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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 and 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.

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Understanding the Art of Selling Your Medical Practice

Part Two of Medical Practice Valuation

By Dr. David Edward Marcinko, MBA, CMP

By Prof. Hope Rachel Hetico, RN, MHA, CMP

www.CertifiedMedicalPlanner.org

In Part 1, we discussed how to establish fair market value (FMV) for a medical practice in the article, “Establish Your Practice’s Fair Market Value.” This time, we’ll review important terms and conditions for the sale transaction.

Valuation Types

Unfortunately, as a general rule, medical practice worth is presently deteriorating. A good medical practice is no longer a good business necessarily, and selling doctors can no longer automatically expect to extract a premium sale price. Nevertheless, appraising your medical practice on a periodic basis can play a key role in obtaining maximum value for it.

Competent practice valuation specialists typically charge a retainer to cover out-of-pocket expenses. Fees should not be based on a percentage of practice value, and may take 30-45 days to complete. Flat fees should be the norm because a sliding scale or percentage fee may be biased toward over-valuation in a declining marketplace. Fees range from $7,500-$50,000 for the small to large medical practice or clinic.

Expect to pay a retainer and sign a formal, professional engagement letter. Seek an unbiased and independent viewpoint. Buyer and sellers should each have their own independent appraisal done, using similar statistics, accounting measures, and economic assumptions.

At the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com we use three engagement levels that vary in intensity, purpose, and cost:

1. A comprehensive valuation provides an unambiguous value range. It is supported by most all procedures that valuators deem relevant, with mandatory onsite review. This gold standard is suitable for contentious situations. A written “opinion of value” is applicable for litigation support activities like depositions and trial. It is also useful for external reporting to bankers, investors, the public, Internal Revenue Service (IRS), etc.

2. A limited valuation lacks additional suggested Uniform Standards of Professional Appraisal Practice (USPAP) procedures. It is considered to be an “agreed upon engagement,” when the client is the only user. For example, it may be used when updating a buy/sell agreement, or when putting together a practice buy-in for a valued associate. This limited valuation would not be for external purposes, so no onsite visit is necessary and a formal opinion of value is not rendered.

3. An ad-hoc valuation is a low level engagement that provides a gross non-specific approximation of value based on limited parameters or concerns involved parties. Neither a written report nor an opinion of value is rendered. It is often used periodically as an internal organic growth/decline gauge.

Structure Sales Transactions

When the practice price has been determined and agreed on, the actual sales deal can be structured in a couple of ways:

(1) Stock Purchase v. Asset Purchase

In an asset transaction, the buyer will receive a tax amortization benefit associated with the intangible value of the business. This tax amortization represents a non-cash expense benefiting the buyer. In this case, the present value of those future tax benefits is added to the business enterprise value.

(2) Corporate Transactions

Typical private deals in the past involved some multiple (ratio) of earning before income taxes (EBIT)—usually a combination of cash, restricted stock, notes receivable, and possibly assumption of liabilities. For some physician hospital organizations, and public deals, the receipt of common stock can increase the practice price by as much as 40-50 percent (to accept the corresponding business risk, in lieu of cash).

Complete the Deal

The deal structure will vary depending on whether the likely buyer is a private practitioner, health system or a corporate partner. Some key issues to consider in the “art of the deal” include:

  • Working capital (in or out?): Including working capital in the transaction will increase the sale price.
  • Stock vs. asset transaction: Structuring the deal as an asset purchase will increase practice value due to the tax amortization benefits received by the buyer for intangible assets of the practice.
  • Common stock premium: The total sale price can be significantly higher than a cash equivalent price for accepting the risk and relative illiquidity of common stock as part of the payment.
  • Physician compensation: If your goal is to maximize practice value, take home a lower salary to increase practice sale price. The reverse is also true.

Understand Private Deal Structure

Assuming a practice sale is a private transaction, deal negotiations are based on the following pricing methodologies:

Seller financing: Many transactions involve an earn-out arrangement where the buyer puts money down and pays the balance under a formula based on future revenues, or gives the seller a promissory note under similar terms. Seller financing decreases a buyer’s risks (the longer the terms, the lower the risk). Longer terms demand premiums, while shorter terms demand discounts. Premiums that buyers pay for a typical seller-financed practice are usually more than what you would expect from a simple time value of money calculation, as a result of buyer risk reduction from paying over time, rather than up front with a bank loan or all cash. Remember to obtain a life insurance policy on the buyer.

Down payment: The greater the down payment for acquisition of a medical practice, the greater the risk is to the buyer. Consequently, sellers who will take less money up front can command a higher than average price for their practice, while sellers who want more down usually receive less in the end.

Taxation: Tax consequences can have a major impact on the price of a medical practice. For instance, a seller who obtains the majority of the sales price as capital gains can often afford to sell for a much lower price and still pocket as much or more than if the sales price were paid as ordinary income. Value attributed to the seller’s patient list, medical records, name brand, good will, and files qualifies for capital gains treatment. Value paid for the selling doctor’s continuing assistance after the sale and value attributed to a non-compete agreement are taxed at ordinary income. A buyer willing to allocate more for items with capital gains treatment, or a seller willing to take more in ordinary income, can frequently negotiate a better price. This is the essence of economically prudent practice transition planning.

Sidestep Common Buyer Blunders

Here are 10 blunders to avoid, as a buyer:

1. Believing the selling doctor’s attestations. Always verify data through an independent appraisal.

2. Wanting to change the culture of the practice. Be careful: Patients may not adjust quickly to change.

3. Using all available cash without keeping a reserve for potential contingencies.

4. Creating a conflict with the seller by recognizing a weakness and continually focusing on it for a bargain price.

5. Failing to realize that managed care plan contracts can be lost quickly or may not be always transferable.

6. Suffering from analysis paralysis. Money cannot be made by continually checking out a medical practice, only by actually running one.

7. Not appreciating the uniqueness of each practice, and using inaccurate “rules of thumb” from the golden age of medicine.

8. Not realizing that practice worth and goodwill value have plummeted lately and continue to decline in most parts of the country.

9. Not understanding that practice brokers may play both sides of the buy/sell equation for profit. Brokers usually are not obligated to disclose conflicts of interest, are not fiduciaries, and do not provide testimony as a court-approved expert witness.

10. Not hiring an appraisal professional who will testify in court, if need be, using the IRS-approved USPAP methods of valuation. Always assume that the appraisal will be contested (many times, it is).

After pricing and contracting due diligence has been performed, the next step in the medical practice sale process—as Donald Trump might say—is just good, old-fashioned negotiation.

Electronic Downloads

Part I: Part I

Part II: Part II

Additional Reading:

Cimasi, R.J., A.P. Sharamitaro, T.A. Zigrang, L.A.Haynes. Valuation of Hospitals in a Changing Reimbursement and Regulatory Environment. Edited by David E. Marcinko. Healthcare Organizations: Financial Management Strategies. Specialty Technical Publishers, 2008.

Marcinko, D.E. “Getting it Right: How much is a plastic surgery practice really worth?” Plastic Surgery Practice, August 2006.

Marcinko, D.E., H.R. Hetico. The Business of Medical Practice (3rd ed). Springer Publishing,New York,N.Y., 2011.

Marcinko, D.E. and H.R. Hetico. Risk Management and Insurance Planning for Physicians and Advisors. Jones and Bartlett Publishers, Sudbury, Mass., 2007.

Marcinko, D.E. and H.R. Hetico. Financial Planning for Physicians and Advisors. Jones and Bartlett Publishers, Sudbury, Mass., 2007.

Marcinko, D.E. and H.R. Hetico. Dictionary of Health Insurance and Managed Care. Springer Publishers, New York, N.Y., 2007.

Marcinko, D.E. and H.R. Hetico. Dictionary of Health Economics and Finance. Springer Publishers,New York,N.Y., 2007.

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Contribute to a Roth 401k WHILE Working in a High Tax State?

How and Why?

By Josh @HeritageWealthPlanning.com

I’ve attached a quick / short analysis that pits a Roth retirement approach versus a pre-tax 401 approach. I’m a bit surprised at the outcome.

Here are the assumptions.

1. Married employee in both cases.
2. An employee who is 55 years old invests $25,000 into the company’s retirement account.
a. $19,000 limit, plus
b. $6,000 over 50 catch-up
3. One employee pays the taxes up-front and invests the net of $16,088 into a Roth.
4. Another employee avoids / defers the taxes and invests the entire $25,000 into a 401.
5. Both investments earn the same return.
6. After 10 years the 401 will be converted over to a Roth.
c. This conversion signals the retirement of the individual in a non-income tax state which is one difference between the two approaches. Their working career was in an income taxed state while they both retire in a non-taxed state.
7. The analysis is taxing the 401 at the same tax-rate level minus any state income tax. If you execute your conversions at a lower tax rate, say 12% the results could even be more divergent.(emphasis mine).

d. Also, the reason I’ve taxed the entire Roth amount at 22% Federal is because that is the bracket the employee’s income tops out at. For the retiree when any Roth conversions is likely to take place the taxes would be on a stepped approach topping out at possible 12%.

Assessment

What am I missing here? If this analysis is correct it seems advantageous to invest in the 401 and convert to a Roth when you are either in a lower tax bracket, in a non-income tax state or both.

LINK: https://heritagewealthplanning.com/contribute-to-a-roth-401k-while-working-in-a-high-tax-state/

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Conclusion: Your thoughts are appreciated.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Child Health Measures and Rankings

For FY 2017

By http://www.MCOL.com

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Playing with the FIRE Movement

“What do you think of the FIRE movement?”

[By Rick Kahler CFP]

“What do you think of the FIRE movement?” a reporter asked me recently. I told her I was ambivalent about it.

The FIRE acronym in this context stands for “Financial Independence, Retire Early.” While a Harris poll done in late 2018 found most people over 45 had never heard of the FIRE movement, it apparently has caught fire among millennials.

The focus of FIRE adherents is lifestyle more than finances. Two books are the foundation of the FIRE movement: Your Money or Your Life, written in 1992 by Vicki Robin and Joe Dominguez, and Early Retirement Extreme, written in 2010 by Jacob Lund Fisker. The concept was popularized in 2011 by blogger Peter Adeney (Mr. Money Mustache), who lives in Longmont, CO. At the age of 30, Adeney and his wife retired with a retirement fund of $600,000 and a paid-for home.

According to the reporter who interviewed me, many advisors have strong opinions against the FIRE movement. This may seem odd. After all, financial independence and retiring early is often a goal of those seeking financial planning. That was certainly one of my goals when I was the age of today’s millennials.

I find very little to criticize about adopting a frugal lifestyle and saving as much as possible. For decades I have suggested living on half of what you make, with a goal of reaching financial freedom as soon as possible. Some FIRE proponents do save up to 50% of their income, which is five times more than their peers, according to a January 21, 2019, InvestmentNews article by Greg Iacurci, “Advisors throw cold water on FIRE Movement.”

What makes many financial planners uncomfortable is the definition of “early.” In my day, early was age 50, not 30. In terms of FIRE, Adeney promotes a lifestyle of aggressive frugality with the goal of retiring as soon as possible, using a 4% withdrawal rate as a guideline to determine the nest egg you need to accumulate.

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This raises two obvious issues that need clarification.

First, you need to earn enough to be able to live on 50 percent of your income. Relatively few young adults make that much. There is no magic income number, since the cost of living varies so much across the country.

One’s definition of frugality is also important. To some that may mean setting the thermostat at 68 all winter or driving a small fuel-efficient vehicle. For  others it may mean chopping your own wood to heat your living space only with a wood-burning stove or doing without a car altogether. As with many things, the wisdom is knowing when frugality crosses the line to dangerous deprivation.

Finally, the earlier you retires the longer your retirement nest egg must last. With a 4% withdrawal rate, someone retiring at age 70 has a much higher probability of seeing their investment portfolio last for their lifetime than someone retiring at age 30. Also, the rate of return on the portfolio is critical. The higher the rate of return the longer the funds will last. If there is any potential problem with the FIRE formula it’s probably this.

Since the average 30 year old may live another 60 years, and assuming a 4% return net of mutual fund and advisor fees, I would make a strong argument for a 2 percent withdrawal rate. Someone age 50 could reasonably withdraw 3%, while someone age 60 or above could probably be safe at 4%.

Assessment:

As with any conflagration, playing with FIRE irresponsibly can end up burning down the house. But used wisely, it can sustain life and make living much more rewarding.

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is a Portmanteau?

Word Play, Anyone?

[By staff reporters]

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A portmanteau or portmanteau word is a linguistic blend of words, in which parts of multiple words, or their phones (sounds), and their meanings are combined into a new word.
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Originally, the word “portmanteau” refers to a suitcase that opens into two equal sections.
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Assessment: Can you think of any others; or construct de-novo?
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What is a “Direct Listing” Process on Wall Street?

On The “Direct Listing” Process

[By staff reporters]

We’ve talked about Wall Street, IPOs, the OTC market and secondary public offerings before. So, now may be a good time to discuss the direct public listing.

The Direct Public Listing

Companies that want to do a public listing may not have the resources to pay underwriters, may not want to dilute existing shares by creating new ones or may want to avoid lockup agreements. Companies with these concerns often choose to proceed by using the “direct listing” process, rather than an IPO.

Direct Listing Process (DLP) is also known as Direct Placement or Direct Public Offering (DPO)

In DLP, the business sells shares directly to the public without the help of any intermediaries. It does not involve any underwriters or other intermediaries, there are no new shares issued and there is no lockup period.

The existing investors, promoters and even employees holding shares of the company can directly sell their shares to the public.

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However, the zero- to low-cost advantage also comes with certain risks for the company, which also trickle down to investors.

For example there is no support or guarantee for the share sale, no promotions, no safe long-term investors, no possibility of options like greenshoe and no defense by large shareholders against any volatility in the share price during and after the share listing.

Assessment:

The greenshoe option is a provision in an underwriting agreement that grants the underwriter the right to sell investors more shares than originally planned by the issuer if the demand proves particularly strong.

MORE: https://www.bing.com/news/search?q=Direct+Wall+Street+Listing&qpvt=direct+wall+street+listing&FORM=EWRE

Conclusion: Your thoughts are appreciated.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is Satisficing?

A decision-making strategy 

[By staff reporters]

Satisficing is a decision-making strategy or cognitive heuristic that entails searching through the available alternatives until an acceptability threshold is met.

The term satisficing, a portmanteau of satisfy and suffice, was introduced by Herbert A. Simon in 1956, although the concept was first posited in his 1947 book Administrative Behavior. Simon used satisficing to explain the behavior of decision makers under circumstances in which an optimal solution cannot be determined. He maintained that many natural problems are characterized by computational intractability or a lack of information, both of which preclude the use of mathematical optimization procedures.

He observed in his Nobel Prize in Economics speech that “decision makers can satisfice either by finding optimum solutions for a simplified world, or by finding satisfactory solutions for a more realistic world. Neither approach, in general, dominates the other, and both have continued to co-exist in the world of management science”.

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Assessment

“Satisficing” – a made-up word created by combining satisfactory and sufficient – indicates something good, but not great. Like the Canadian single-payer health system, like Medicare-for-All.

MORE: https://www.acsh.org/news/2018/09/18/canadas-single-payer-health-system-satisfices-13272

Conclusion: Your thoughts are appreciated.

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Severity and Price of ER Visits

Severity Level – 2017

By http://www.MCOL.com

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Conclusion: Your thoughts are appreciated.

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Why Your Financial Planner May be Replaced

 By a Computer [FIN-TECH]

[By Rick Kahkler CFP®]

If Ken Fisher is right, in the future you will be talking to a computer about your asset allocation and loving every minute of it.

Fisher has built Fisher Asset Management into the largest fee-only investment advisory firm in the US, with over $100 billion under management. Speaking at the Investment News Innovation Summit in New York City on April 17, 2019, he said, “We need to get machines talking to people in a way that is more human than human.”

If you view “talking to machines” mostly in terms of using four-letter words when your computer locks up, you might be skeptical.

Fisher explained there are six personality profiles that fit almost every investor. “When you (or a machine) knows what they are, then you deal with them according to their profile.” In Ken’s thinking, machines will be able to spot the profile and then, using an algorithm free of human error, interact with the customer in a manner superior to a human advisor. He sees this happening within the next ten years.

I asked him, “What happens to the human advisors when machines talk to your customers better than a human?” Ken replied, “I don’t know the answer to that question,” suggesting that people will need to gain new skills and move on to the next thing. “You can’t keep doing the same thing you were before or you will be out of luck.”

As shocking as this idea is to investment advisors, it’s not at all far-fetched. In an “Axios AM Deep Dive” article on April 6, 2019, Mike Allen quoted Axios Future Editor Steve LeVine as saying that Millennials (those born between 1981 and 1996) will be the first generation to fully face the new age of automation, which could wipe out jobs faster than the economy creates new ones.

Like most before them, many Millennials have taken entry level, minimum wage jobs. Allen suggests that, unlike prior generations, they may not find much of a ladder up from there. Part of that is because of the aftermath of the great recession and part is because technology and globalization have reduced middle-wage jobs.

The median income of younger Millennials is $21,000, according to the AXIOS article. Contrast that to the median wage of $84,000 for statisticians and financial analysts, both of which have high concentrations of older Millennials.

It’s those $84,000 a year jobs that Fisher thinks will be done better by machines. If this happens, it will disrupt the financial services industry in spectacular fashion.

Danielle Fava of TD Ameritrade didn’t agree that human investment advisors will become obsolete in ten years. She does see voice digital assistants making email obsolete. She also believes that artificial intelligence will “enhance the conversations advisors are having with their clients,” rather than replace the human advisor.

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robo

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While staring my professional demise in the face in ten years, I drew solace from knowing I am nearing the end of my career. Another fact that should comfort some financial professionals is the difference between investment advisors and analysts (like those who work for Ken Fisher) and financial planners. Investment advising is relatively easy; that’s why a machine may be able to do it all in ten years. Also, investment advice comprises only a small fraction of what financial planners do. It will take a really, really smart machine to integrate all the complex aspects of someone’s financial picture into a sensible plan.

Assessment

So maybe ten years from now a machine will flawlessly figure out your asset allocation. But it may be another ten years before your financial planner is a machine, and maybe another 50 before a machine can do financial therapy.

Conclusion

Your thoughts are appreciated.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is Doxxing?

Can You Avoid It?

[By staff reporters]

Doxing (from dox, abbreviation of documents), or doxxing, is the Internet-based practice of researching and broadcasting personally identifiable information about an individual.

The methods employed to acquire this information include searching publicly available databases and social media websites (like Facebook), hacking, and social engineering.

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Doxing is therefore a standard tactic of online harassment and has been used by people associated with 4chan and in the Gamergate and vaccine controversies.

The ethics of doxing by journalists, on matters that they assert are issues of public interest, is an area of much controversy. Many authors have argued that doxing in journalism blurs the line between revealing information in the interest of the public and releasing information about an individual’s private life against their wishes.

MORE: https://www.gohacking.com/what-is-doxing-and-how-it-is-done/

THINK: HIPAA

Conclusion: Your thoughts are appreciated.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is Cryonics?

Cryonics: Using low temperatures to care for the critically ill

By Aschwin de Wolf

Introduction

In contemporary medicine terminally ill patients can be declared legally dead using two different criteria: whole brain death or cardiorespiratory arrest. Although many people would agree that a human being without any functional brain activity, or even without higher brain function, has ceased to exist as a person, not many people realize that most patients who are currently declared legally dead by cardiorespiratory criteria have not yet died as a person. Or to use conventional biomedical language, although the organism has ceased to exist as a functional, integrated whole, the neuroanatomy of the person is still intact when a patient is declared legally dead using cardiorespiratory criteria.

It might seem odd that contemporary medicine allows deliberate destruction of the properties that make us uniquely human (our capacity for consciousness) unless one considers the significant challenge of keeping a brain alive in a body that has ceased to function as an integrated whole. But what if we could put the brain “on pause” until a time when medical science has become advanced enough to treat the rest of the body, reverse aging, and restore the patient to health?

Myths: https://www.alcor.org/cryomyths.html#myth6

MORE: https://www.alcor.org/

Assessment

Your thoughts are appreciated.

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is the Doppler Effect?

How does it work?

[By staff reporters]

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The Doppler effect (or Doppler shift) is the change in frequency of a wave (or other periodic event) for an observer moving relative to its source. It is named after the Austrian physicist Christian Doppler, who proposed it in 1842 in Prague. It is commonly heard when a vehicle sounding a siren or horn approaches, passes, and recedes from an observer.
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An animation illustrating how the Doppler effect causes a car engine or siren to sound higher in pitch when it is approaching than when it is receding. The pink circles represent sound waves.

Passing car horn

Wikipedia: The reason for the Doppler effect is that when the source of the waves is moving towards the observer, each successive wave crest is emitted from a position closer to the observer than the crest of the previous wave. Therefore, each wave takes slightly less time to reach the observer than the previous wave. Hence, the time between the arrivals of successive wave crests at the observer is reduced, causing an increase in the frequency. While they are traveling, the distance between successive wave fronts is reduced, so the waves “bunch together”. Conversely, if the source of waves is moving away from the observer, each wave is emitted from a position farther from the observer than the previous wave, so the arrival time between successive waves is increased, reducing the frequency. The distance between successive wave fronts is then increased, so the waves “spread out”.

For waves that propagate in a medium, such as sound waves, the velocity of the observer and of the source are relative to the medium in which the waves are transmitted. The total Doppler effect may therefore result from motion of the source, motion of the observer, or motion of the medium. Each of these effects is analyzed separately. For waves which do not require a medium, such as light or gravity in general relativity, only the relative difference in velocity between the observer and the source needs to be considered.

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Medicare Part D – Drug Plan Enrollment

Distribution 2019

By http://www.MCOL.com

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What is the Elderly CPI?

The CPI-E

[By staff reporters]

We’ve written about the CPI and Chained CPI before on this ME-P.
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Q = So, what is the Elderly CPI?
A = It is experimental CPI for the elderly called the CPI-E.
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Mature Woman
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MORE:
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According to the Bureau of Labor Statistics, or BLS, the CPI-E includes households whose reference person or spouse is 62 years of age or older.
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What is Knightian Uncertainty in Economics?

About Frank Knight PhD

[By staff reporters]

In economics, Knightian uncertainty is a lack of any quantifiable knowledge about some possible occurrence, as opposed to the presence of quantifiable risk (e.g., that in statistical noise or a parameter’s confidence interval). The concept acknowledges some fundamental degree of ignorance, a limit to knowledge, and an essential unpredictability of future events.

Knightian uncertainty is named after University of Chicago economist Frank Knight (1885–1972), who distinguished risk and uncertainty in his work Risk, Uncertainty, and Profit:[1]

“Uncertainty must be taken in a sense radically distinct from the familiar notion of Risk, from which it has never been properly separated…. The essential fact is that ‘risk’ means in some cases a quantity susceptible of measurement, while at other times it is something distinctly not of this character; and there are far-reaching and crucial differences in the bearings of the phenomena depending on which of the two is really present and operating…. It will appear that a measurable uncertainty, or ‘risk’ proper, as we shall use the term, is so far different from an unmeasurable one that it is not in effect an uncertainty at all.”

MORE: RD

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Assessment: Your thoughts are appreciated.

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On Immigrant Health Care Workers

CIRCA – 2017

By http://www.MCOL.com

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Assessment

Your thoughts are appreciated.

Product DetailsProduct Details

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Is Value Investing Dead?

 

Vitaliy Katsenelson CFA

Is Value Investing Dead?

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MORE: http://www.msn.com/en-us/money/topstocks/value-stocks-are-trading-at-the-steepest-discount-in-history/ar-AACuYES?li=BBnbfcN

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Of Pareto’s and Parkinson’s Law

The 2-Ps [80/20] Rule

[By staff reporters]

Pareto’s law is either of the following closely related ideas: Pareto principle or law of the vital few, stating that 80% of the effects come from 20% of the causes Pareto distribution

Pareto distribution

The Pareto distribution, named after the Italian civil engineer, economist, and sociologist Vilfredo Pareto, is a power law probability distribution that is used in description of social, scientific, geophysical, actuarial, and many other types of observable phenomena. en.wikipedia.org

Parkinson’s law

Originally, Parkinson’s law is the adage that “work expands so as to fill the time available for its completion”, and the title of a book which made it well-known.

Assessment

However, in current understanding, Parkinson’s law is a reference to the self-satisfying uncontrolled growth of the bureaucratic apparatus in an organization.

COMPARISON

Conclusion

Your thoughts are appreciated.

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What is Hedege Fund “Carried Interest”?

What it is – How it works?

[By staff reporters]

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Carried interest or carry, in finance, specifically in alternative investments (i.e., private equity and hedge funds), is a share of the profits of an investment or investment fund that is paid to the investment manager in excess of the amount that the manager contributes to the partnership.
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As a practical matter, it is a form of performance fee that rewards the manager for enhancing performance.
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Tax Status

Carried interest, income flowing to the general partner of a private investment fund, often is treated as capital gains for the purposes of taxation.

Some view this tax preference as an unfair, market-distorting loophole.

Others argue that it is consistent with the tax treatment of other entrepreneurial income.

MORE: News about Carried Interest Tax Break

Assessment

Your thoughts are appreciated.

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On Accounting -VERSUS- Economic Profit

Yes – There is A Difference

[By staff reporters]

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D-Day 1944 – 2019

75 Years

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Real Estate Market Values Always Local

Location – Location – Location

By Rick Kahler CFP 

What investment asset class grabs the most attention of the average American?

My guess is that it isn’t the stock market, but a category many people don’t even think of as an investment—the local real estate market. While I don’t have data to back up this assumption, I find that people tend to be more interested in what’s happening in their local real estate markets than on national stock exchanges.

Why?

I think the reason is simple. Houses are tangible, understandable assets that we can see and touch. Most of us live in them, and some of us are in love with our homes. You likely know the ballpark value of your house from the annual assessed value you receive from the county. Chances are you know what repairs your home needs and have an idea of the rent you could charge for it. You probably have an idea of the price trends in your neighborhood or city. You know the best areas in which to live and the neighborhoods to avoid. You know these things because all real estate is local. There is no “national” real estate market.

Not so with common stocks. Because most of us own our stocks in mutual funds and exchange traded funds, we often don’t really know what companies we own, what town their headquarters are in, the price of the stock, the current yield, the trend of the company or sector, and any weaknesses or strengths of the company. Unlike real estate, publicly traded stocks are priced based on national rather than local influences. Further, we don’t work for or live in the companies in our portfolio. And few of us are in love with our portfolio of stocks.

It’s no wonder that most of us are far more interested in the economics of our homes than our stocks. This is even less of a surprise when we consider the average American has more invested in their home than they do the stock market.

Research

According to CoreLogic, the average annual price increase of real estate has slowed down in 2019. “During the first two months of the year, home price growth continued to decelerate,” said Dr. Frank Nothaft, chief economist for CoreLogic in an April 2, 2019 press release.

But that is just the average. Annual price changes range from an increase of 10.2% in Idaho to a decrease of -1.7% in North Dakota. South Dakota showed a 1.6% increase over the past 12 months.

Also according to CoreLogic, of the country’s top 100 housing markets, 35 percent are overvalued, 38 percent were at value, and 27 percent were undervalued. An under- or overvalued market is one in which home prices are at least 10 percent above or below the long-term sustainable level.

While my hometown of Rapid City, SD, is not among the top 100 markets, home prices are booming, according to Jeremy Kahler, a Realtor with Keller Williams of the Black Hills. He indicates that through April, the 12-month price increase in Rapid City is over 7%, which puts our local market into the top quartile for price increases on a national level. Zillow shows our average sales price as $204,100 compared with the national sales price of $226,800, so my hunch is that the Rapid City market might be at value to undervalued.

Assessment

However, I think it’s a reasonable generalization that most homes in flyover country are priced lower than their coastal cousins. Some of the reasons are what I call the snowflake discount, seasonal weather patterns, and the distance from major metropolitan areas. Those that can cope with those challenges are rewarded with lower housing costs.

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homes

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Opine: Your thoughts are appreciated.

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[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

Front Matter with Foreword by Jason Dyken MD MBA

Book of Month

 

 

Prescription Drug Uses and Costs

Seclected Facts: 2015-2016

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Out-Of-Pocket Spending Among People with Employer Health Insurance Coverage

Circa 2016-2017

By http://www.MCOL.com

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Ten “Unusual” ICD-11 Codes

You May not Have Known

By http://www.MCOL.com

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MORE:

https://www.medicaleconomics.com/health-law-policy/20-bizarre-new-icd-10-codes

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What is a “Kinked” Demand Curve?

Modified Supply-Demand

[By staff reporters]

The Kinked-Demand curve theory is an economic theory regarding oligopoly and monopolistic competition.

When it was created, the idea fundamentally challenged classical economic tenets such as efficient markets and rapidly changing prices, ideas that underlie basic supply and demand models.

Kinked demand was an initial attempt to explain sticky prices.

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Assessment: Your thoughts are appreciated.
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