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    As a former Dean and appointed Distinguished University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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Doubting Doctor AUM Model

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Dear Medical Executive-Post

This is an excellent communications forum and blog; I tell all my friends about it. So, here is my dilemma. 

The Problem?

My financial planner charges me a percentage of assets-under-management. He explained that in this way we are both on the “same side of the economic table”, with aligned interests. It all sounded good at first; but now I am wondering after doing some research and readings?  

For example: 

  1. Doesn’t this produce an “equity bias”, as he earns more income with equities than cash or bonds? This seems especially problematic with automated DRIP programs that don’t produce cash for purchases during market price downturns, but seem to constantly buy-up; at least 2/3 of the time according to my readings.
  2. Why can’t I pay a percentage of the assets he “grows” for me, rather than on the assets I have already amassed myself – without his help, or brought in from elsewhere?  And, why pay if he looses money?
  3. Is it true that my account is just bundled and outsourced with many other similar accounts, and is not really specific for me at all? Of course, this probably does reduce his risk by remaining within the “standard of care” for his industry. But, common industry practice doesn’t mean it’s good for me. And, why do I have to sign a brokerage arbitration agreement? Why is he not a fiduciary like my CPA and attorney?
  4. What is the deal with all these meetings and client engagements that don’t seem to add any value? And, he doesn’t seem interested in financial planning at all, despite being a “financial planner.” My other concerns are glossed-over, and then he just recommends I see an “expert”, when pressed.


Is it time for me to “do-it-myself”; and go to a passive investment management style, use index funds or ETFs, and be done with it all? This strategy sure seems a lot cheaper. Of course, I fear my “doubts” will affect our relationship.


Am I wrong, or right? The more I investigate and learn about all these industry practices, the more concerned I have become. Any thoughts are appreciated?  Yet, maybe I don’t really have a problem at all! 

Nevertheless, where does a doctor (or anyone else for that matter) go for “honest advice”?  

PS: Your books are excellent sources, but I still need some help with execution.

Thank you. 

Dr. Mark-Me Anonymous

[Washington, DC]   


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About CLIA

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Clinical Laboratory Improvement Amendments

 By Patricia A. Trites; PhD, MPA, CHBC, CMP™ (Hon)


The Clinical Laboratory Improvement Amendment (CLIA) was passed in 1988 and pertains to any healthcare provider or entity that performs any laboratory test.   

A Series of Acts 

This legislation is actually a series of acts that established quality standards for laboratory testing in order to ensure the accuracy, reliability and timeliness of patient test results regardless of where the test was performed.   

Certification Types 

Providers must register with the Centers for Medicare and Medicaid Services (CMS) by filling out an application and paying the required fees. These fees vary upon the type or complexity of certificate requested. After completing all of the requirements, the provider will receive a CLIA Certificate.   

The four types of CLIA certificates are:  

  1. Waived Complexity
  2. Provider Performed Microscopy [sub-group of moderate complexity]
  3. Moderate Complexity
  4. High Complexity 

Revised Regulations 

In 1997 CMS enacted a new regulation that requires providers to include their CLIA number on all claim forms (ex: HCFA/CMS 1500) that contain requests for payment for clinical laboratory services.  

This is to insure that: (1) the provider has a current CLIA certificate and, (2) that the provider is performing only the laboratory tests that are allowed for the particular level of certificate. There are specific regulations and documentation requirements for the different levels of service.

Compliance Issues 

A recent study in 2001 found that a large percentage of clinical laboratories were not in compliance.  It has been recommended that increased inspection, both announced and unannounced, be instituted to better insure the quality of laboratory services.  

The CLIA requirements can be found at: http://www.cms.gov/clia. 


What has been your experience with CLIA?


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