IRS again defers minimum distribution penalty for IRA beneficiaries

By Doug Bailey - For the fourth year in a row, the the Internal Revenue Service has punted on the matter of required minimum distribution (RMD) penalties for IRA beneficiaries under the vaunted 10-year rule. Read Full Article…

VBA Article Summary

1. Extended Relief on RMD Penalties: The IRS has recently extended relief from penalties for beneficiaries subject to Required Minimum Distribution (RMD) rules, allowing them to withdraw inherited IRA balances over a 10-year period without penalty. This extension, initially proposed in 2022, has been prolonged until 2024, offering beneficiaries more flexibility in managing withdrawals.

2. Impact on Tax Liability: Prior to the SECURE Act of 2019, beneficiaries could stretch withdrawals over their lifetime, reducing yearly tax liabilities. However, under current regulations, beneficiaries may face larger annual distributions to deplete the inherited IRA within the specified timeframe, potentially pushing them into higher tax brackets and increasing their tax liability.

3. Long-Term Tax Strategy Considerations: While the extended relief may seem beneficial, it may not align with optimal long-term tax planning. Tax experts suggest that beneficiaries consider taking distributions throughout the 10-year period, even if not required, to balance overall tax bills and leverage current low tax brackets. With tax rates scheduled to increase in 2026, proactive tax planning becomes crucial for optimizing tax outcomes.

Business owners have new choices in retirement plans

By James Shoobridge - If you own a business and you offer a 401(k) or similar retirement plan to your employees, you'll want to stay current on the various changes affecting these types of accounts. And in 2024, you may find some interesting new developments to consider. Read Full Article…

VBA Article Summary

1. Introduction of "Starter" Retirement Plans: The SECURE 2.0 Act introduces "starter" 401(k) and "safe harbor" 403(b) plans aimed at employees who haven't yet established a retirement plan. These plans offer lower contribution limits and disallow employer contributions, providing a low-cost and simple option for employers. However, the tax credit for employer contributions doesn't apply, and while start-up costs are minimal, corresponding tax credits are reduced compared to full-scale plans.

2. Matching Contributions for Student Loan Payments: To address the challenge of saving for retirement while repaying student loans, the act allows employers to offer matching contributions to retirement plans for employees making qualified student loan payments. Though this may increase costs for employers, the contributions are tax deductible and can attract and retain recent graduates and young talent.

3. Expanded 401(k) Eligibility for Part-Time Employees: Part-time employees meeting certain criteria now must be eligible to contribute to existing 401(k) plans. While this inclusion may raise business expenses depending on employer contributions, it offers an attractive benefit for quality part-time employees and enhances retirement savings accessibility.

Medicare beneficiaries could be eligible for Wegovy coverage, study shows

By Reuters - About 3.6 million overweight or obese patients with heart conditions insured under the U.S. Medicare program could be eligible for coverage of Novo Nordisk's (NOVOb.CO), weight-loss drug Wegovy, a study published by Kaiser Family Foundation (KFF) showed on Wednesday. Read Full Article…

VBA Article Summary

1. Expanded Access to Heart Health Treatment: The approval of Wegovy for reducing the risk of stroke and heart attack in overweight or obese adults without diabetes marks a significant milestone in addressing heart conditions in this population. This decision opens up new avenues for managing cardiovascular health among a sizable portion of Medicare beneficiaries diagnosed with obesity and heart disease.

2. Broader Medicare Coverage: The potential expansion of Medicare coverage for Wegovy signifies a shift in policy that acknowledges the intersectionality of obesity and heart disease. By allowing Medicare prescription drug plans to cover drugs approved for secondary use in conditions Medicare already covers, such as heart disease, this decision paves the way for improved access to innovative treatments among vulnerable populations.

3. Implications for Healthcare Spending: The anticipated impact of expanded Wegovy coverage on Medicare spending hinges on several factors, including the uptake of coverage by Part D plans, utilization rates among eligible beneficiaries, and negotiated pricing agreements. While initial coverage may begin in some plans as early as this year, a more widespread adoption is expected by 2025, highlighting the need for careful monitoring of spending patterns and utilization trends to ensure the long-term sustainability of Medicare programs.

FTC makes changes to healthcare breach reporting

By Naomi Diaz - The Federal Trade Commission made changes to the Health Breach Notification Rule as it aims to better address the evolving landscape of health technology. Read Full Article…

VBA Article Summary

1. Broadened Notification Mandates: The updated rule mandates vendors of personal health records and related entities outside of HIPAA's jurisdiction to notify affected individuals, the FTC, and, when relevant, the media in the event of a breach of unsecured personally identifiable health data.

2. Third-Party Accountability: Third-party service providers to vendors of protected health records are now required to inform the vendors and relevant entities upon discovering a breach, emphasizing accountability throughout the data management chain.

3. Improved Consumer Protections: The revisions introduce enhanced consumer notice requirements, expanding the content of breach notices to include disclosure of third parties acquiring unsecured PHR identifiable health information. Furthermore, the rule permits broader electronic notification methods and imposes modified timing requirements for breaches affecting 500 or more individuals, aiming to bolster consumer protection and streamline response efforts.

Automated Patient Risk Assessment Lowers Antibiotic Prescribing Rates

By Brittany Vargas - An algorithm-driven risk assessment embedded in an electronic health record (EHR) helped clinicians reduce inappropriate broad-spectrum antibiotic prescribing by 17.4% and 28.4% in patients with UTIs and pneumonia, respectively, according to two related studies published in the Journal of the American Medical Association. Read Full Article…

VBA Article Summary

1. Scope of Study: The randomized control trials encompassed over 200,000 adult patients across 59 hospitals owned by HCA Healthcare, focusing on non-life-threatening pneumonia or urinary tract infections (UTIs). The study analyzed prescribing behaviors over an 18-month baseline period starting April 2017, and a subsequent 15-month period of implementing the new antibiotic system starting April 2019.

2. Intervention Strategy: The trials introduced a stewardship bundle called INSPIRE (Intelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection), comparing it with routine antibiotic practices. Both groups received educational materials, coaching calls, and were required to provide reasons for antibiotic prescriptions. However, the intervention group received additional monthly coaching calls, feedback reports, and Electronic Health Record (EHR) prompts suggesting standard-spectrum antibiotics if the risk of developing multidrug-resistant infections was low.

3. Effectiveness of Intervention: Results demonstrated a significant reduction in the use of broad-spectrum antibiotics during the first 72 hours of hospitalization for both UTIs (17.4% reduction) and pneumonia (28.4% reduction) in the intervention group compared to the control. Dr. Shruti K. Gohil emphasized that while the exact element driving the reduction couldn't be determined, the EHR prompt appeared to be the primary driver. Moreover, safety outcomes between control and intervention groups remained similar, indicating the feasibility and safety of the intervention.

US Senate committee investigates pricing of Novo's Ozempic and Wegovy

By Reuters - A U.S. Senate committee said on Wednesday it had launched an investigation into the prices of Novo Nordisk's (NOVOb.CO), opens new tab diabetes and weight loss drugs Ozempic and Wegovy in the United States. Read Full Article…

VBA Article Summary

1. Senator Sanders' Inquiry: Senator Bernie Sanders, as chair of the Senate Committee on Health, Education, Labor, and Pensions, has directed a letter to Novo's CEO regarding the pricing of two drugs in the United States, which surpasses prices observed in other nations. This inquiry seeks to gather more information on the pricing strategies employed by the company.

2. Price Reduction Inquiry: The committee has posed a question to Novo regarding its intention to significantly lower both the list price and the net price of the two drugs under scrutiny. This line of questioning aims to understand the company's approach to ensuring affordable access to essential medications for American patients.

3. Disparity in Pricing: Novo has been asked to justify the pricing disparity between two drugs, Wegovy and Ozempic, despite both containing the same compound. Specifically, Senator Sanders seeks clarification on why Wegovy, designed for weight loss, commands a higher price compared to Ozempic, which is approved for diabetes treatment. This highlights concerns about fairness and transparency in pharmaceutical pricing practices.

Health plan costs to rise for some Virginia state workers

By Dave Ress - Some Virginia state employees will pay more for health insurance beginning July 1, following the state’s latest review and projection of claims. Read Full Article…

VBA Article Summary

1. Proposed Premium Increase: The Virginia Department of Human Resource Management (DHRM) has proposed a 6.3% increase in total premiums for state employee health insurance in the next fiscal year. This rise is lower than the national average of 7% and aligns with budget expectations.

2. Employee Contribution Adjustments: While some state employees will experience rises in their contributions for health insurance, full-time employees will see comparatively smaller increases, with some plans experiencing no increase at all. Contributions for plans with additional coverage options, such as out-of-network coverage, expanded dental coverage, and vision and hearing coverage, will also see smaller percentage increases.

3. Benefit Adjustments and Cost Distribution: Plan administrators, including Anthem and Aetna, are introducing new benefits such as cancer care navigator services, children's hearing aid coverage, and virtual physical therapy. Employee contributions remain unchanged for certain plans, while others see nominal increases. The state continues to cover the majority of health plan costs for employees working more than 30 hours per week, with those working fewer than 30 hours bearing the full premium cost, which varies depending on coverage options and family size.

Medtronic wins FDA approval for adjustable spine-pain implant

By Daniel Gilbert and David Ovalle - Medtronic said Friday that the U.S. Food and Drug Administration has approved a new spinal-cord implant that relieves chronic pain, a bid to expand into a patient population that relies heavily on medications like opioids. Read Full Article…

VBA Article Summary

1. Advanced Pain Management Technology: The newly approved spinal-cord stimulation device by Medtronic, named Inceptiv, represents a significant advancement in pain management. It functions by delivering precise electrical pulses to the spinal cord, intercepting pain signals before they reach the brain. Unlike previous models, Inceptiv has the capability to adaptively adjust stimulation intensity, enhancing patient comfort by avoiding uncomfortable sensations triggered by everyday movements like sneezing or coughing.

2. Revolutionizing Patient Experience: Inceptiv's innovative features address longstanding challenges faced by patients using traditional spinal-cord stimulators. With its ability to read nerve signals and dynamically adjust stimulation levels, Inceptiv offers a more personalized and comfortable experience, akin to "adaptive cruise control." Furthermore, its compact design, featuring a rechargeable lithium battery and ultra-thin leads, makes it the world's smallest fully implantable spinal-cord stimulator, promising enhanced convenience and mobility for patients.

3. Complexity of Pain Management: Despite the promising benefits of advanced spinal-cord stimulation technology, experts caution against viewing it as a panacea for chronic pain. While studies indicate improved pain relief compared to older models, pain management remains multifaceted, requiring comprehensive care beyond technological interventions. Professor Stefan Kertesz emphasizes the complexity of chronic pain and the necessity for individualized treatment, suggesting that while spinal-cord stimulators may offer significant relief for some, they are not a universal solution and should be approached with careful consideration of each patient's needs and circumstances.

Best practices for identifying compliance risks

By Steve Brown - In the highly regulated world of financial advising, the ability to proactively manage compliance risks is not just advantageous — it’s essential. Read Full Article…

VBA Article Summary

1. Cost-effective Compliance Strategies: Financial advisors must recognize the significant financial investment required for regulatory compliance, with studies indicating that U.S. firms spend between 1.3% and 3.3% of their total wage bill on compliance. Implementing smart and cost-effective compliance strategies not only satisfies regulatory requirements but also maintains service quality without excessive financial strain.

2. Proactive Risk Assessment: Effective compliance management begins with proactive risk assessment, involving the identification, evaluation, and mitigation of potential compliance breaches. Utilizing techniques like SWOT analysis and regularly updating risk assessments enables advisors to adapt to regulatory changes, market developments, and internal adjustments, ensuring prompt management of compliance incidents before they escalate.

3. Strategic Benefits of Compliance Management: Adopting best practices in compliance management provides strategic advantages for financial advisors, including enhanced client confidence, proactive identification of compliance risks, and strengthened client trust. By prioritizing compliance as a cornerstone of their professional responsibility, advisors safeguard their clients' interests and ensure long-term success in a dynamic regulatory environment.

5 things workers should know about the new federal ban on noncompete agreements

By Kate Gibson - Employment prospects just got brighter for the estimated 30 million U.S. workers who are currently bound by so-called noncompete agreements. U.S. regulators on Tuesday banned nearly all noncompetes, which restrict about 1 in 5 employees around the U.S. Read Full Article…

VBA Article Summary

1. Content of the FTC Rule: Noncompete agreements deemed unfair by the Federal Trade Commission (FTC) are now prohibited, preventing employers from initiating new agreements and rendering existing ones unenforceable for most workers. Exceptions include senior executives earning above $151,164 annually in a "policy-making position." Employers are mandated to inform workers holding noncompetes about their unenforceability. Noncompete agreements remain permissible in business sale transactions.

2. Implementation Timeline: The rule becomes effective 120 days following its publication in the Federal Register, the official repository for federal agency rules and executive orders. The exact timing of publication is at the discretion of the Federal Register following FTC submission and procedural steps.

3. Rationale Behind the FTC Decision: Noncompete agreements have been identified as hindrances to labor mobility and entrepreneurship, often compelling workers to remain in undesirable roles and impeding career advancement or entrepreneurial endeavors. Overwhelming public support, with over 25,000 out of 26,000 comments received by the FTC favoring the ban on noncompetes, underscores the need for regulatory intervention.

4. Exemptions and Potential Challenges: Nonprofit health care providers may be exempt from the FTC's jurisdiction, potentially leaving a significant portion of health care workers still subject to noncompete agreements. Legal challenges from entities like the U.S. Chamber of Commerce contest the FTC's authority to enact such bans, with potential escalation to the U.S. Supreme Court, where conservative justices hold a majority, indicating significant legal uncertainties ahead.

Do New Antiobesity Meds Still Require Lifestyle Management?

By Robert F. Kushner, MD, MS - Is lifestyle counseling needed with the more effective second-generation nutrient-stimulated, hormone-based medications like semaglutide and tirzepatide? If so, how intensive does the counseling need to be, and what components should be emphasized? Read Full Article…

VBA Article Summary

1. Integration of Intensive Behavioral Therapy (IBT) with Second-Generation Medications: With the advent of highly effective second-generation medications like semaglutide and tirzepatide for obesity treatment, the role of lifestyle management needs to evolve. Trials indicate that combining IBT with these medications enhances weight loss outcomes, necessitating a shift in focus towards comprehensive treatment approaches that integrate both pharmacotherapy and behavioral interventions.

2. Optimization of Dietary Counseling: Lifestyle management strategies should prioritize optimizing the quality of patients' diets rather than solely focusing on caloric reduction. Patients on second-generation medications experience reduced appetite and cravings, making it easier to adhere to healthier eating patterns. Counseling should emphasize lean protein sources, increased intake of fruits, vegetables, fiber, and complex carbohydrates, along with adequate hydration and supplementation with multivitamins to prevent micronutrient deficiencies.

3. Emphasis on Physical Activity and Exercise Counseling: Preserving lean body mass and promoting physical activity are crucial components of obesity management, especially with the potential loss of lean mass associated with weight loss interventions. Counseling should encourage a combination of aerobic and resistance training to maintain muscle mass, improve cardiovascular fitness, mobility, and bone density. Moreover, robust physical activity has been shown to be predictive of weight loss maintenance, highlighting its importance in long-term obesity management.