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    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.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital recruited BOD member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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What are Exempt Securities?

Exemptions from the SEC Act of 1933

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

Historical Definition

The SEC Act was landmark legislation that established the SEC and gives it authority over proxy solicitation and registration of organized stock exchanges. In addition, the Act sets disclosure requirements for securities in the secondary market, regulates insider trading, and gives the Federal Reserve authority over credit purchases of securities. When established, the Act reflected an effort to extend and overcome shortcomings of the Securities Act of 1933. These two pieces of legislation are the basis of securities regulation in the twentieth century.

Exemptions

Today, there are many securities which are exempt from the Securities Exchange Commission [SAC] Act of 1933, its’ registration and resuting prospectus requirements.

They include the following securities and types:

  • US Government and Federal Agency issues.
  • Municipal, State issues and commercial paper with a maturity not in excess of 270 days.
  • Intra-state offerings (Rule 147) because they are blue-sky chartered within the state.
  • Small Public offerings (Regulation A) if the value of the securities issued does not exceed $5,000,000 in any 12 month period. An issuer using the Regulation A exemption does not make the normal filings with the SEC in Washington. Instead, they file a simplified disclosure document with their SEC Regional Office, known as an Offering Statement. It must be file at least 10 business days prior to the initial offering of the securities.  No securities may be sold unless issuer has furnished an offering circular (full disclosure document) to the purchaser at least 48 hours prior to the mailing of confirmation of the sale, and, if not completed within 9 months from the date of the offering circular, a revised circular must be filed. Every 6 months, issuers must file a report with the SEC of sales made under the Regulation A exemption until offering is completed.
  • Traditional insurance policies are considered to be securities and are exempt, as are fixed annuities. However, some of the newer forms of life insurance, like variable life, as well as variable annuities, have investment characteristics and, therefore are not exempt from registration.
  • Commercial paper and banker’s acceptances (9 month or shorter maturity), since they are money market instruments.

Assessment

What did we miss?

Here is a guide to help understand how to raise capital and comply with federal securities laws.

Link: http://www.sec.gov/info/smallbus/qasbsec.htm

Conclusion

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About the Mobile Health Market

Sensor-Based Mobile Apps Show How M-Health Business Models Could Work

By Markus Pohl

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Making money with mobile healthcare applications takes much more effort than most developers expected. M-Health apps normally do not get into the app stores’ top ranking lists and thus do not receive high download numbers.

m-Health Applications Business Models

But, there are working business models for the mHealth applications. Within the mobile health app category revenue won’t be generated through app stores. More and more mHealth app publishers have understood that they have to adapt their business model accordingly. Turning away from the “normal” pay-per-download models to practices like charging for medical service (call a doc) or sensor based models.

Sensor Based Models

Sensor based business models seem to have particularly caught the attention of mHealth app publishers over the last 6 months. The idea behind this model is not to sell an app but to use the app to promote the sales of a sensor. Revenue will be generated outside the app store.

Trend Examples: 

Here are some examples to highlight this trend.

  • Health and Wellness Monitoring tools combine fitness-related equipment to track pulse, calories, running speed, heart rate, or use sensor-devices to monitor weight control, fetus observation and eye testing. Target groups for these products are fitness and health-conscious users aged mainly between 35 and 45 years.
  • Chronic Condition Monitoring tools monitor health conditions like heart disease, hypertension, diabetes, asthma and obesity. They generate revenue from selling a sensor-device with a free application. Target groups are healthcare providers, medical personnel and chronically ill people between 30 and 50 years.
  • Diagnosis Tools are mainly targeted at professionals, who increasingly demand more portable and easy-to-use devices for easier communication with patients and peers.
  • Educational and Motivational Tools monitor habit patterns (e.g. sleep monitoring via app/device) or serve as useful didactic instruments for science education (e.g. portable microscopes).

Traditional health care service providers and especially medical device manufacturers should be aware of these trends and start to connect to the smartphone world.

To find a detailed overview of mHealth business models – please see the Mobile Health Market Report 2010-2015. Or, take a look at more mobile healthcare research from research2guidance.

Assessment

Outside app store revenue will drive the market. Sensor-based business models prove how to actually make money with mobile applications.

Conclusion

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Treatment for Plantar Fasciitis is Expensive and Ineffective

Plantar Fasciitis Truth

By Angry Orthopod, MD

There are nearly 2 million cases of plantar fasciitis in the United States every year. As an orthopaedic surgeon, I’m quite familiar with this issue since nearly 20 percent of my patients come to me about plantar fasciitis.

Although there is a surefire way to fix the problem, the current treatments aren’t really addressing the issue, and they are costing millions for those who suffer from the heel pain. Many are quick to blame the chosen treatments on profit, but I’m here to set the record straight.

Two Factors

There are two main factors that are contributors to mistreatment, neither of which is profit. Many doctors dealing with plantar fasciitis think their treatment plans are the right course of action. That is, expensive surgeries, useless orthotics, and temporary relief through medicine. The other factor leading to the mistreatment is that patients are demanding these treatments; despite how medical studies have shown they are ineffective. Many believe that a surgery will fix their plantar fasciitis problems; it’s a misconception that surgery is what they need.

Expensive Treatments

Honestly, I don’t think the patients or the doctors know how expensive these treatments end up. In 2007 alone, there was an estimated $376 million in expenses for third parties. But what about the patient costs?

The authors of this study revealed that this estimate is low, and I have to agree; it’s definitely a conservative number since the patient’s expenses aren’t part of the study. The study doesn’t take into account lost time from work, OTC items, chiropractic visits, acupuncture, night splints, diagnostic studies, among other costs.

Study: 2010_American_Journal_of_Orthopedics

Assessment

So what should we learn from this? An exorbitant amount of money is spent on these treatments every year, but the real issue isn’t just the expense, it’s that most treatments are unnecessary and ineffective.

How much have you paid to relieve your plantar fasciitis problems? Were the treatments effective?

Link: http://www.plantarfasciitistruth.com/

Conclusion: The “Angry Orthopod” is an orthopedic surgeon who blogs at his self-titled site, The Angry Orthopod. And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Understanding Over the Counter (OTC) Markets

A Decentralized, Dealer-2-Dealer Market

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]       

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Securities are bought and sold every day by physicians and other investors who never meet each other. The market impersonally enables transfer (or sale) of securities from individuals who are selling to those who are buying. These trades may occur on an organized exchange such as the New York Stock Exchange, or, a decentralized, dealer to dealer market, which is called the over-the-counter (OTC).  Any transaction that does not take place on the floor of an exchange, takes place over-the-counter.

A Negotiated Market

The over-the-counter market is a national negotiated market, without a central market place, without a trading floor, composed of a network of thousands of brokers and dealers who make securities transactions for themselves and their customers. Professional buyers and sellers seek each other out electronically and by telephone and negotiate prices on the most favorable basis that can be achieved. Often, these negotiations are accomplished in a matter of seconds, there is no auction procedure comparable to that on the floor of an exchange.

The over-the-counter market is far the largest market in terms of numbers of securities issues traded. There are over 40,000 issues on which regular quotations are published OTC, while there are less than 5,000 stocks listed on all securities exchanges. There are frequently days when the reported volume of over-the-counter trades exceeds that of the NYSE. What really is the over-the-counter market? Is it where securities of inferior quality trade? Here is a list to remember of the types of securities traded exclusively over-the-counter:

  • All Government bonds .
  • All municipal bonds.
  • All mutual funds.
  • All new issues (primary distributions).
  • All variable annuities.
  • All tax shelter programs.
  • All equipment trust certificates.

Of course, the OTC market is also where all of the “unseasoned” issues are traded and most of them are quite speculative, but there certainly are many high quality issues available over-the- counter. Now, let’s take a look at how this over-the-counter market works.

The Market Maker

Whereas, the “main player” on the exchange is the specialist, his OTC counter part, in terms of importance, is the market maker. In the over-the-counter market, many securities firms act as dealers by creating and maintaining markets in selected securities. Dealers act as principals in a securities transaction and buy and sell securities for their own account and risk. Since they do not act as agents or brokers but instead as principals or dealers in securities transactions, they do not receive any commission for their services but instead buy at one price and sell at a higher price making a profit from “mark-up” on the security price. A dealer is said to have a position in a stock when he purchases and holds a security in his inventory. He, of course takes a risk that the market price of the security he holds may decline in value. This is how dealers make money; they buy wholesale and sell it retail, and the physician investor pays retail.

The OTC market bears little resemblance to the one of the mid-sixties. The major difference has been the electronic technological advances as embodied by the NASDAQ system. NASDAQ stands for National Association of Securities Dealers Automated Quotation system. Back in 1966, if you wanted to find out who was the market maker in the particular security you would go to a brightly colored stack of papers called the pink sheets, containing a listing, alphabetically, of over-the-counter stocks and underneath each issue is listed the name of one or more market makers, securities firms willing to trade that stock. After each firm name is the firm’s telephone number and a ‘bid and ask price”, that is, an approximate price representing what the dealer is asking for the stock and is bidding for the stock. 

Back 35-40 years ago, the only way of locating a market maker was by using the pink sheets, while O-T-C traded corporate bonds are quoted on yellow sheets. Under certain conditions, it could take a good deal of effort to try to get the best deal. Today, with the computer that sits on doctor’s desks, or a mobile device or smart-phone, you can push a few buttons and instantaneously see the best bid and the best offer that exists right now on over 5,000 of the most active over-the- counter stocks. Not only that, you can pull up the names of every market maker in that particular stock and the actual (firm) quotes on those securities right now.

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Electronic Sources of Securities Information

Level 1 service, available on the stock broker’s desk top, provides price information only on the highest bid and the lowest offer (the inside market). No market makers are identified, and since this is an inside quote, it may not be used by the registered representative (stock broker) for giving firm quotes. 

Level 2 service provides a doctor subscriber with price information and quotation sizes of all participating registered market makers. When a trader, or medical investor, looks at his computer screen on Level 2, he sees who’s making a market, their firm bid – or – ask; and the size of the market. One can get firm calls from level 2 information.

Level 3 service takes it one step further; and allows registered market makers to enter bid and ask prices (quotes) and quotation sizes into the NASDAQ system and to report their trades. This is the level of service maintained by market makers.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com and http://www.springerpub.com/Search/marcinko

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

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Next Generation Physician Recruitment

Filling the Funnel with Candidates

By Susan L. Theuns; PA-C, CPC, CHC

The best-kept secret about physician recruiting is to keep the funnel filled with a pool of candidates. With the dearth of primary care physicians – and some specialists for example – modern healthcare organizations can’t afford to wait for doctors to beat a path to their door; they have to go after the physicians they want.  That means generating a sizeable list of prospects on the front end to narrow it down to the 100 or so doctors who will be called for an initial conversation.  From there, the team may do some 50 telephone screening interviews to generate five site visits in order to select the one perfectly matched prospect who will sign on the dotted line.

The Prospect List

Depending upon the opportunity, there are a number of ways to generate a list of prospects:

  • Direct mail using a purchased list of physicians culled from criteria such as medical specialty and current geographical location.  The American Board of Medical Specialties, the American Medical Association [AMA], and licensure boards can supply these lists.  The organization sends direct mail announcing the opportunity and then has a team member follow-up with outbound calling.  If the physician is not interested, the caller should ask if s/he knows someone who is.
  • Personal calls following recruitment fairs and specialty meetings.
  • Advertising in medical and specialty journals and on the web, Twitter, etc.
  • Resident campaign using posted flyers and announcements.
  • Physician networking based on group member recommendations.
  • Medical Staff Office contacts at the local hospital.
  • Networking through specialty or group management organizations. Some organizations offer free on-line job postings for members.
  • Affiliations with residency programs.

Screenings and Interviews

From the initial pool of candidates, the internal recruiter must call prospects and conduct preliminary screenings to verify licensure status and board certification, gather professional and personal details about the candidate, and answer his or her questions about the opportunity. Whenever possible, research should be done to secure the prospect’s home or cell telephone number. Calling prospects in the evening at home gives them more time and privacy to talk freely.

www.BusinessofMedicalPractice.com

Assessment

Although this screening step generates a smaller list of credible prospects that meet the search criteria generated at the beginning of the recruitment process, it is a more viable one.

Front Matter: Front Matter BoMP – 3

About the Author: Susan Theuns has an extensive background in healthcare, business management, facilities/operations and compliance that spans three decades. She holds degrees in Allied Health and Business Management and has been a Certified Physician Assistant for 32 years. She is also a Certified Professional Coder and is certified in Healthcare Compliance. Susan has published a variety of articles for Coding Edge, Healthcare Compliance Today, and the Group Practice Journal and serves on the Advisory Board for Ingenix.  Her professional memberships and affiliations include the American Medical Group Association, National Honor Society in Business Administration (Delta Mu Delta), Health Care Compliance Association, American Academy of Professional Coders, and the National Commission on Certification of Physician Assistants. She was MedStar Health’s Compliance Director of the Year in 2003 and is currently Administrative Director of Physician Practices for Union Memorial Hospital in Baltimore, Maryland. 

Conclusion

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Practice Management: http://www.springerpub.com/product/9780826105752

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

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Assessing the Affordable Care Act

Comment Period of Solicitation

By Staff Reporters

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Last week marked the first anniversary of the Affordable Care Act (ACA) being signed into law by President Obama, and one year into the new era of health care reform it’s clear that Americans remain divided in their views on the ACA.

Depending on the source, polls show the public remains confused about many aspects of the law, with mixed support for several provisions and strong opposition to the individual mandate and other parts of the ACA.

Legal Challenges

With several lawsuits challenging the constitutionality of the ACA, governors and state legislators vowing to refuse funding to implement certain ACA programs, and Congress poised to revise or repeal some or all of the law, opponents of the ACA are hopeful that they will have the chance to go back to the drawing board to craft reform legislation more to their liking.

Supporters

Meanwhile, supporters are pointing to widespread public approval of many of the insurance reforms in the law and claiming that once the health exchanges and other major components of the ACA take effect, public support will continue to grow.

The ME-P Wants to Know:

  • Has your support for the ACA changed at all in the year since it was signed into law?
  • Are you pleased with the outcomes to date of the Affordable Care Act?
  • Will the major provisions that have not yet been implemented be able to fulfill the stated goal of covering more patients while reducing overall health care costs?
  • If you are not a supporter of this law, which sections are in most need of revision? Or are you in favor of complete repeal of this law?
  • If you prefer repeal, what alternative approach to health care reform do you favor?

Assessment

Please opine in the comment box below.

Conclusion

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