Showing posts with label nursing education. Show all posts
Showing posts with label nursing education. Show all posts

Tuesday, November 3, 2020

Providing a Learning Environment for Medical Students During the COVID-19 Crisis

Most physicians who work in an academic or private practice setting teach medical students. If students who have been assigned to you for their clinical rotations have had limitations placed on their level of patient contact due to the coronavirus 2019 (COVID-19) pandemic, you are likely very concerned about their medical education. There are some approaches you can use to maximize your medically students’ learning—even during this unusual time.


Assign Critical Data Evaluation


Most of us have never experienced anything like the COVID-19 crisis ever before. The infection can alter the way patients in many specialties are cared for. Your students can work on finding the most accurate and reliable information available when it comes to the implications for patients that are cared for in your specialty.

Students can learn how to research updated information about local and worldwide statistics, the risks for your patient population, and preventative strategies. Even if your students aren’t allowed to have personal contact with your patients, they can become proficient in issues that weren’t ever considered prior to this crisis, like assessing information about patient immunity. And students will be able to use skills built through this process for the remainder of their medical careers.

It is impossible to predict which new challenges may emerge in the future and how these challenges will affect different patient populations. Guiding your students to critically evaluate data that is emerging in real time is valuable for their eventual independence as future physicians.



Promote Technology Proficiency


Students will soon walk into residency training with the expectation to use electronic medical records (EMR) for documentation, billing, and communication between different providers. And the doctors of tomorrow also have a high likelihood of incorporating telemedicine and remote patient monitoring into their practices.

While telemedicine certainly has its limitations, it can be a safe vehicle for students to observe patient care and decision making. Students can get valuable experience by understanding the utility of different methods used for patient care besides the traditional clinic visit and in-hospital modes of delivery. Medical students can learn to appreciate the ways that patients can benefit from discussing concerns like subtle changes in their symptoms or possible medication side effects.

And home monitoring devices that provide you with updates on your patients’ readings of blood glucose and heart rhythm may be taken into consideration when making medication adjustments without an in-person patient visit. The doctors of tomorrow will no doubt be using remote tools, and it is never too early for students to learn the utility and limits of virtual patient care.



Emphasize the Physical Examination


Telemedicine and social distancing always mean skipping parts of the patient physical examination. But there is a difference between eliminating steps out of necessity and rushing or cutting corners. When your student can’t be part of the physical examination process, they should still learn what the missing parts of the physical examination are and why these aspects of the physical exam are important.

Students need to hear which components of the physical examination would have been done if it were possible and what the different findings could be. They need to understand how information gained from the physical exam can change the patient care plan.

And while some medical schools may incorporate artificial mannequins for students to practice on, students need to be reminded that they will eventually have to guide real live patients through diagnostic tests that require touching or that might cause a small degree of pain. This is especially important given that when patients eventually return to more in-person care after the crisis is over, they might be skittish about the risks of physical contact for years to come.



Evaluate Diagnostic Tests Carefully


Diagnostic tests can carry more weight than usual when the risk of infection prevents patients from having these evaluations as often as would have otherwise been recommended. This means that medical decisions might be made with less information than in the past.

Students might not have the advantage of comparing changes in test results over time. So, each portion of a diagnostic test must be scrutinized carefully with an understanding that the results might have changed if the test could be easily repeated. And students may have more time to read official radiology reports and compare the reports to the original images, deepening their ability to interpret diagnostic tests.

Teaching is a challenge that most physicians welcome. But creating a valuable learning environment for medical students is especially challenging because the world differs so dramatically from when you were a “hands-on” student. It’s important to explore ways to maximize the experiences of medical students so they can face the challenges of the potentially different world that they will one day practice medicine in.

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Monday, November 2, 2020

The CARES Act and Net Operating Losses

With stay at home and shelter in place orders, it is safe to assume many practices have seen a significant decline in visits and revenue. It is probably also safe to assume that many practices will suffer a loss this year. While this is undoubtedly an unfortunate event, Congress passed the CARES Act in an attempt to provide relief. As you can imagine from an 880-page bill, there are many tax and nontax provisions in the bill. This article will focus solely on the changes made to net operating losses (NOL). We will start with defining an NOL, discussing the legislative history of NOLs, and finish up with some examples of the benefits of the new rules.


Background


According to IRS Publication 536, an NOL occurs when deductions exceed income. In 2020, losses are generally caused by deductions from a trade or business, casualty and theft losses from a federally declared disaster, or rental property. Business losses are the most common cause of an NOL. Even though partnerships and ‘S corporations’ generally cannot use NOLs, partners and shareholders can use their portion of the business’s income and deductions to calculate their own NOL.

Prior to the passage of the Tax Cuts and Jobs Act (TCJA) in late 2017, NOLs could be carried back two years and carried forward 20 years. The TCJA generally disallowed NOLs from being carried back and allowed them to be carried forward indefinitely. There was also an 80 percent of taxable income limitation placed on NOLs.

Enter pandemic. Stay at home orders and social distancing guidelines have decimated small businesses. In an effort to blunt the effects, Congress passed the CARES Act. The Act now allows losses arising in 2018, 2019, and 2020 to be carried back five years. This means that a 2018 NOL can be carried back to 2013. Taxpayers can, however, elect to forgo the carryback and carry the loss forward, instead. The CARES Act also allows losses carried to 2019 and 2020 to offset 100 percent of taxable income.


Benefit


Taxpayers are encouraged to consult their tax preparers to see if carrying back or forward is more beneficial. If one decides to carry back a loss, they can either amend a return or file an application for tentative refund depending on deadlines. If a carryforward is decided upon, taxpayers must file an election to waive the carryback period.

Given the TCJA’s decrease in marginal tax rates, carrying back a loss to years with higher brackets could provide a tax rate arbitrage. For example, a married filing joint taxpayer with $150,000 of taxable income in 2019 would be in the 22 percent bracket. If the same were true in 2013, they would be in the 28 percent tax bracket. So, assume this taxpayer had an unusually bad year in 2018 and experienced a $50,000 net operating loss. The taxpayer could carry that back to 2013 to offset their income or carry it forward to offset 2019 income. Additionally, there could be an even greater tax benefit for higher income earners choosing to carryback an NOL to pre TCJA years. Some high-income earners were subject to an exemption and itemized deduction phase out due to the Pease limitation before 2018, both of which are currently nonexistent. Lastly, some practitioners could be currently eligible for the new 199A deduction possibly reducing their effective rate even further compared to pre TCJA years with higher marginal rates and no 199A deduction.


Conclusion


While our current circumstances are dire, the new NOL rules could provide some financial solace. Practitioners should consider how these new rules impact them.

Medical Practice Supplies
 



VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL