BUSINESS PLAN CONSTRUCTION: For Health Industry Modernity

FOR MEDICAL AND HEALTHCARE ENTREPRENEURS AND INNOVATORS

By Dr. David Edward Marcinko MBA MEd CMP®

I was asked by business schools and medical colleagues – and their bankers, CPAs and advisors – to speak about this topic several times last year before the pandemic.

Now, with the specter of M-4-A etc; it certainly is a vital concern to all young entrepreneurs, doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.

Now, with the specter of tele-health, tele-medicine, M-4-A etc; it certainly is a vital concern to all young doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.

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New Product Business Plan Sample [2021 Updated] | OGScapital

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READ: https://healthcarefinancials.files.wordpress.com/2017/08/mba-business-plan-capstone-outline.pdf

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The Medical Practice Business Plan EXECUTIVE SUMMARY?

WHAT IT IS – HOW IT WORKS

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

THE BUSINESS PLAN STANDARD FORMAT

Physician Executive Summary

The Physician Executive Summary is always included at the beginning of a formal business plan and represents a brief synopsis of the medical prarctice entire plan.  Its appearance, grammar and style should be sharp and crisp as it represents an enticement for the reader to maintain interest and contribute intelligent or economic input into the new venture.

It should contain information about the practice, advertising and marketing opportunities, physician management, proposed financing with four Pro Forma financial statements, business operations and exit strategy.  This last point, while unpleasant is often overlooked by naive practitioners.  Business experts however, look favorably upon an escape plan and view it as the mark of mature professional that realizes the possibility of success as well as failure. 

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Ultimately, the plan must explain to potential investors how you will make the practice   profitable and produce the required Return on Investment (ROI) for them.  It must describe medical services, patient acceptance and benefits, provider qualifications and accomplishments, the amount of capital required, market size, potential practice growth rate, and market niche. 

Additional information may include office location, proximity to labor, transportation, license requirements, business entity status, proprietary technology and potential working agreements with various insurance, managed care, ACA and HMO plans.  If all of the above seems bewildering to the uninitiated, you are correct. 

Remember however, that if you do not have, or can’t borrow the funds to begin a private practice, you will just have to become an employed practitioner until you can.  It is therefore imperative to start off on the right foot, with a sound business plan, as you begin your medical career.

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Colleagues know that I enjoy personal coaching and public speaking and give as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.

These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.

 Topics Link: imba-inc-firm-services

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The “Halloween Indicator” [Investment Strategy]

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What it is – How it works?

[By Dr. Marcinko and staff reporters]

Sell in May and go away is an investment strategy for stocks based on a theory (sometimes known as the Halloween indicator) that the period from November to April inclusive has significantly stronger growth on average than the other months.

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“DANCE OF DEATH”

[Copyright 2018 iMBA Inc., All rights reserved. USA]

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The Strategy

In such strategies, stocks are sold at the start of May and the proceeds held in cash (e.g. a money market fund); stocks are bought again in the autumn, typically around Halloween. “Sell in May” can be characterised as the belief that it is better to avoid holding stock during the summer period.

Though this seasonality is often mentioned informally, it has largely been ignored in academic circles (perhaps being assumed to be a mere superstition). Nonetheless analysis by Bouman and Jacobsen (2002) shows that the effect has indeed occurred in 36 out of 37 countries examined, and since the 17th century (1694) in the United Kingdom; it is strongest in Europe. While the effect may reflect a failure of the efficient-market hypothesis, alternatives exist such as small sample size or time variation in expected stock market returns.

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halloween

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Causes the Effect

Although it’s not clear what causes the effect, what’s most interesting is that it shows that stock market returns in many countries during the period May–October are systematically negative or lower than the short-term interest rate, which also goes against the efficient-market hypothesis. Stock market returns should not be predictably lower than the short-term interest rate (risk free rate).

Popular media often refer to this market wisdom in the month of May, claiming that in the six months to come things will be different and the pattern will not show.

However, as the effect has been strongly present in most developed markets (including the United States, Canada, Japan, the United Kingdom and most European countries) in the last decade – especially May–October 2009 – these claims are often proved wrong.

That said, between April 30 and October 30, 2009, the FTSE 100 gained 20% (from 4,189.59 to 5,044.55)

Academics

The effect has largely been ignored in academic circles. The idea contradicts much established theory, especially the efficient-market hypothesis.

Maberly and Pierce extended the data to April 2003. They also tested the strategy for April 1982 through April 2003 except for two months, October 1987 and August 1998. They found that it doesn’t work well in the time period April 1982–September 1987 plus November 1987–July 1998 plus September 1998–April 2003.[7] Other regression models using the same data but controlling for extreme outliers have found the Halloween effect to still be significant.[8]

“Sell in May and go away” has persisted as a profitable market-timing strategy for stock investors, according to a follow-up study by Andrade, Chhaochharia and Fuerst (2012). They find that the Sell-in-May seasonal pattern persists after the end of Bouman and Jacobsen’s (2002) sample. This is important in showing that the Halloween effect is not a statistical fluke detected by data mining. Strikingly, in the 1998–2012 sample on average November–April returns are larger than May–October returns in all 37 markets they study. On average, the difference is equal to about 10% percentage points. Also strikingly, the magnitude of the difference is the same in Bouman and Jacobsen’s (2002) and in the out-of-sample analysis of Andrade, Chhaochharia and Fuerst (2012). Further backtesting by Mebane Faber has shown this effect has been in place since 1950.

Source: Sell in May Wikipedia, the free encyclopedia

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BBmmXXC

http://www.msn.com/en-us/money/markets/best-6-months-for-stocks-could-be-right-around-the-corner/ar-BBmma2Y?li=AA4Zjn&ocid=U348DHP

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More: 

Even More:

Much More:

Assessment

Was this indicator appropriate for 2018?

Conclusion

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.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

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PODCAST: Private Equity Partially Buying Medical Group Practices

OLDER DOCTORS SELLING OUT

BY ERIC BRICKER MD

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The Health Economic Costs Moving from Adult EMPLOYER Sponsored Health Insurance to MEDICARE Coverage

Impact of Moving Older Adults from Employer Coverage to Medicare

Peterson-KFF’s recent brief “How Lowering the Medicare Eligibility Age Might Affect Employer-Sponsored Insurance Costs” explores potential percent reduction in employer health plan spending if all enrollees in age group leave large employer-sponsored coverage.

The brief found:

 •  Ages 60-64 would cause a 15% reduction
 •  Ages 55-64 would cause a 30% reduction
 •  Ages 50-64 would cause a 43% reduction

CITE: https://www.r2library.com/Resource/Title/0826102549

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Understanding Medicare options to help make confident ...

Source: Peterson-KFF Health System Tracker, “How Lowering the Medicare Eligibility Age Might Affect Employer-Sponsored Insurance Costs”

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Healthcare Costs Projected to Grow in 2022

Healthcare Costs Projected to Grow in 2022

Health Capital Consultants - Healthcare Valuation

A June 2021 PricewaterhouseCoopers (PwC) report found that healthcare costs have been on a steady decline for the past decade, but trailing effects from the COVID-19 pandemic could cause increases above anticipated rates over the next several years.

In 2007, the annual cost growth for healthcare spending was 11.9% and declined steadily until 2017, where it floated between 5.5% and 6.0% until 2020. However, projected healthcare cost growth for 2022 is expected to reach 6.5% due to factors such as deferred or forgone care, increased mental health issues, preparation for future pandemics, and investment in digital tools. (Read more...)

ASSESSMENT: Your thoughts are appreciated.

Citation: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Inflation Update

NOT TRANSITORY … YET!

imausa-vitaliy-katsenelson

By Vitaliy Katsenelson CFA

Here is my advice to you

Instead of straining your eyes, you can strain your ears and listen to the following articles. I’m providing links to my pieces on the inflation landscape (read, listen) and how we invest in inflation (read, listen).

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Five Facts On Inflation | RealClearPolicy

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CITE: https://www.r2library.com/Resource/Title/0826102549

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OVERVIEW: Healthcare Finance and Insurance Terms & Definitions

Produced FROM Merck Manual

By Roger I. Schreck

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Health care in the US is technologically advanced but expensive, costing about $3.6 trillion in 2018, which was 16.9% of gross domestic product (GDP) (1). This percentage is significantly higher than in any other nation.

According to the Organization for Economic Cooperation and Development (OECD), in 2018 the next highest spending countries were Switzerland (12.2% of GDP) and France, Germany, Sweden, and Japan (each about 11%), while the average of the 35 OECD countries (OECD35) was 8.8% (2).

ASSESSMENT: Of course, the absolute amount and the rate of increase of health care spending in the US are widely regarded as unsustainable. Consequences of increased US spending on health care include the following:

LINK: https://www.merckmanuals.com/professional/special-subjects/health-care-financing/overview-of-health-care-financing

CMS GLOSSARY: https://www.cms.gov/CCIIO/Resources/Files/Downloads/dwnlds/uniform-glossary-final.pdf

GOVERNMENT: https://www.bls.gov/ncs/ebs/sp/healthterms.pdf

Product Details

CITE: https://www.r2library.com/Resource/Title/0826102549

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SPAC v. Direct Listing v. IPO?

What’s the difference between an IPO, a special purpose acquisition company (SPAC), and a direct listing?

[By staff reporters]

IPOs are a 6–12 month journey where a company works with investment banks and underwriters, who buy a bunch of shares and then sell them to investors in the public market during the actual IPO. Early investors are able to liquidate their shares, and the company raises new funds.

CITE: https://www.r2library.com/Resource/Title/0826102549

Direct listings skip the underwriting hullabaloo. But without that stability guarantee, direct listings can result in a more volatile opening. Some companies, like Coinbase, find that it’s worth it to keep their hard-earned money out of bankers’ hands.

SPACs, aka “blank-check companies,” offer yet another alternative path to public markets. A SPAC is a shell company that raises money through the traditional IPO process, then merges with a private company and takes it public. 

MORE: https://medicalexecutivepost.com/2019/06/24/what-is-a-direct-listing-process-on-wall-street/

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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PODCAST: UHC’s David Wichmann Steps Down as CEO

THE WHOLE STORY?

By Eric Bricker MD

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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™

ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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The STEP-UP In Investment Value?

Understanding the TAX loophole of a ‘step up’ in BASIS value

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

The term “step-up” refers to the difference in value and tax liability that an asset has when it is acquired and when it is transferred to an inheritor.

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CITE: https://www.r2library.com/Resource/Title/0826102549

EXAMPLE #2: The proverbial millionaire Doctor Joe, for example, could buy a home for $350,000 and sell it for $1 million, after which he’d pay taxes on the $650,000 gain. But if Dr. Joe passes the home onto his daughter Ella, and she has it appraised at $1 million, its value has taken a “step up” in value to $1 million. If Ella sells the home for $1 million or less, she wouldn’t owe anything in taxes.

ASSESSMENT: For billionaires like Jeff Bezos, Bill Gates and Elon Musk who earn far more through their investments than their salaries, this loophole is a perfect way to shield their wealth. Intergenerational wealth has contributed to surging inequality in America, which grew wider during the pandemic. Since 2019, the wealth of the top 400 richest people in the US increased by $1.4 trillion, per research from Gabriel Zucman and Emmanuel Saez, a pair of left-leaning economists at the University of California, Berkeley.

“Often, for these people, wealth accumulates tax-free their entire lives,” Frank Clemente, executive director at the left-leaning advocacy group Americans for Tax Fairness, opined. President Joe Biden proposed ending this loophole and making billionaires “pay their fair share,” so why does it look like his party won’t touch it?

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What is ABSOLUTE VALUE?

A MATH AND FINANCIAL-INVESTING TERM

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

In mathematics, the absolute value or modulus of a real number x, denoted |x|, is the non-negative value of x without regard to its sign. Namely, |x| = x if x is positive, and |x| = −x if x is negative (in which case −x is positive), and |0| = 0. For example, the absolute value of 3 is 3, and the absolute value of −3 is also 3. The absolute value of a number may be thought of as its distance from zero.

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In finance, absolute value, also known as an intrinsic value, refers to a business valuation method that uses discounted cash flow (DCF) analysis to determine a company’s financial worth. The absolute value method differs from the relative value models that examine what a company is worth compared to its competitors. Absolute value models try to determine a company’s intrinsic worth based on its projected cash flows.

CITE: https://www.r2library.com/Resource/Title/0826102549

In investing, the key issues are as follows:

  • Absolute value refers to a business valuation method that uses discounted cash flow analysis to determine a company’s financial worth.
  • Investors can determine if a stock is currently under or overvalued by comparing what a company’s share price should be given its absolute value to the stock’s current price.
  • There are some challenges with using the absolute value analysis including forecasting cash flows, predicting accurate growth rates, and evaluating appropriate discount rates.
  • Absolute value, unlike relative value, does not call for the comparison of companies in the same industry or sector.

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PODCAST: The RIGHT To REPAIR Electronics Movement

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The right to repair electronics refers to proposed legislation that would provide the practical means for equipment owners to repair their devices, and not a new legal right. The implications for medicine are huge.

Advocates observe that while repair is legal under copyright law and patent law, owners are often prohibited from making their own repairs or hiring technicians they trust to help by manufacturer limitations on access to repair materials such as parts, tools, diagnostics, documentation and firmware.

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See the source image

R2R ASSOCIATION: https://www.repair.org/stand-up/#:~:text=Right%20to%20Repair%20or%20%22Fair%20Repair%22%20legislation%20is,-%20not%20their%20distributors%2C%20retailers%2C%20or%20even%20franchisees.

MICROSOFT: https://www.digitaltrends.com/mobile/microsoft-expands-right-to-repair/

STEVE WOZNIAK PODCAST: https://lynnwoodtimes.com/2021/07/25/right-to-repair-wozniak/

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DONATE: Your Body to Science?

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Advancing the Science of Medicine with a Priceless, No Cost Option

Everything we know about the human body comes from studying whole body donors. At MedCure, they connect you or your loved ones to the physicians, surgeons, and researchers who are continuing this vital work. Their discoveries and innovations help people live longer, make treatments less invasive, and create new ways to prevent illness or disease.

They are constantly overwhelmed by the incredible generosity and selflessness of donors.  MedCure honors their gifts by covering, upon acceptance, all expenses related to the donation process. These costs include transportation from the place of passing, cremation, and a certified copy of the death certificate, as well as the return of cremated remains to the family or a scattering of the ashes at sea. By request, they can provide a family letter that shares more detailed information on how you or your loved one contributed to medical science.

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How to Donate Your Body to Science | Discover Magazine

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READ: https://www.msn.com/en-us/health/wellness/what-exactly-happens-when-you-donate-your-body-to-science/ar-AAPaNJm?li=BBnb7Kz

CRYONICS: https://www.cryonics.org/

LONGEVITY: https://medicalexecutivepost.com/2021/09/26/podcasts-jeff-bezos-and-altos-longevity-labs/

RELATED: https://www.msn.com/en-us/news/crime/crematorium-owner-faces-10-years-for-improper-body-storage-charges-license-revoked/ar-AAPaCLV?li=BBnb7Kz

Body Facts: https://lifehacker.com/14-weird-facts-about-the-human-body-you-probably-never-1847829288/slides/2

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CASH FLOW ANALYSIS: Real Life ACO Accounting Example

ACCOUNTABLE CARE ORGANIZATION EXAMPLE

Touring with Marcinko | The Leading Business Education ...

BY DR. DAVID EDWARD MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.

Citation: https://www.r2library.com/Resource/Title/0826102549

Case Model

Now, suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.

Cost of Medical Services Provided (COMSP):

The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract.  Since gross margin is 35% of revenues, the COMSP is 65% or $65,000.  Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.

Assumptions

Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:

  • All income tax, salaries and Accounts Payable (AP) are paid at once.
  • Durable medical equipment inventory and pre-paid advertising remain constant.
  • Gains/losses on sale of equipment and depreciation expenses remain stable.
  • Gross margins remain constant.
  • The office is efficient so major new marginal costs will not be incurred.

Physician Reactions:

Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era.  Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:

1. Extend Account’s Payable

Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business

2. Reduce Accounts Receivable

According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.

The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.

3. Borrow with Short-Term Bridge Loans

Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.

4. Cut Expenses

While this is often possible, it has to be done without demoralizing the practice’s staff.

5.  Reduce Supply Inventories

If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.

6. Taxes

Do not stop paying withholding taxes in favor of cash flow because it is illegal.

Hyper-Growth Model:

Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses.  Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows!  Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.

ASSESSMENT: Your comments are appreciated.

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CONTACT: Ann Miller RN MH

[Executive Director]

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PODCAST: How Modernized Self-Directed IRAs Help Democratize Retirement

In this podcast, host Dara Albright and guest, Eric Satz, Founder and CEO of Alto IRA, discuss how modern Self-Directed IRAs (SDIRAs) are democratizing retirement planning by providing all Americans with the ability to add non-correlated alternative asset classes to tax-advantaged accounts.

The single greatest – and free – investment tool is also disclosed.

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What are the Advantages of Rolling the Money of My Retirement Plan into an  IRA? - Protection Point Advisors, Inc.

Discussion highlights include:

  • How SDIRAs offer wealth building opportunities for “not-yet accredited investors”;
  • How SDIRAs have evolved to accommodate micro-sized alternative investments; 
  • Why alternative assets belong in retirement vehicles;
  • Three reasons most retirement savers are underweighted in non-correlated assets;
  • Trading cryptocurrencies without tax consequences; 
  • Why RIAs are looking to ALTO for clients’ crypto allocation;
  • How to open a cryptoIRA account.

PODCAST: https://dwealthmuse.podbean.com/e/episode-12-how-modernized-selfdirected-iras-help-democratize-retirement-1623424270/

Your comments are appreciated.

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RELATED TEXTS: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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PODCAST: 25 Years of Healthcare and Economic Macro Trends

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BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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RELATED 25 Healthcare Cost ITEMS: https://medicalexecutivepost.com/2018/03/11/medical-treatment-costs-becoming-expensive-25-factors/

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How to NAME Your New Medical Practice?

PRAGMATIC BUSINESS – NOT PERSONAL – MANAGEMENT ADVICE

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

THE MEDICAL PRACTICE NAME

Did you know that most experts recommend against naming a practice with your own name because it limits future growth and you may lose the benefits that a more descriptive name would bring?

Your business name will likely be incorporated using your practice’s name, although larger (multi-specialty group) practices may use a more general name for the entire enterprise; and then having multiple “dba’s” (”Doing Business As”) for the individual practices under the umbrella. It is important to discuss these options with an attorney if you believe this arrangement has advantage; others find it confusing.

Healthcare Marketing: How to Name Your Medical Practice - The Medically

Usually, your medical specialty can be used as a base-name, and then some descriptor to differentiate it from local competing practices. Selecting a name like “The Allegiance Partners” does not indicate that medicine is your service. On the other hand, naming your practice “Podiatry Associates of Your Town” won’t be helpful to patients looking for you in the yellow pages, health insurance provider network list, or internet search engines, and finding your practice listed just before “Your Town Podiatry Partners”. It is therefore good to be cognizant of your competitors’ names when choosing your own. And, you should select a name that will hopefully grow with you into a larger enterprise.

For example, are you a solo doctor, but are pretty sure you’ll take on one or more partners in the future? Then besides not naming your practice after yourself, you may choose to add “Group” or “Partners” to your name initially even if you’re the only doctor. Is there any possibility you’ll open a second office in another town? Naming your medical practice something like the ”Apple Street Internal Medicine Group” may not make sense when your second office is opened on Main Street in a nearby city, in a few years.

Order Forms and Practice Stationary

Orders forms, invoices, purchase and estimate forms, business cards, envelopes, stationary and specialty labels can all be personalized for your medical practice name, script, colors and logo. Often, local or regional printers are the most cost effective and you support another entrepreneur, as well.

Well-know internet companies that print stationary are: www.nebs.com; www.paperdirect.com; and www.vistaprint.com

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“Churning”, “Front Running” and “Pumping & Dumping”

BE ALERT AND BE AWARE

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Front Running (Definition, Examples) | How Traders Use it?

Churning: The practice of a provider seeing a patient more often than is medically necessary, primarily to increase revenue through an increased number of visits. A practice, in violation of SEC rules, where a salesperson affects a series of transactions in a customer’s account which are excessive in size and/or frequency in relation to the size and investment objectives of the account. An insurance agent who is churning an account is normally seeking to maximize the income (in commissions, sales credits or mark-ups) derived from the account.  

FRONT-RUNNING: Form of market manipulation where a broker/dealer delays processing of a large customer trade in an underlying security until the firm can execute an options trade in that security in anticipation of the client’ s trade impact on the underlying security.

Pump and dump: A a form of securities fraud that involves artificially inflating the price of an owned stock through false and misleading positive statements, in order to sell the cheaply purchased stock at a higher price. Once the operators of the scheme “dump” their overvalued shares, the price falls and investors lose their money.

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CORRELATION in Modern Portfolio Theory Investing

“Correlation” has been used over the past twenty years by institutions, [physician] investors and financial advisors to assemble portfolios of moderate INVESTMENT risk

By Dr. David Edward Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Modern Portfolio Theory approaches investing by examining the complete market and the full economy. MPT places a great emphasis on the correlation between investments. 

DEFINITION: Correlation is a measure of how frequently one event tends to happen when another event happens. High positive correlation means two events usually happen together – high SAT scores and getting through college for instance. High negative correlation means two events tend not to happen together – high SATs and a poor grade record. No correlation means the two events are independent of one another.

CITATION: https://www.r2library.com/Resource/Title/0826102549

CORRELATION: https://medicalexecutivepost.com/2021/02/05/correlation-is-not-causation/

In statistical terms two events that are perfectly correlated have a “correlation coefficient” of 1; two events that are perfectly negatively correlated have a correlation coefficient of -1; and two events that have zero correlation have a coefficient of 0.

In calculating correlation, a statistician would examine the possibility of two events happening together, namely:

  • If the probability of A happening is 1/X;
  • And the probability of B happening is 1/Y; then
  • The probability of A and B happening together is (1/X) times (1/Y), or 1/(X times Y).

There are several laws of correlation including;

  1. Combining assets with a perfect positive correlation offers no reduction in portfolio risk.  These two assets will simply move in tandem with each other.
  2. Combining assets with zero correlation (statistically independent) reduces the risk of the portfolio.  If more assets with uncorrelated returns are added to the portfolio, significant risk reduction can be achieved.
  3. Combing assets with a perfect negative correlation could eliminate risk entirely.   This is the principle with “hedging strategies”.  These strategies are discussed later in the book.

In the real world, negative correlations are very rare.  Most assets maintain a positive correlation with each other.  The goal of a prudent investor is to assemble a portfolio that contains uncorrelated assets.  When a portfolio contains assets that possess low correlations, the upward movement of one asset class will help offset the downward movement of another.  This is especially important when economic and market conditions change.

As a result, including assets in your portfolio that are not highly correlated will reduce the overall volatility (as measured by standard deviation) and may also increase long-term investment returns. This is the primary argument for including dissimilar asset classes in your portfolio. Keep in mind that this type of diversification does not guarantee you will avoid a loss.  It simply minimizes the chance of loss. 

In this table provided by Ibbotson, the average correlation between the five major asset classes is displayed. The lowest correlation is between the U.S. Treasury Bonds and the EAFE (international stocks).  The highest correlation is between the S&P 500 and the EAFE; 0.77 or 77 percent. This signifies a prominent level of correlation that has grown even larger during this decade.   Low correlations within the table appear most with U.S. Treasury Bills.

Historical Correlation of Asset Classes

Benchmark                             1          2          3         4         5         6            

1 U.S. Treasury Bill                  1.00    

2 U.S. Bonds                          0.73     1.00    

3 S&P 500                               0.03     0.34     1.00    

4 Commodities                         0.15     0.04     0.08      1.00      

5 International Stocks              -0.13    -0.31    0.77      0.14    1.00       

6 Real Estate                           0.11      0.43    0.81     -0.02    0.66     1.00

Table Source: Ibbotson 1980-2012

ASSESSMENT: Your thoughts are appreciated.

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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PODCAST: DECEPTIONS, EXPLOITATIONS & SCAMS in Healthcare

32 EXAMPLES

By Eric Bricker MD

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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™ book cover

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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INVESTMENT SCAMS: https://medicalexecutivepost.com/2015/03/29/top-ten-investment-scams/

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COVID-19 UPDATE: Vaccine Booster Shots

BY MEDICARE TEAM

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Important update on COVID-19 vaccine booster shots
If you previously got 2 doses of the Pfizer-BioNTech COVID-19 vaccine, you can get a booster shot of the Pfizer-BioNTech COVID-19 vaccine if you fall into one of these groups:

You’re 65 and older,You’re 18+ and have certain underlying medical conditions, or
You’re 18+ and work or live in a high-risk setting.

You can get your booster shot at least 6 months after you complete your second dose of the Pfizer vaccine.
The booster shot can help strengthen and prolong your protection against COVID-19.

Learn More: Visit CDC.gov for more information on other groups already vaccinated with the Pfizer vaccine that may be eligible for a booster shot.

Remember: Medicare covers a Pfizer vaccine booster shot at no cost to you.

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Oregon says it's ready to provide COVID-19 booster shots to those eligible,  but asks for patience - KTVZ

Sincerely,
The Medicare Team
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The FIDUCIARY OATH for “Financial Advisors”

“Will you sign a fiduciary oath?”

PHYSICIAN COLLEAGUES AND MEDICAL PROFESSIONALS ASK

By Dr. David Edward Marcinko MBA CMP®

CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

https://certifiedmedicalplannerdotorg1.files.wordpress.com/2012/03/cmp-logo17.jpg

“SIGN IT -OR- FORGET IT”

Asking a “Financial Advisor” if they’re a fiduciary isn’t always enough to hire them. People can “ice skate” around that terminology and give fuzzy or unclear answers to that question. Instead, you may consider asking them to sign a fiduciary oath.

“If someone is fee-only, not “fee-based”, they shouldn’t have a problem signing a document stating how they get compensated.” “If someone is, for example, a broker dealer, insurance agent or investment advisor who works on commissions, they probably wouldn’t be allowed to sign it.” Just say NOT to contract arbitration clauses, too! As well as “Dual Registration”. Remember Bernie Lawrence Madoff.

THE FIDUCIARY OATH

This one-page document outlines five fiduciary principles a financial adviser must follow to put the client’s interests ahead of their own. They include acting with prudence, not misleading the client, avoiding conflicts of interest, and disclosing and managing unavoidable conflicts.

The oath, meant to be printed out and signed by an adviser, has been around for several years. But recent events, such as the 5th Circuit Court of Appeals striking down the DOL rule, have increased the urgency to get it into circulation.

“With the 5th Circuit ruling, it is just so important to have this oath out there because it states fiduciary principles,” said Ms. P. Houlihan, president of Houlihan Financial Resource Group. “The oath is the answer, given that the DOL rule is gone.”

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;,nbv

 fiduciaryoath_individual

Conclusion

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.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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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PODCAST: Machine Learning For Population Health

BY ERIC BRICKER MD

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

POPULATION HEALTH: https://medicalexecutivepost.com/2016/06/28/what-is-population-health/

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What are “MEME” Stocks?

A FINANCIAL EXPLANATION

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Image result for meme stocks

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DEFINITION: The meaning of meme stocks is sort of self-explanatory: hyped stocks that perform well. But from a fundamental perspective, they shouldn’t do well at all.

CITE: https://www.r2library.com/Resource/Title/0826102549

For example, Reddit forums and social media hype drive meme stocks. Speculators on Twitter and Reddit united together to trade their favorite companies in hopes of driving them “to the moon.” 

It may not be fair to call them speculators. These hype beasts want to buy and hold stocks of companies that might not have a great long-term outlook.

Brokerages like Robinhood helped level the playing field with apps and ‘easier’ access. That’s giving retail traders more opportunity. Robinhood traders can buy with just a few clicks on their smartphones and use partial positions to buy chunks of stocks.

And it’s helped create meme stock madness.

MORE: https://www.msn.com/en-us/money/savingandinvesting/7-meme-stocks-with-the-most-potential-for-runaway-success/ss-AAPQbYU?li=BBnbfcL

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INVESTING RISKS DOCTORS SHOULD KNOW: Types & Definitions

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Financial Investing risk is any of various types of risk associated with financing, including financial transactions that include company loans in risk of default. Often it is understood to include only downside risk, meaning the potential for financial loss and uncertainty about its extent.

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See the source image

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Understanding Financial Risk

Although broad investing risks can be quickly summarized as “the failure to achieve spending and inflation-adjusted growth goals,” individual assets may face any number of other subsidiary risks:

  • Call risk – The risk, faced by a holder of a callable bond that a bond issuer will take advantage of the callable bond feature and redeem the issue prior to maturity. This means the bondholder will receive payment on the value of the bond and, in most cases, will be reinvesting in a less favorable environment (one with a lower interest rate)
  • Capital risk – The risk an investor faces that he or she may lose all or part of the principal amount invested.
  • Commodity risk – The threat that a change in the price of a production input will adversely impact a producer who uses that input.
  • Company risk – The risk that certain factors affecting a specific company may cause its stock to change in price in a different way from stocks as a whole.
  • Concentration risk – Probability of loss arising from heavily lopsided exposure to a particular group of counterparties
  • Counterparty risk – The risk that the other party to an agreement will default.
  • Credit risk – The risk of loss of principal or loss of a financial reward stemming from a borrower’s failure to repay a loan or otherwise meet a contractual obligation.
  • Currency risk – A form of risk that arises from the change in price of one currency against another.
  • Deflation risk – A general decline in prices, often caused by a reduction in the supply of money or credit.
  • Economic risk – the likelihood that an investment will be affected by macroeconomic conditions such as government regulation, exchange rates, or political stability.
  • Hedging risk – Making an investment to reduce the risk of adverse price movements in an asset.
  • Inflation risk – The uncertainty over the future real value (after inflation) of your investment.
  • Interest rate risk – Risk to the earnings or market value of a portfolio due to uncertain future interest rates.
  • Legal risk – risk from uncertainty due to legal actions or uncertainty in the applicability or interpretation of contracts, laws or regulations.
  • Liquidity risk – The risks stemming from the lack of marketability of an investment that cannot be bought or sold quickly enough to prevent or minimize a loss.

CITE: https://www.r2library.com/Resource/Title/0826102549

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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™

Risk Management Textbook: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: The Blue Cross / Shield Organization[s]

36 Blue Cross Health Insurance Companies Explained

Eric Bricker, MD (@DrEricB) | Twitter

BY ERIC BRICKER MD

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Blue Cross Blue Shield - Health for Life Grand Rapids

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PODCAST: https://www.ahealthcarez.com/blue-cross-explained

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Why are CERTIFIED MEDICAL PLANNER® Textbooks SO DARN Popular?

[By Dr. David Edward Marcinko MBA CMP®]

http://www.CertifiedMedicalPlanner.org

OK – I was a Certified Financial Planner® before my academic team launched the Certified Medical Planner™ online and on-ground chartered education and board certification designation program a few years ago. I am now CFP reformed and in remission.

MORE: Enter CPMs

Enter the Certified Medical PlannerChartered Designation

Today, we are of course, gratified that Certified Medical Planner™ mark notoriety is growing organically in the healthcare, as well as financial services, industry.

Even uber-blogger Mike Kitces MSFS, MTAX, CFP, CLU, ChFC, RHU, REBC, CASL has taken note of us in his musings on the Nerd’s Eye View website. And, the reality is that there are a growing number of CFP educational programs at the post-CFP niche market level.

But, none for healthcare industrial complex: for doctors … by doctors!

Popularity of our Text Books

However, it is our modern, innovative and proprietary Certified Medical Planner™ textbooks and dictionaries that have exploded in the academic marketplace.

In fact, they are now redacted in thousands of medical, graduate, law and B-schools and libraries, as well as colleges and universities throughout the nation. This includes the Library of Congress, National Institute of Health and  the Library of Congress.

What Gives?

We have been told that this textbook popularity and publishing success is because of their balanced and peer-reviewed nature; something not very widespread in the financial services industry that is prone to gross and overstated advertising, salesmanship and marketing hyperbole. And, for this we are very gratified.

But, is there another reason our books are so popular?

A bit of networking and research suggests that interested folks may be eschewing the actual course work in favor of just the high quality textbooks! UGH!

Another reason may be that our books and curricula are kept fresh and updated on our corporate website: http://www.MedicalBusinessAdvisors.com

Assessment

So, what do you think? Matriculation with the professional mark versus self study without the designation mark. Please opine.

Conclusion

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.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

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

Product DetailsProduct Details

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Product DetailsProduct Details

Adult Learners and Students:

Product DetailsProduct DetailsProduct Details

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The “BADLANDS” Off-Shore Tax Havens in South Dakota

By Morning Brew, NF and Staff Reporters

One of the world’s most prolific offshore tax havens is located more than 1,000 miles from any shore.

The US state of South Dakota now rivals notorious tax shelters like Panama, the Cayman Islands, and Switzerland as a destination for the top 0.01% to shield their  wealth from the grubby hands of tax authorities, the newly released Pandora Papers show.

Product Details

CITE: https://www.r2library.com/Resource/Title/0826102549

Quick recap: The Pandora Papers, published one week ago, represent one of the biggest leaks of financial docs in history. They show how celebrities, world leaders, and business magnates take advantage of opaque financial laws to hold onto as much of their wealth as they can…and, in some cases, get away with crimes.

And while none of that is particularly surprising, what is surprising is the changing geography of tax havens. The ultrarich are taking their money out of traditional tax shelters like the island of Jersey (one of the Channel Islands) and stashing it in rural US states like Nevada, Wyoming, and, most of all…South Dakota.

  • Of the more than 200 US trusts appearing in the Pandora Papers, 81 were located in South Dakota.

South Dakota’s trust industry held $367 billion in anonymous, untraceable assets in 2020, a nearly 4x increase from $75.5 billion in 2011. And these trusts aren’t catering to cattle ranchers who made it big—they’re linked to individuals in 40 different countries outside the US.

The bigger issue? 28 US-based trusts are linked to individuals or companies accused of misconduct overseas, such as money laundering, bribery, and human rights abuses, per the Washington Post.

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Badlands National Park Has Stunning Landscapes and Diverse Wildlife -  Here's How to Experience It (Video) | Travel + Leisure

And now the question you’ve all been waiting for…

Why South Dakota?

It’s not why most people arrive in South Dakota—by accident. For decades, the state has intentionally loosened regulations on its financial services sector to grow its economy and create finance jobs, particularly in the city of Sioux Falls.

This deregulation push, spurred by trust industry insiders, turned a South Dakotan trust into “the most potent force-field money can buy,” wrote the Guardian’s Oliver Bullough.

By setting up a trust in South Dakota…

  • Your assets are protected from claims by creditors, angry clients, or even your ex-spouse (a level of security not afforded by other tax havens).
  • You are not subject to income tax, inheritance tax, or capital gains tax in the state…because South Dakota has none of those.
  • You never actually have to go to South Dakota.

In sum, if you’re a shady billionaire or a corrupt president of a Latin American country with something to hide, South Dakota looks like a mighty attractive place to shield your fortune from governments.

Or, rather, the US more broadly is an attractive place to hide your wealth. After years of bashing “offshore” havens for sheltering tax avoiders, the US has moved up to second in the world rankings for financial secrecy.

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MORE: https://www.msn.com/en-us/money/markets/the-worlds-rich-and-powerful-are-stashing-dollar500-billion-in-this-tax-haven/ar-AAPw6Ny?li=BBnb7Kz

MORE: https://www.msn.com/en-us/news/politics/opinion-the-reason-its-so-easy-for-wealthy-americans-to-hide-their-money-%e2%80%94-and-how-to-stop-it/ar-AAPzf9W?li=BBnb7Kz

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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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™ book cover

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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STOCK ORDERS: Positions Doctors Should Know

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ACADEMIC C.V. | DAVID EDWARD MARCINKO

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Miscellaneous STOCK Orders and MARKET Positions

Product Details

CITE: https://www.r2library.com/Resource/Title/0826102549

Beside market, limit and stop orders, there are some other miscellaneous orders for the physician or guided investor, to know:

A stop limit order is a stop order that, once triggered or activated, becomes a limit order. Realize that it is possible for a stop limit to be triggered and not executed, as the limit price specified by the doctor may not be available.

In addition, there are all or none and fill or kill orders, and even though both require the entire order to be filled, there are distinct differences. An all or none (AON) is an order in which the broker is directed to fill the entire order or none of it.

A fill or kill (FOK) is an order either to buy or to sell a security in which the broker is directed to attempt to fill the entire’ amount of the order immediately and in full, or that it be canceled.

The difference between an all or none and a fill or kill order is that with an all or none order, immediate execution is not required, while immediate execution is a critical component of the fill or kill. Because of the immediacy requirement,

FOK orders are never found on the specialist’s book. Another difference is that AON orders are only permitted for bonds, not stocks, while FOK orders may be used for either.

Also, there exists an immediate or cancel order (IOC), which is an order to buy or sell a security in which the broker is directed to attempt to fill immediately as much of the order as possible and cancel any part remaining. This type of order differs from a fill-or-kill order which requires the entire order to be filled. An IOC order will permit a partial fill. Because of the immediacy requirement, IOC and FOK orders are never found on the specialist’s book.

 Long and Short Positions

A long buy position means that shares are for sale from a market makers inventory or owned by the medical investor outright. Market makers take long positions when customers and other firms wish to sell, and they take short positions when customers and other firms want to buy in quantities larger than the market maker’s inventory. By always being ready, willing, and able to handle orders in this way, market makers assure the investing public of a ready market in the securities in which they are interested. When a security can be bought and sold at firm prices very quickly and easily the security is said to have a high degree of liquidity, also known as marketability. 

A short position investor seeks to make a profit by participating in the decline in the market price of a security.

Now; let’s see how these terms, long and short, apply to transactions by medical investors [rather than market makers] in the securities markets.

When a doctor buys any security – he is said to be taking a long position in that security. This means the investor is an owner of the security. Why does a doctor take a long position in a security? Well, receiving dividend income to make a profit from an increase in the market price is one reason. Once the security has risen sufficiently in price to satisfy the investor’s profit needs, the investor will liquidate his long position, or sell his stock. This would officially be known as a long sale of stock, though few people in the securities business use the label “long sale”. This is the manner in which the above investor had made a profit is the traditional method used; buy low, sell high.

Let’s look at an actual investment in General Motors to investigate this principle further. A medical investor has taken a long position in 100 shares of General Motors stock at a price of $70 per share. This means that the manner in which he can do that is by placing a market order which will be executed at the best “available market price at the time, or by the placing of a buy limit order with a limit price of $70 per share. The investor firmly believes, on the basis of reports that he has read about the automobile industry and General Motors specifically, that at $70 a share, General Motors is a real bargain. He believes that based on its current level of performance, it should be selling for a price of between $80 and $85 per share. But, the doctor investor has a dilemma. He feels certain that the price is going to rise but he cannot watch his computer, or call his broker, every hour of every day. The reason he can’t watch is because patients have to be seen in the office. The only people who watch a computer screen all day are those in the offices of brokerage firms (stock broker registered representatives), and doctor day traders, among others. 

In the above example, with a sell limit order, if the doctor investor was willing to settle for a profit of $12 per share, what order would he place at this time? If you said, “sell at $82 good ’til canceled”, you are correct. Why GTC rather than a day order? Because our doctor investor knows that General Motors is probably not going to rise from $70 to $82 in one day. If he had placed an order to sell at $82 without the GTC qualification, his order would have been canceled at the end of this trading day. He would have had to re-enter the order each morning until he got an execution at 82. Marking the order GTC (or open) relieves him of any need to replace the order every morning. Several weeks later, when General Motors has reached $82 per share in the market, his order to sell at 82 is executed. The medical investor has bought at 70 and sold at 82 and realized a $12 per share profit for his efforts.

Let’s suppose that the medical investor, who has just established a $12 per share profit, has evaluated the performance of General Motors common stock by looking at the market performance over a period of many years. Let’s further assume that the investor has found by evaluating the market price statistics of General Motors that the pattern of movement of General Motors is cyclical. By cyclical, we mean that it moves up and down according to a regular pattern of behavior.

Let’s say the investor has observed that in the past, General Motors had repeated a pattern of moving from prices in the $60 per share range as a low, to a high of approximately $90 per share. Further, our investor has observed that this pattern of performance takes approximately 10 to l2 months to do a full cycle; that is, it moves from about 60 to about 90 and back to about 60 within a period of roughly l2 months. If this pattern repeats itself continually, the investor would be well advised to buy the stock at prices in the low to mid 60’s hold onto it until it moves well into the 80’s, and then sell his long position at a profit. However, what this means is that our investor is going to be invested in General Motors only 6 months of each year. That is, he will invest when the price is low and, usually within half a year, it will reach its high before turning around and going back to its low again. How can the doctor-investor make a profit not only on the rise in price of General Motors in the first 6 months of the cycle, but on the fall in price of General Motors in the second half of the cycle? One technique that is available is the use of the short sale.

The Short Sale

If a doctor investor feels that GM is at its peak of $ 90 per share, he may borrow 100 shares from his brokerage firm and sell the 100 shares of borrowed GM at $ 90. This is selling stock that is not owned and is known as a short sale. The transaction ends when the doctor returns the borrowed securities at a lower price and pockets the difference as a profit. In this case, the doctor investor has sold high, and bought low. 

Odd Lots

Most of the thousands of buy and sell orders executed on a typical day on the NYSE are in 100 share or multi-100 share lots. These are called round lots. Some of the inactive stocks traded at post 30, the non-horseshoe shaped post in the northwest corner of the exchange, are traded in 70 share round lots due to their inactivity. So, while a round lot is normally 700 shares, there are cases where it could be 10 shares. Any trade for less than a round lot is known as an odd lot. The execution of odd lot orders is somewhat different than round lots and needs explanation.

When a stock broker receives an odd lot order from one of his doctor customers, the order is processed in the same manner as any other order. However, when it gets to the floor, the commission broker knows that this is an order that will not be part of the regular auction market. He takes the order to the specialist in that stock and leaves the order with the specialist. One of the clerks assisting the specialist records the order and waits for the next auction to occur in that particular stock. As soon as a round lot trade occurs in that particular stock as a result of an auction at the post, which may occur seconds later, minutes later, or maybe not until the next day, the clerk makes a record of the trade price.

Every odd lot order that has been received since the last round lot trade, whether an order to buy or sell, is then executed at the just noted round lot price, the price at which the next round lot traded after receipt of the customer’s odd lot order, plus or minus the specialist’s “cut “.  Just like everything else he does, the specialist doesn’t work for nothing. Generally, he will add 1/8 of a point to the price per share of every odd lot buy order and reduce the proceeds of each odd lot sale order by 1/8 per share. This is the compensation he earns for the effort of breaking round lots into odd lots. Remember, odd lots are never auctioned but, there can be no odd lot trade unless a round lot trades after receipt of the odd lot order. 

Product Details

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Hospital Price Transparency Regulations

EXPLAINED IN TWO MINUTES

By Eric Bricker MD

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PODCAST: https://www.fshealth.com/hospital-price-transparency-regulations?utm_campaign=Weekly%20Pulse&utm_medium=email&_hsmi=2&_hsenc=p2ANqtz-_ZmuwSwhqaUng6ccvspXNYBrjn8VoHnicgZRLgUpvdYNdXo-YeeDF2nYCu67N5F8dGsrg3Fr5guW-c-rdwZqmR2_XGkg&utm_content=2&utm_source=hs_email&mc_cid=c535b3053b&mc_eid=0192794229

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MORE: https://medicalexecutivepost.com/2021/06/02/hospital-financial-price-transparency/

RELATED: https://medicalexecutivepost.com/2019/09/09/physician-perspectives-on-price-transparency/

MORE: https://medicalexecutivepost.com/2016/08/22/us-state-healthcare-price-transparency-laws/

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What is the FOREX MARKET?

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By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

The foreign exchange market is a global decentralized or over-the-counter market for the trading of currencies. This market determines foreign exchange rates for every currency. It includes all aspects of buying, selling and exchanging currencies at current or determined prices.

In terms of trading volume, it is by far the largest market in the world, followed by the credit market.

CITE: https://www.r2library.com/Resource/Title/0826102549

The forex market is not dominated by a single market exchange, but a global network of computers and brokers from around the world. Forex brokers act as market makers as well and may post bid and ask prices for a currency pair that differs from the most competitive bid in the market.

The forex market is made up of two levels—the interbank market and the over-the-counter (OTC) market. The interbank market is where large banks trade currencies for purposes such as hedging, balance sheet adjustments, and on behalf of clients. The OTC market, on the other hand, is where individuals trade through online platforms and brokers.

INDICATORS: https://medicalexecutivepost.com/2014/02/08/top-forex-indicators/

NOTE: FOREX.com is a registered FCM and RFED with the CFTC and member of the National Futures Association (NFA # 0339826). Forex trading involves significant risk of loss and is not suitable for all physicians or investors.

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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™ book cover

ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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The “HEMLINE INDEX”

Hemline Index

The hemline index is a theory presented by economist George Taylor in 1926.
The theory suggests that hemlines on women’s dresses rise along with stock prices. In good economies, we get such results as miniskirts (as seen in the 1920s and the 1960s), or in poor economic times, as shown by the 1929 Wall Street Crash, hems can drop almost overnight.
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Non-peer-reviewed research in 2010 supported the correlation, suggesting that “the economic cycle leads the hemline with about three years”.
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Assessment: Your thoughts are appreciated
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Primary Care Physician Supply and Demand

Supply and Demand Economics

By http://www.MCOL.com

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OLD versus NEW Paradigm

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Conclusion

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.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

MORE FOR DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

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WHAT IS “MEDICAL SENTINEL” CASE SURVEILLANCE IN PUBLIC HEALTH?

WHAT IS “MEDICAL SENTINEL” CASE SURVEILLANCE IN PUBLIC HEALTH?
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By Dr. David E. Marcinko MBA
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SENTINEL SURVEILLANCE is a medical case observation system in which a designated group of reporting sources, hospitals and agencies agrees to report all cases of one or more notify-able conditions; such as the Corona Virus.
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I first became interested in this concept during the HIV/AIDS epidemic of the early 1980s. In fact, it prompted me to later become a Certified Physician in Healthcare Quality [CPHQ].
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Now recently, Deborah Leah Birx MD coordinator for the White House Corona Virus Task Force mentioned the term on the daily presidential briefings.
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PODCAST: How to Sell in Healthcare

How to Read 4 Personality Types

BY ERIC BRICKER MD

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PROSPECT THEORY: Client Empowerment for Financial Decision Making

OVERHEARD IN THE DOCTOR’S LOUNGE

Image result for doctors lounge

By Jaan E. Sidorov MD

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DEFINITION:
Prospect theory is a theory of behavioral economics and behavioral finance that was developed by Daniel Kahneman and Amos Tversky in 1979. The theory was cited in the decision to award Kahneman the 2002 Nobel Memorial Prize in Economics.

CITE: https://www.r2library.com/Resource/Title/0826102549

CASE MODEL:

Amanda, an RN client, was just informed by her financial advisor that she
needed to re-launch her 403-b retirement plan. Since she was leery about
investing, she quietly wondered why she couldn’t DIY. Little does her FA know
that she doesn’t intend to follow his advice, anyway! So, what went wrong?


The answer may be that her advisor didn’t deploy a behavioral economics
framework to support her decision-making. One such framework is the
“prospect theory” model that boils client decision-making into a “three step
heuristic.”

Prospect theory makes the unspoken biases that we all have more explicit. By
identifying all the background assumptions and preferences that clients
[patients] bring to the office, decision-making can be crafted so that everyone
[family, doctor and patient] or [FA, client and spouse] is on the same page.

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Prospect theory - Sketchplanations

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Briefly, the three steps are:

  • Simplify choices by focusing on the key differences between investment
    [treatment] options such as stock, bonds, cash, and index funds.
  • Understanding that clients [patients] prefer greater certainty when it comes to
    pursuing financial [health] gains and are willing to accept uncertainty when
    trying to avoid a loss [illness].
  • Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority
    and hindsight biases.

ASSESSMENT

Much like in healthcare today, the current mass-customized approaches to the financial services industry fall short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.

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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™

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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AT YOUR SERVICE: Invite Dr. Marcinko to Your Next Event, Video Conference or Blog-Cast in 2021

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ABOUT | DAVID EDWARD MARCINKO

BY ANN MILLER RN CPHQ

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

MORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

PODCAST: “Signify Health” Start-Up Risk Adjustments [Medicare Advantage Part C]

BY ERIC BRICKER MD

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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On Bull -OR- Bear Markets?

YOU DECIDE AND OPINE

By Dr. David E. Marcinko MBA

The Plot Thickens

Autumn is here, and leaves aren’t the only thing falling.

Bull market breaks a new record on Wall Street. So what's a bull market? -  ABC News

After seven months of higher monthly closes, plus one record-setting high early in the month, the benchmark S&P 500® Index wobbled its way to a 5% pullback in September. The causes were many—uncertainty emanating from Washington, inflation, supply chain problems, and softer earnings growth forecasts—and now the horizon is looking foggy as we gaze ahead toward the final months of 2021.

Shipping bottlenecks and a near-record number of job openings are raising costs and putting upward pressure on wages, which may start to hurt profit margins, and the twin specters of inflation and higher interest rates are making investors wonder when the Federal Reserve might step in to raise interest rates.

Related: https://medicalexecutivepost.com/2016/03/18/doctors-and-bull-and-bear-markets/

But, if there’s a potential bright spot, we have to look across the sea to the Eurozone, where the signs point toward an era of increased government spending that could be positive for global economic growth.

CITE: https://www.r2library.com/Resource/Title/0826102549

And then came October, 2021; thus far!

Bull -OR- Bear?

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Become a Board CERTIFIED MEDICAL PLANNER®

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Help Physicians and Medical Professionals Thrive

[FINANCIAL PLANNING AND MEDICAL PRACTICE MANAGEMENT]

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XPAS

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LEARN MORE HERE: https://medicalexecutivepost.com/2021/10/02/the-certified-medical-planner-curriculum/

CONTACT: ANN MILLER RN MHA CMP®

Phone: 770-448-0769

EMAIL: MarcinkoAdvisors@msn.com

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What is a Stock Market Index IMPLIED OPEN?

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FINANCIAL TERMS AND DEFINITIONS FOR PHYSICIANS AND ALL INVESTORS

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By Dr. David E. Marcinko MBA CMP®

https://certifiedmedicalplannerdotorg1.files.wordpress.com/2012/03/cmp-logo17.jpg

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The stock markets have been near all time highs, lately. Physician colleagues and clients are so excited that they are even checking the overnight status of favorite stocks and/or the domestic/overseas markets.

US Stock Futures

DOW Futures

407.001.17%

  • Level35,191.00
  • Fair Value35,124.36
  • Implied Open66.64

S&P 500 Futures

36.250.82%

  • Level4,465.25
  • Fair Value4,477.37
  • Implied Open-12.12

Nasdaq Futures

107.000.71%

  • Level15,144.25
  • Fair Value15,286.71
  • Implied Open-142.46

Data as of October 15, 4:59 PM EDT. Based on — contract. Fair value provided by IndexArb.com.

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Some colleagues are even becoming a bit OCD by checking the implied open of various markets the night before. But, what exactly is the Implied Open? How is it calculated?

DEFINITION: The Implied Open attempts to predict the prices at which various stock indexes will open, at 9:30am New York time. It is frequently shown on various cable television channels prior to the start of the next business day.

Product Details

CITE: https://www.r2library.com/Resource/Title/0826102549

EXAMPLE: Considering the DJIA as an example, the basis of calculating implied open is the price of a “DJX index option futures contract”. This is not the price of the DJIA itself but rather the current ticker price of an option issued by the Chicago Board Options Exchange.

CBOE: The Chicago Board Options Exchange, located at 400 South LaSalle Street in Chicago, is the largest U.S. options exchange with annual trading volume that hovered around 1.27 billion contracts at the end of 2014. CBOE offers options on over 2,200 companies, 22 stock indices, and 140 exchange-traded funds.

CALCULATION: https://www.quora.com/How-do-you-calculate-the-implied-open-from-futures

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CNBC on Twitter: "US stock futures extending losses, point to Dow opening  lower by more than 870 points, S&P by 80 and Nasdaq by 150  https://t.co/oEUrsK8Oop… https://t.co/Yt7I4yvKFf"

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NOTE: We would like to remind you that new amendments adopted by the U.S. Securities Exchange Commission (SEC) have gone into effect as of September 28, 2021. These amendments restrict the ability of market makers to publish OTC quotations for those companies that have not made required current financial and company information available to regulators and investors.

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PODCAST: 70% Doctors Owned by Private Equity and Hospitals

THE BUSINESS OF MEDICINE

By Eric Bricker MD

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HBCUs and the Production of Doctors

By Marybeth Gasman, Tiffany Smith,Carmen Ye, and Thai-Huy Nguyen

Abstract

An important issue facing the world of medicine and health care is the field’s lack of diversity, especially regarding African American doctors. African Americans made up 6% of all physicians in the U.S. in 2008, 6.9% of enrolled medical students in 2013 and 7.3% of all medical school applicants.

The existing literature on the lack of diversity within the medical field emphasizes the role that inclusion would play in closing the health disparities among racial groups and the benefits acquired by African Americans through better patient-doctor interactions and further respect for cultural sensitivity. A large portion of current research regarding Black medical students and education focuses on why minority students do not go into medical school or complete their intended pre-med degrees.

Common notions and conclusions are that many institutions do not properly prepare and support students, who despite drive and desire, may lack adequate high school preparation and may go through additional stress unlike their other peers. Historically Black Colleges and Universities (HBCUs) are institutions that were designed to support African American students by providing an educational learning environment that caters to their unique challenges and cultural understandings. Given that HBCUs have had much success in preparing minority students for STEM fields, and for medical school success more specifically, this article looks at the history of such universities in the context of medical education, their effective practices, the challenges faced by African Americans pursing medical education, and what they can do in the future to produce more Black doctors.

We also highlight the work of Xavier University and Prairie View A&M University, institutions that regularly rank among the top two and top ten producers, respectively, of future African American doctors among colleges and universities.

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See the source image

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READ: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111265/

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Celebrate Multicultural Diversity Day 2021

OCTOBER 18th, 2021

By Staff Reporters

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October 18, 2021 (every third Monday in October) is Multicultural Diversity Day, a national day created by Cleorah Scruggs, a fourth-grade teacher in Flint, Michigan.

CITE: https://www.mlive.com/news/flint/2013/05/retired_flint_teacher_cleorah.html

The day was adopted as a national event by the NEA’s 1993 Representative Assembly to “increase awareness of the tremendous need to celebrate our diversity collectively.”

CITE: https://www.nea.org/

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See the source image

Your comments are appreciated.

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PODCAST: How Healthcare Policy Sausage is Made

‘America’s Bitter Pill’ by Steven Brill … Contemporary History of Healthcare in America

BY ERIC BRICKER MD

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Two Vital IRS Audit Flags for Physicians

For Doctors and all Investors

By Hayden Adams

Image result for irs

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Red Flag #1: Under reporting income

Generally speaking, all income is taxable unless it’s specifically excluded, as is the case with certain gifts and inheritances. In most instances, the income you earn will be reported to both you and the government on an information return, such as a Form 1099 or W-2. If the income you report doesn’t match the IRS’s records, you could face problems down the road—so be sure you include the income from all of the following forms that are applicable to your situation:

  • 1099-B: The form on which financial institutions report capital gains.
  • 1099-DIV: The form on which financial institutions report dividends.
  • 1099-MISC: The form used to report various types of income, such as royalties, rents, payments to independent contractors, and numerous other types of income.
  • 1099-R:The form on which financial institutions report withdrawals from tax-advantaged retirement accounts.
  • Form 1099-INT: The form on which financial institutions report interest income.
  • Form SSA-1099:The form on which the Social Security Administration reports Social Security benefits (a portion of which may be taxable, depending on your level of income).
  • Form W-2:The form on which employers report total annual compensation, payroll taxes, contributions to retirement accounts, and other information.

If you receive an inaccurate statement of income, immediately contact the responsible party to request a corrected form and have them resend the documents to both you and the IRS as soon as possible to avoid delaying your tax return. Also, be aware that you must report income for which there is no form, such as renting out your vacation home.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Red Flag #2: Misreporting investment gains

When you sell an investment, you’ll need to know both the cost basis (what you paid for the investment) and the sale price to determine your net gain or loss. The cost basis of your investment may need to be adjusted to account for commissions, fees, stock splits, or other events, which could help reduce your taxable gain or increase your net loss.

Financial institutions are required to adjust your investments’ cost basis and provide that information on a Form 1099. However, brokerages aren’t required to report the cost basis for investments purchased prior to a certain date, which means you’ll be responsible for supplying that information (see the table below). Be sure to keep records of all investment purchases and sales—even those for which your brokerage is responsible.

Your reporting responsibility

Depending on security type and date of purchase, you—rather than your brokerage—could be responsible for reporting the cost basis of your investment to the IRS.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Security typeInvestor’s responsibility if
Stocks (including real estate investment trusts)Acquired before 01/01/2011
Mutual funds, exchange-traded funds, and dividend reinvestment plansAcquired before 01/01/2012
Other specified securities, including most bonds, derivatives, and options

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PODCAST: The ACA “FAMILY GLITCH?

Health Insurance GLITCH-OR-NOT!

BY ERIC BRICKER MD

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MEDICAL RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Can electronic dental records survive the ransomware cure?

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By Darrell K. Pruitt DDS


Compared to hospitals, the business of dentistry is as simple as a lemonade stand. Dental practice management software is an option – not a necessity.

Thank goodness.

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Do Dentists Need To Comply With HIPAA?

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“Cyber Daily: Congress Inches Toward Response to Ransomware Attacks – U.S. legislators in the House and Senate have several bills in play that would put new requirements on companies [including dental offices] to report cyber incidents, including details about ransomware payments.”

WSJ.com, Oct. 11, 2021.
https://www.wsj.com/articles/cyber-daily-congress-inches-toward-response-to-ransomware-attacks-11633974966

As transparency makes it increasingly difficult for dentists to hide ransomware breaches from their patients by quietly paying the ransom (one or more times), paper dental records remain the gold standard of security. Practice management software is not only more expensive than paper records, but it vastly increases patients’ risk of identity theft while offering them NO TANGIBLE BENEFITS… Just ask anyone.

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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