEM. Your staff will be more comfortable in making this a part of their daily routine if they get a chance to practice during staff training sessions.

Silkin Management Group has helped thousands of practices grow using marketing procedures that really work. How do we know they work? They get results! Our tailor made marketing programs include some of the basic techniques mentioned in these tips, but reach far beyond what we’ve been able to include here. Our consultants develop surveys and questionnaires that health care practitioners all over the country have used to drive more new patients into their practices – and keep them coming back. As the number of patients increase, Silkin continues to provide management and organizational consulting that supports stable growth. This is accomplished by offering specialized administrative training for doctors and their staffs, job descriptions, office policies, organizational charts and much, much more.

I invite you to share any thoughts through our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

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Financial Crisis: More Background Info

Several months ago, I presented on this blog a series of articles written by Bruce Wiseman on the financial crisis this planet has been experiencing over the past year or so. I recently received another article by Mr. Wiseman elucidating even more information concerning the background of events that led up to and precipitated this crisis and I thought I would, again, pass it along to the readers of our blog as it is extremely fascinating and informative.

I invite you to share any thoughts through our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

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Larry Silver
President, Silkin Management Group

THE FINANCIAL CRISIS: THE HIDDEN BEGINNING

by Bruce Wiseman
On April 2, 2009, control of the planet’s banks was turned over to the secret decisions of eleven men—board members of a Swiss organization with a troubling Nazi past.

Banking wasn’t always that way...

My secretary would come into my office every morning at 9:00 a.m. with a room-service smile and an armload of computer printouts. She would place the reports on my desk as if she were serving a fine meal and arrange them just so, with the overdraft report on top, and then slip out of the office as if she were trying not to wake anyone.

The customer’s name was on the left side of the page followed by the date the account was opened, the six-month average balance, and a listing of the offending checks that had sentenced the account to the OD report. The amount of the checks and the total overdraft were featured prominently on the right-hand side of the page like perps in a police lineup.

The decisions were twofold: do I pay the checks and, whether paid or not, do I assess overdraft charges? Overdraft charges have gotten rapacious in recent years, but they were $4.00 an item back then, and believe it or not, it takes time, money and effort for bank personnel to track down the impostor and send it home branded with banking’s scarlet letter—insufficient funds.

I would usually let the charges stand, but I was not a tough close if someone called in with a plausible story on why the check beat the deposit to their account. This was usually good for one round of reversed OD charges, but rarely repeated despite screenplay-quality presentations.

A friend of mine had a leather shop down the street where he handcrafted sandals, belts and wallets adorned with peace symbols, which, in those days, were found on everything from condoms to dog collars. He was of the genus Hippy, drove a ratty VW van covered in flowery orange and yellows, and wore iconic bell-bottomed Levi’s. There was great profit in leather goods, but Jimmy paid no attention to his bank balance and overdrew the account with such regularity I sometimes wondered if he was trying to ensure the branch remained profitable.

Banking was more personal then:

“Jimmy, you’re OD again.”

“That’s bullshit, man.”

“No, Jimmy. It’s not bullshit. You’re overdrawn $312.”

“I can’t be overdrawn. I just gave you guys a bunch of bread. You probably held it so some checks would come in first and you could hit me with a bunch of overdraft charges.”

“Lay off the weed, Jimmy. When did you make the deposit?”

“Yesterday. Seven hundred bones. Gave it to that foxy black chick with the Afro.”

“Yes. I see it. But you’re still OD.”

“You’re bummin’ me out, man, really bummin’ me out.”

“When was the last time you reconciled your account, Jimmy?”

“Don’t put that on me, man. That form is a bad trip. Gives me a migraine.”

“Bring your last three statements down to the branch and I’ll have bookkeeping reconcile the account for you.”

“Groovy. You gonna reverse the OD charges?”

“Not a prayer. Bring $312 with you.”

“Fascist.”

Your local bank was also where you went to get a loan to buy your new home. And there it stayed until it was paid off.

A customer would come into the branch, fill out an application and, if approved, we would finance 75%–80% of the purchase. The borrower would come up with the balance. When the loan was approved, we would issue the funds to escrow at the appropriate time and put the loan on our books, where it would stay, earning the bank the going rate of interest for home loans.

I’m sure there are still some community banks that offer personal service instead of having you talk to someone in the Philippines about your credit card, but I wrote this to make the point that banking—and mortgage banking in particular—had changed.
Banks started selling loans to investors while keeping the servicing. In other words, the borrower would keep making his mortgage payments to the bank that made the loan but the payment would be sent on to the investor who had purchased the loan from the bank. The investors were usually pension plans or large investment funds.

But this change in mortgage lending was just beginning.

A group of leading bankers would soon turn mortgage banking into a cancer that would eat the industry alive. What follows is the earlier beginning to our story “The Financial Crisis: A Look Behind the Wizard’s Curtain”—a chronicle of the men and institutions who designed the current crisis: a crisis by design.

The purpose of this financial crisis is to take down the United States and the U.S. dollar as the stable datum of planetary finance and, in the midst of the resulting confusion, put in its place a Global Monetary Authority—a planetary financial control organization to “ensure this never happens again.”

But I am getting ahead of myself.

THE JAPANESE

It is 1985 and the Land of the Rising Sun has become the planet’s largest creditor nation. Words like Toyota, Panasonic and Yamaha have become part of the lexicon in places such as Omaha, Cleveland and Des Moines. In 1970, the ten largest banks in the world were American. By the end of the eighties, six of the ten largest banks in the world are Japanese.

What happened?

The Japanese banks were pampered and protected by their government like corporate rock stars. They were permitted to operate with small amounts of reserve capital, which gave them an advantage over other banks and enabled them to expand their market share at the expense of their competition—the major money-center banks in New York and London represented by the dual-headed Darth Vaders of international finance, the U.S. Federal Reserve Bank and the Bank of England.

The Gunfight at the O.K. Corral had nothing on what was about to occur to the banking samurai of Tokyo.

In the eighties, governments had varying regulations about how much capital their banks had to maintain. These standards were supposed to ensure that banks had enough in reserves to protect themselves and their depositors against bad loans.
These “capital adequacy standards” were set as a percentage of the bank’s assets. In other words, if the capital requirements were 8% and a bank had $8,000,000 in capital, they could expand their balance sheet to $100,000,000 in assets (loans and other investments).

But let’s say the capital requirements were 4%. Taking the same bank with the same $8,000,000 in capital, they could carry $200,000,000 in loans and other assets, generating a great deal more income and profit for the bank.

If the capital requirements were 10%, that same bank could have assets of $80,000,000—fewer loans, less income.

You get the picture: the capital requirements dictated what amount of assets the bank could carry. And the amount of assets determined how much income the bank could generate.

The Japanese banks had low capital requirements—one central banker reported them to be as low as 3%. Others claimed 6%. But in either case, they were low. The low capital requirements enabled them to hold more assets, which in turn spun off more income. The elevated income enabled them to offer lower interest rates on loans than the competition could. Their market share grew.

In time, Japanese banking became the Godzilla of international finance—a condition that did not sit well with Alan Greenspan, the recently appointed Chairman of the Federal Reserve Bank, who dealt with the matter like a Mafia chieftain whose turf had been violated by the yakuza.

As soon as he assumed the throne at the Fed, Greenspan, complaining about advantage enjoyed by the Japanese banks, went to his comrades in coin at the Bank of England and executed a two-party agreement establishing capital adequacy standards for U.S. and UK banks. The two of them then turned on their pinstriped Nipponese brothers and told them that they were going to be excluded from Western markets unless they agreed to an international standard of capital adequacy.

The Japanese, dragged to the agreement like a dog to a bath, signed the agreement on July 15, 1988, along with the central bankers of nine other industrialized nations, setting forth “international . . . regulations governing the capital adequacy of international banks.”

The agreement was signed at the secretive Bank for International Settlements in Basel, Switzerland, and is referred to as the Basel Accord. However, since a second accord was signed in 2004 (which we deal with in “Behind the Wizard’s Curtain”), this agreement is now referred to as Basel I and the 2004 agreement as Basel II.

THE BANK FOR INTERNATIONAL SETTLEMENTS

I have dealt with the Bank for International Settlements in the two previous articles on the financial crisis and am going to take the liberty of quoting from them here. First, “A Look Behind the Wizard’s Curtain”:

Central banks . . . govern a country’s monetary policy and create the country’s money.

The Bank for International Settlements (BIS), located in Basel, Switzerland, is the central bankers’ bank. There are 55 central banks around the planet that are members, but the BIS is controlled by a board of directors, which is comprised of the elite central bankers of 11 different countries (U.S., UK, Belgium, Canada, France, Germany, Italy, Japan, Switzerland, the Netherlands and Sweden).

Created in 1930, the BIS is owned by its member central banks, which, again, are private entities. The buildings and surroundings that are used for the purpose of the bank are inviolable. No agent of the Swiss public authorities may enter the premises without the express consent of the bank. The bank exercises supervision and police power over its premises. The bank enjoys immunity from criminal and administrative jurisdiction.

In short, they are above the law.

And from the second article, “Hitler’s Bank Goes Global”:

But then the Bank for International Settlements (BIS) . . . has never seen transparency as one of its core values. In fact, given its fascist pedigree, transparency hasn’t been a value at all. Known as Hitler’s bank, the Bank for International Settlements worked arm in arm with the Nazis, facilitating the transfer of gold from Nazi-occupied countries to the Reichsbank, and kept their lines open to the international financial community during the Second World War. . .

It is like a sovereign state. Its personnel have diplomatic immunity for their persons and papers. No taxes are levied on the bank or the personnel’s salaries. The grounds are sovereign, as are the buildings and offices. The Swiss government has no legal jurisdiction over the bank and no government agency or authority has oversight over its operations.

BASEL I

Basel I established the terms for the minimum capital requirements for the ten central banks that signed the accord: Belgium, Canada, France, Italy, Japan, the Netherlands, the UK, the U.S., Germany and Sweden (Switzerland signed later).
A standard had been set: banks had to maintain capital of 8% of their assets. But according to the agreement, all assets were not the same. Basel I introduced a special system of weighing the risk of different kinds of assets and loans—they referred to it as risk-weighted assets. For example, corporate loans to businesses called for a higher percentage capital than mortgage loans. As a consequence, banks started cutting back on corporate loans and seeking ways to expand their mortgage portfolios.

As for the Japanese banks, they had to adjust. But the Nikkei Index (the Japanese stock market) was booming at the time, so they didn’t consider it a big problem. Between 1984 and 1989 the Nikkei had risen from 11,500 to 38,900. As stocks increased in value, the capital base of the Japanese banks (made up largely of stock) increased as well.

Things were cool. Sake flowed, geishas danced and banker-san was happy. But the good times were short lived. Less than a year later, in May of 1989, the Nikkei began a decline that eventually brought the index down to below 8,000.

As went the Nikkei, so went the capital structure of the banks. Down they went, slashing their ability to lend and sending the entire Japanese economy into a recession that has been called the “Lost Decade.”

You don’t cross the Fed and the Bank of England and get away with it. Not on this planet.

It was a different story for the U.S. banks. The new capital adequacy standards laid down as Basel I had loopholes through which the American bankers were able to drive their Porsches to bonuses larger than the budgets of several third-world countries.

THE INTENTIONS OF BASEL I

Writers have referred to the consequences of Basel I as unintended.

Were they really?

Greenspan not only sat on the board of directors of the Bank for International Settlements, he was also of course the Chairman of the Federal Reserve Bank. From this position he kept interest rates suppressed at abnormally low levels, ushering in a lethal binge of credit excess in America; advanced the Community Reinvestment Act, which mandated mortgage lending to anyone who drew breath (and some who didn’t); and, along with Robert Rubin and Larry Summers, actively fought efforts to regulate the exploding market in toxic financial instruments called derivatives.
This included using his influence to help eliminate laws that had been on the books for decades protecting people from speculative excess and abuse in financial markets (see “The Financial Crisis: A Look Behind the Wizard’s Curtain”).

DERIVATIVES

Derivatives are what Warren Buffet has called “financial weapons of mass destruction”—financial products that seem to have been imported from a galaxy far, far away.

Derivatives are financial instruments that derive their value from some underlying asset. An example of a derivative is one you have heard a lot of lately: mortgage-backed securities.

Here’s how this works. Mortgage loans are packaged up and legally pooled into a financial document called a security. This simply means that there is a formal certificate that represents a group of loans. The investor buys the security. The security pays interest to the investor, which is based on the interest rates of the underlying mortgages.

You can see where the name comes from: the financial instrument, the mortgaged-backed security, is backed by the mortgages.

It is a derivative because the financial instrument, the security, derives its value from the underlying assets (the mortgage loans).

So what were the intentions of the central bankers when they crafted Basel I? One was to take out the Japanese banks. Mission accomplished.

The other was obvious: to curtail lending to corporations while focusing the attention and appetites of those same lenders on the increased income and bonuses available by investing in mortgage-backed securities.

Under Basel I, banks only had to have half as much capital to invest in mortgages as was required for corporate loans. Or put another way, they could invest twice as much in mortgages as they could in corporate loans with the same amount of capital. The more loans, the more income.

What else did the bankers of Basel think was going to happen other than an explosion in mortgage lending? Nothing of course. And later, when the lenders bought credit insurance for the securities, the capital requirements were reduced even further, pouring gas on what had by then become a raging inferno of credit speculation.

CREDIT DEFAULT SWAPS

It wasn’t actually called credit insurance, though. It had another one of those off-planet names: credit default swaps,, but in essence that’s what it was. Here’s how this piece of the puzzle fit.

The bank would buy a contract from an insurer that covered the credit risk of the derivative. In other words, the bank would pay a fee to the insuring company—just like an insurance premium—and if the security turned bad, if the loans failed to pay, the insurance company was obligated to cover the bank’s loss.

When banks bought credit default swaps for their derivatives from an AAA-rated insurance company, the derivative itself took on an AAA rating.

When the derivative received an AAA rating, the bank’s capital requirements—already reduced because the derivatives were made up of mortgages—were reduced even more, freeing up more capital, which enabled them to buy more derivatives, which . . .

There were just a couple of small problems. The credit default swaps—not technically being insurance—were entirely unregulated. This meant that the insurance companies that issued these—think American Insurance Group (AIG), which was the world’s largest insurance company and rated AAA, but which is now owned by thee and me—did not have to carry reserves to cover the loss if the trillions of dollars of derivatives they insured went bad.

The other was the fact that with the passage of the Community Reinvestment Act, the mortgage market was awash in subprime loans (borrowers with poor credit, low income, and no or low down payments). And it was these loans that were packaged into mortgage- backed securities by the trillions and sold to virtually every major bank on the planet, making the international financial structure pregnant with disaster.

It was at this point, having originally set the stage with Basel I, that the world’s central bankers returned to the Bank for International Settlements in Basel, Switzerland, and issued a second set of rules referred to as Basel II. Included in the Basel II Accord was an accounting rule called mark to market, which brought the planet’s entire financial system to its knees. Mark to market was like pulling the pin on an enormous hand grenade made up of trillions of dollars of toxic derivatives.

THE FINANCIAL STABILITY BOARD

On April 2, 2009, at a meeting of world leaders in London, the final card was played: terrified about the potential consequences of a planetary meltdown, they agreed to a plan that established a global financial dictatorship at the Bank for International Settlements called the Financial Stability Board. And this, dear friends, was the goal from the beginning.

If we are going to be realists, we must acknowledge that Greenspan—along with a few fellow monetary jihadists like Paulson, Rubin, Summers and Geithner—planted the bomb in Basel I, lit the fuse by ensuring any meaningful protection against it was removed, and then detonated it with Basel II. What followed the explosion was a global financial coup, which was executed in April.

It took a while for the fuse to burn and the bomb to detonate, but when viewed as a well-constructed plan, the intentions seem inescapable: this financial crisis was and is a Crisis by Design.

The story of how Basel II created the worldwide financial crisis and how the Financial Stability Board was created is covered in detail in my earlier articles on this subject: “The Financial Crisis: A Look Behind the Wizard’s Curtain” and “Hitler’s Bank Goes Global.”

It is the second article that spells out what action to take, and what can and should be done.

The articles can be found at www.brucewiseman.net.
A documentary film based on the articles is in pre-production. If you would like more information about the film, contact me at the email address below.

Keep your powder dry.

bruce@brusewiseman.net
www.brucewiseman.net

© 2009 Bruce Wiseman.
All rights reserved.

JOB LOSSES, FORECLOSURES AND YOUR PRACTICE

"We are about to have a big problem...Foreclosures were bad last year? Its going to get worse, " says Morris A. Davis, a real estate expert at the University of Wisconsin. Davis isn't the only pundit talking about this. Mark Zandi, the brilliant author and chief economist at Moody's Economy.com is saying: "... loss of jobs and loss of overtime hours and being forced from a full-time to part-time job is resulting in [mortgage] defaults." All over the US, doctors are having to deal with individuals who cannot cover deductibles, co-pays, and are less reluctant to see the doctor. Where elective type treatment is involved, patients are just not accepting treatment as readily as they have in the past.

Silkin research in over 50 practices in the past 3 months indicates that doctors in every category of health care are having a much more difficult time getting patients to comply with treatment plans. Let's face it. The general public is scared when it comes to spending money, and the doctor and staff have to know how to deal with this. Otherwise, their practices go the same direction as the economy!

Allen Jackson, one of Silkin's senior analysts and consultant for over 20 years made this observation recently: "When credit was lax, and everyone was getting 0% credit card offers in the mail, it didn't require any skill to get a patient to comply with a treatment plan. If a practice was not growing during that period at a solid 15-20% then something was wrong. Now, its a different world; management skills like, "selling" treatment, keeping staff motivated and efficient, and increasing profitability in a private practice take expertise and knowing what to do. Doctors need to start managing and they need staff who are on their toes and know their jobs cold. During those "good times" lack of management expertise in a practice was hidden by the fact that patients had an abundance of credit available. The danger of that time period, Jackson says, "led to complacency and not being as alert as possible to the signs of downturns practices."

We recently did a survey on about 150 of our clients and found that they have continued to grow at a solid rate over the past 12 to 18 months, while revenue in private practices nationally continues to decline. We asked these clients if they felt things had slowed down for them with the economy being so poor. Over 90% said no, that they were continuing to grow.

Some of the comments were:

"We're in control of our new patients, so it's not a problem."

"It (the economy) hasn't been a problem with the things I've learned from you."

"I'm still moving up, last month was the best month of my entire practice." "We've actually grown. March growth was 7% and April was 20%."

Learning basic practice management skills puts one in control of the growth and profitability of any practice. As a philosopher once said, "knowledge is power" and that holds true whether referring to running a country, a business or a health care office. Get yourself trained in practice management, whether you use Silkin or another practice management program. It will help you be pro-active during these tougher economic times.

We also invite your feedback to this blog or previous blogs by participating in our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin

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An Argument for developing a Web Presence

An impressive web presence is generally not a high priority for most private practice health care owners. Although many practices now have website, the importance and use of them is often not taken to seriously.

I am not a computer genius nor do I know the first thing about HTML (Hyper Text Markup Language - used for creating web sites) formatting. I use a computer at work and like many people, I have a computer at home that I use for email and more importantly, to "Google."

By "Google" I am of course referring to the massively popular activity of searching for information on the web to find a restaurant, a vacation spot or a doctor's practice that I am considering going to.

Over the past three years, it has become more and more obvious that Americans are more and more using the World Wide Web to find out about companies that they wish to do business with. The days of looking up a doctor's phone number in the bulky, yellow, phone book are gone. I am not implying that paper phone books are no longer useful, they most certainly are. I use mine at home to shore up a short leg on my basement desk. However, if I am interested in finding a good doctor to visit, I am just a mouse click away from the largest resource of information of doctors in my area ever known.

For example, my Veterinarian's site provides directions to her practice so that I can easily refer my friends to her. Her site also lets me know about new services for my pet, background information on her new employees and emergency hours. I even discovered that her office is starting a grooming service! (Hmm, good idea, I am scheduling an appointment for my dog "Bo" next week.)

The idea for this blog was created from an incident that occurred just recently. In the normal course of doing business, I was invited to speak with a Veterinarian in Colorado. Prior to my call, I decided to look up the doctor's practice on the web to find out more about the doctor himself and his practice. As a professional, I find it helpful knowing something about a client before meeting them. I was surprised that I could not find any information regarding the doctor on-line. I attempted to find him on several search engines; I even varied my search. I tried his name, I tried his name plus DVM in "City Name," CO. I even did a search just for Veterinarians in his town. Finally, I was able to find the doctor's name in the web site of his competitor in the same town! His competitor's site was very beautiful with plenty of information about his practice, the staff, his facilities, etc. If I were a resident with a pet in this beautiful town in Colorado, I would now know exactly which practice to go to, and it wasn't his. And yes, I did call the doctor as scheduled and made the doctor very aware of what was happening in his neighborhood. Interestingly enough, the doctor was wondering why his practice was contracting in a community that was expanding quite rapidly.

Unfortunately this is not only a true story it is also very common.

Developing a web presence now is more important than ever. Home computer use is not going to slack off in the years to come. More than ever, Mr. and Mrs. Patient and Client are going to go to the World Wide Web to find information regarding the doctor or practice that they are going to visit.

And yes, word of mouth is still the number one draw of new patients and clients to your practice. But know this - after I hear your name and how wonderful your practice is from my best friend, I promise you, I will Google you. What happens after that is up to you.

We also invite your feedback to this blog or previous blogs by participating in our
Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin Management Group

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The U.S. Dollar

In our last two blogs, I presented a two part article from Mr. Bruce Wiseman about the international financial crisis and the "Big Brother" controls that are being implemented.

Mr. Wiseman also predicted the potential fall of the dollar as the world's reserve currency. Well, lo and behold, the NY Times op-ed pieces for Thursday, May 14 had not one, but two pieces on the fall of the dollar. I thought it would be of interest to pass these articles along to anyone interested in following this situation.

The first article is by a professor of economics at the New York University Stern School of Business, and the second article is by an executive director of the Beijing Private Equity Association who is also a director of the China National Association of International Studies. Click on the links below to read the articles. I think you will find them interesting in light of the two previous articles by Mr. Wiseman.

The Almighty Renminbi?

China’s Heart of Gold

We also invite your feedback to this blog or previous blogs by participating in our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin Management Group

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THE REAL SITUATION

Here is Part 2 of the latest article by Mr. Bruce Wiseman regarding the sources of the worldwide financial crisis.  Part 1 can be seen in our previous Blog below. If you haven't read Part 1, please do so before reading Part 2, below.

Larry Silver
President Silkin Management Group

THE REAL SITUATION
More to the point, you may have noticed that you weren’t consulted on this setup. Neither was Congress. In other words, the command channel for implementing global financial strategies goes from the FSB leadership to its central banker members and from them to the world’s financial institutions. You don’t get a peek, neither does Congress, nor, for that matter, does the White House.

And while there may be some accountability in some of the member countries, by and large these central bankers have the authority to implement these regulations and strategies. And they are held responsible by the FSB to do so.

In short, on April 2, 2009, the President signed a communiqué that essentially turns over financial control of the country, and the planet, to a handful of central bankers, who, besides dictating policy covering everything from your retirement income to shareholder rights, will additionally have access to your health and education records. There is also this troubling little line about “clear specification of the structure and functions of government.” What the hell is that suppose to mean? There is no oversight here. Not by you, not by Congress, not by anybody. No oversight over a handful of central bankers who operate out of a clandestine organization that is above the law and is responsible for having implemented and enforced the “standards” that froze world credit markets and precipitated the worst financial crisis in the planet’s history (see “The Financial Crisis: A Look Behind the Wizard’s Curtain”).

I haven’t heard word one out of Congress about this, but I’m afraid they are a few clowns short of a circus up there. Which begs the question, what do we do about this?
                                
THE SOLUTION
There are two critical things that need to be done. The first lies in the fact that the communiqué signed by the President is an agreement that is binding on the United States and, as such, requires approval by Congress. If classed as a Treaty, it requires approval by two-thirds of the Senate. At the very least, approval should be by Congressional Executive Agreement, which requires a majority of both houses of Congress. The agreement signed in London on April 2 has been called a New Bretton Woods (Bretton Woods being the location of a meeting of world leaders toward the end of the Second World War, which gave birth to the international financial organizations the World Bank and the International Monetary Fund). The original Bretton Woods agreement was put in place as a Congressional Executive Agreement. So this “new Bretton Woods” should at least do the same. But this step is just to get Congress to recognize their responsibility here. The Federal Reserve Act, the bill that established the Federal Reserve System, was passed in 1913 two nights before Christmas by a sparsely attended Congress. People have been complaining about this ever since. What do you say we don’t let this happen again? Not on our watch. Congress needs to understand that it has a responsibility to approve any agreement signed by the President that is binding on this nation. But the point is not to get Congress to approve what has been done. It is to first get them to recognize that agreements have been made that affect our entire financial system and that it is their responsibility to shape these agreements in a way that is beneficial to our Republic AND to provide a mechanism for real oversight of this international body. Central bankers should not be making decisions about international finance without oversight and a system of checks and balances that are reflective of those provided by a republican form of government. I am, of course, not talking about a political party here. No, no. I’m talking about the American form of government where citizens elect others to represent them. 

A republican form of government is one that is operated by representatives chosen by the people. Congress must step up to the plate. They must insist that the Financial Stability Board be ratified either by Treaty or Congressional Executive Agreement. And that ratification must include the creation of a body with oversight and corrective powers that is comprised of representatives of all the nations involved who are chosen from each country’s elected officials. There is nothing inherently evil about an international financial organization. As much as we might protest it, it is a global world today, and a body that oversees the smooth flow and interchange of currencies and other financial instruments is needed in today’s world. But the organization cannot be controlled by international bankers who are not answerable to the citizens of the countries in which they operate. It should be overseen by a senior level group which itself is organized as a liberal republic, following the original model of the United States. Why? Because the system of government originally created by the United States has been the most successful form of government in man’s history. Any problems with the system have come about as a result of deviations from the original structure—a representative form of government with adequate checks and balances. Such a body could help create an international economic system in which those that want to be successful can be so. It would also allow them to take an active role in controlling their futures by effectively participating in the legislative process. ACT!

Let your Representatives and Senators know: the Financial Stability Board must be approved by Congress and must be subject to oversight by elected officials of the
countries involved. Personal visits, followed by calls and faxes to both Washington and local offices, are the most effective. Don’t be surprised if they don’t know what you’re talking about. Politely insist they find out and take action. And understand this when dealing with legislators or their staffs: they are focused almost exclusively on legislation that has already been introduced—a bill with a number on it.

That is not the case here. You want them to take action on this matter by introducing legislation that brings the approval and structure of the Financial Stability Board under congressional control. This can be accomplished.  

“All tyranny needs to gain a foothold is for people of good conscience to remain silent.” —Thomas Jefferson
 
Find your elected officials here:
http://www.visi.com/juan/congress/

Bruce Wiseman
bdwiseman@earthlink.net
www.Brucewiseman.net
Copyright © 2009 Bruce Wiseman

About a month ago, I presented a 3 part article from Bruce Wiseman concerning his research on the "whys and wherefores" of the global financial crisis. I followed his article with another piece I found in my research by Dick Morris, former Clinton advisor and political strategist, that echoed some of the information that Wiseman wrote about. I just got a follow up piece by Wiseman that I thought was very, very interesting and worth sharing with anyone reading this blog. His data seems factual and, from what I can tell, accurate although I certainly haven't gone and attempted to verify every piece of it. I invite you to read it and share any thoughts through our Discussion Forum at the the Silkin Facebook Page BY CLICKING HERE.

Larry Silver,
President Silkin Management Group

Here is Part 1.

HITLER’S BANK GOES GLOBAL

THE PURPOSE OF THE FINANCIAL CRISIS

By Bruce Wiseman

A towering citadel housing what is essentially a sovereign state known as the Bank for International Settlements is located in Basel, Switzerland. The bank now controls the financial affairs of planet Earth.

If you think this is an exaggeration or the conspiratorial ramblings of the author . . . or not, I invite you to read on.

I wrote the first installment of this article—“The Financial Crisis: A Look Behind the Wizard’s Curtain”—in mid-March of this year. The article included the following statement: “The purpose of this financial crisis is to take down the United States and the U.S. dollar as the stable datum of planetary finance and, in the midst of the resulting confusion, put in its place a Global Monetary Authority—a planetary financial control organization “to ensure this never happens again.”

This purpose has now been accomplished.

The dollar, the former king of currencies, now goes begging in the pant-suited persona of Hillary Clinton to our creditors at the Chinese Communist Party. Almost unthinkable a few short years ago, the U.S. dollar is fast losing its status as the world reserve currency, and any thought of saving it is being nuked by the Larry, Moe and Curly of U.S. economic policy - Bernanke, Geithner and Summers - and their Alice in Wonderland trillion-dollar budget deficits. I would not be surprised to see central banks start using the renminbi (the currency of the newly awakened People’s Republic of China—also called the yuan) for international trade and reserves in the not too distant future. This prediction will likely be scoffed at by global economists, but then they have about as much credibility as pharmaceutical salesmen these days. A more generally discussed alternative is the International Monetary Fund’s SDR (which stands for Special Drawing Rights). There is no production or property behind the SDR. It is one of those clown currencies that are made up out of thin air—a magic trick central bankers like to do. Intoxicated by the power of the purse, they think of themselves as fiscal alchemists. But the dollar has seen its glory. It can return one day, if Washington ever finds its financial backbone. But let’s be real, with the exception of a very few, like Ron Paul in the House and Tom Coburn in the Senate, these folks are addicted to spending like junkies on horse.
More importantly, the other shoe has dropped. Like some ghoulish predator from another Alien sequel, a Global Monetary Authority has been born. It lives.

THE FINANCIAL STABILITY BOARD

On April 2, 2009, the members of the G-20 (a loose-knit organization of the central bankers and finance ministers of the 20 major industrialized nations) issued a communiqué that gave birth to what is no less than Big Brother in a three-piece suit.

Which means? . . .

The communiqué announced the creation of the all too Soviet sounding Financial Stability Board (FSB)—and no, I’m not going to make a crack about the fact that this acronym is the same as that of the Russian intelligence service that replaced the KGB. The Financial Stability Board. Remember that name well, because they now have control of the planet’s finances . . . and, when one peels the onion of the communiqué, control of much, much more. The FSB morphed into existence from an earlier incarnation called the Financial Stability Forum. The Financial Stability Forum (FSF) was established in 1999 to promote international financial stability through co-operation in financial supervision and surveillance. Since it had done such a wonderful job, the central bankers decided to expand its powers and give it a new name.

A board sounds like it has more authority than a forum. But the name change isn’t the problem. The FSB’s broadened mandate includes under point 5, “As obligations of membership, member countries and territories commit to pursue the maintenance of financial stability, maintain the openness and transparency of the financial sector, implement international financial standards (including the 12 key International Standards and Codes), and agree to undergo periodic peer reviews, using among other evidence IMF/World Bank public Financial Sector Assessment Program reports.” Rather a mouthful of elitist banker-speak. But, as a friend of mine is fond of saying, “The Devil is in the details.”

THE 12 INTERNATIONAL STANDARDS AND CODES

While several press releases from the G-20’s London conclave reference these codes as though they were handed down from a fiscal Mount Sinai, finding the specifics takes some digging. But then the Bank for International Settlements (BIS), out of which the FSB operates, has never seen transparency as one of its core values. In fact, given its fascist pedigree, transparency hasn’t been a value at all. Known as Hitler’s bank, the Bank for International Settlements worked arm in arm with the Nazis, facilitating the transfer of gold from Nazi-occupied countries to the Reichsbank, and kept their lines open to the international financial community during the Second World War.

As noted in the first article, the BIS is completely above the law. It is like a sovereign state. Its personnel have diplomatic immunity for their persons and papers. No taxes are levied on the bank or the personnel’s salaries. The grounds are sovereign, as are the buildings and offices. The Swiss government has no legal jurisdiction over the bank and no government agency or authority has oversight over its operations. In a 2003 article titled “Controlling the World’s Monetary System the Bank for International Settlements,” Joan Veon wrote: “The BIS is where all of the world’s central banks meet to analyze the global economy and determine what course of action they will take next to put more money in their pockets, since they control the amount of money in circulation and how much interest they are going to charge governments and banks for borrowing from them. . . .“When you understand that the BIS pulls the strings of the world’s monetary system, you then understand that they have the ability to create a financial boom or bust in a country. If that country is not doing what the money lenders want, then all they have to do is sell its currency.”

And if you don’t find that troubling, a close reading of the new powers of the FSB are chilling. The 12 key International Standards and Codes, which are minimum requirements, contain such things as

• clear specification of the structure and functions of government;


• statistical and data gathering from ministries of education, health, finance and other agencies;


• corporate governance principles;


• shareholder rights;


• personal savings;


• secure retirement incomes;


• international accounting standards to be observed in the preparation of financial statements;


• international standards of auditing;


• securities settlement;


• foreign exchange settlement;


• minimal capital adequacy for banks;


• risk management;


• ratification and implementation of UN instruments; and


• criminalizing the financing of terrorism.

“Sounds oppressive,” you say; “but I don’t really care what a bunch of bankers do in Basel, Switzerland. It’s got nothing to do with me.” But I am writing this to tell you that it has everything to do with you, your family, your business, your country, and—if you’re up to it—your planet. Because as currently structured, the dictates of the Financial Stability Board will impact your life without any say-so on your part whatsoever.

Here’s one example from an article written by former Clinton advisor and political strategist Dick Morris in an article for The Bulletin on April 6, 2009. “The FSB is also charged with ‘implementing . . . tough new principles on pay and compensation and to support sustainable compensation schemes and the corporate social responsibility of all firms.’ “That means that the FSB will regulate how much executives are to be paid and will enforce its idea of corporate social responsibility at ‘all firms.’”

You begin to see what’s involved here.

You see, these standards and codes are commitments, obligations and requirements, not merely advice. The strategy, policies and regulations of the FSB are worked out at the senior levels of the bank. They are approved by the plenary and implemented through the national representatives.

THE STRUCTURE

The plenary, in this sense, is the complete membership body of the FSB. And the membership, my friends—the national representatives who implement these policies—just happen to be the heads of the planet’s more powerful central banks. And in case it slipped your mind, most central banks are private institutions and answerable to no one. Take our central bank, the Federal Reserve Bank. Yes, the chairman is appointed by the President and often testifies before Congress, but there is virtually no public control over the institution. It can’t be audited nor can Congress tell it what to do. It is not really accountable to anyone. The idea that the Fed is a government agency subject to the control of Congress is a PR line. It is simply not true. Among other things, central banks govern a country’s monetary policy and create (print) the country’s money. They make income by charging interest on the money they loan to the government.

Watch this, because if you blink, you’ll miss it.

Governments are perpetually in debt. They are always borrowing money. They have a mental disorder that prevents them from spending less than they collect in taxes—BDD, Budget Deficit Disorder. And if it looks like they might balance the books some year, why, someone can always start a war.

Here’s an example.

Let’s say the annual budget calls for the U.S. government to spend $2.5 trillion. But the income will only be $2 trillion. They’re going to be a little short. But no worries, they have the ultimate credit card—a debt limit that they themselves control. If they borrow up to the established limit, they can just vote it higher —which they have done to the tune of a cool $11.2 trillion dollars.

The Fed loves this.

Listen as the Secretary of the Treasury calls the Chairman of the Fed.

“Ben. It’s Tim.”

“Dude. What’s happening?”

“I need a little bread. Friggin’ Taliban again.”

“No problem, Timbo. How much you looking for?”

“Five hundred big ones.”

Ben licks his lips. “Anything for you, big guy. Send me the notes and I’m down with the five hundred. Five percent work for you?”

“Whatever.”

So the Treasury prints up $500 billion dollars’ worth of IOUs—they are called Treasury bills (short term), notes (medium term) or bonds (long term)—and sends them over to the Fed with a fifth of Chivas.

In the old days, the Fed would print the cash. These days, they click a mouse.

Now here’s the part where you aren’t allowed to blink.

When the Fed prints the money or clicks the mouse, they have no money themselves. They are just creating it out of thin air. They just print it, or send it digitally. And then they charge interest on the money they lent to the Treasury. A hundred-dollar bill costs $0.04 to print. But the interest is charged on the $100. Go ahead: read it again; the words won’t change.

The interest on the national debt last year was $451,154,049,950.63. That’s $1.23 billion a day. These are the same people that are now running our banks, insurance companies and automobile manufacturers.

Reason weeps.

Sure, I oversimplified it. The Fed doesn’t own all the debt and they do some other things. But these are the basics. That is how a central bank works. It is the heads of the planet’s central banks and some finance ministers that make up the membership of the FSB.

In brief, here’s how it works: the Board’s leadership provides strategies, policies and regulations to the membership. The members vote on the matters and then see to their implementation in their respective countries.

FSB leadership is in the hands of the chairman, Mario Draghi. Mr. Draghi is also the governor of Italy’s central bank. He is a former executive director of the World Bank and like his comrade in international finance, Henry Paulson—the former U.S. Secretary of the Treasury who bludgeoned Congress out of the first $700 billion bailout package—Draghi was a managing director of Goldman Sachs until 2006. Like Paulson, he left Goldman in 2006, a year before the financial crisis exploded: Paulson went to Washington to run the U.S. Treasury; Draghi went to Rome to run Italy’s financial system as well as the Financial Stability Forum (forerunner to the Financial Stability Board).

Let’s call it government by Goldman, shall we?

END PART 1

Are You Getting Enough Compliance to your Treatment Plans?

Are You Getting Enough Compliance to your Treatment Plans?

We have found over the years that one of the most rapid ways to increase practice production is to increase patient compliance to recommended treatment plans. This increase in production can be done without increasing the number of new patients. A minor 10% increase in compliance can result in tens of thousands of dollars of additional production and income with no change in overhead. The biggest single factor in increasing patient compliance is the doctor's ability to properly present treatment plans to the patient. Below you will find some helpful tips along this line.

Treatment Presentation Tips

A sale is an exchange whereby all parties involved receive something of value. In health care professions, a patient/client receives care to remedy a health problem and/or to maintain good health. In exchange for the work done, the staff and doctor are paid. A successful practice has doctors and staff members in it who care enough to sell patients exactly what they need.

The doctor's role in the sale cycle is to diagnose and plan treatment for the correct care. Without that, there would be nothing to sell. Does this sound easier than it actually is? Most doctors would say "yes".

From working with doctors for over 25 years, we've isolated many common mistakes doctors make when presenting treatment plans. Three of those are covered below.

Convincing vs. Selling

Convincing people they need to buy something is different than selling them on an idea, service or product. Selling is really nothing more than obtaining agreement. A patient/client who understands the treatment needed, agrees that it needs to be done and commits to doing it is the result of a successful treatment plan presentation. In an attempt to convince a patient/client to accept a plan, doctors often talk too much which, in most cases, works against them. Don't overwhelm your patients/clients with information or with too much communication.

Plan A vs. Plan B vs. Plan C

Do you give your patients/clients too many choices? Your patients/clients don't know what's best for them. They rely on you to tell them what they need. If you don't do that, but give them a choice between Plan A, Plan B or Plan C, the patient/client will naturally ask the cost of the different plans and select the least expensive one. Asking someone to make a choice between a $600 plan, a $350 plan and a $195 plan can even cause suspicion. The patient/client may wonder why you would do a $600 plan if a $195 plan will suffice. Don't let the patient/client decide what he/she needs or what is best for them. That's your job. You are the professional and should give your professional opinion as to what is the right thing for them to do.

"Maybe" vs. "You Need"

As mentioned, you know what your patients/clients need in order to be in good health now and in the future. You spent years and years and years in school learning this. However, when discussing treatment with patients/clients, doctors will often "water down" the presentation. Phrases such as "I think" or "Maybe it's a good idea" instead of "You need" create uncertainty in the patient's/client's mind. If a patient/client needs a specific treatment that may be costly, and this is presented to them with obvious hesitation, they will follow your lead and get the idea that it's an optional treatment. They may not understand that it's vital to their well-being. When you have confidence in the treatment you're providing, you don't need to back off from stating it with certainty. Your patients/clients will appreciate your sincerity, honesty and competence. A very successful application of this concept is to say, "If it was my situation, I would do....". As long as that is the truth, and you say it with sincerity and certainty, the patient/client will follow your lead.

Try following the above tips and I think you'll find an increase in your patient compliance to the treatment plan you present.

We invite your feedback to this blog or previous blogs by participating in our Discussion Forum at the Silkin Facebook Page BY CLICKING HERE.

Larry Silver
President, Silkin Management Group