The ME-P is Seeking Healthcare “Metaverse” Input

By Ann Miller RN MHA

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Facebook’s latest release, Meta, is said to be the next evolution of social connection. A virtual, 3D network that allows connection and collaboration in ways many of us have never even considered! And while many are buzzing over how Meta will shape everything from education to healthcare – we are eager to get your opinion on our own ME-P ecosystem.

Can patients trust Facebook and others again?

Are you interested in exploring a new platform for connection?

Have you subscribed to the ME-P?

We want to hear all about it! We’re actively collaborating to bring your perspectives to the discussion around the Metaverse and the patient, economics, finance and healthcare community.

If you have insights or experiences to share – just comment and/or let us know.

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THANK YOU

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UPDATE: Oil & Energy Prices

By Staff Reporters

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  • West Texas Intermediate crude for May delivery rose $3.58, or 3.4%, to settle at $107.82 a barrel on the New York Mercantile Exchange after posting a loss of 1.6%.
  • May Brent crude the global benchmark, rose $3.22, or 2.9%, to $113.45 a barrel on ICE Futures Europe, following a 2% loss.
  • May natural gas rose 5.2% to $5.605 per million British thermal units.
  • April gasoline  rose 3.8% to $3.325 a gallon and April heating oil climbed 2.5% to $3.809 a gallon.

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Hospital Finance 101

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A basic understanding of hospital finance is crucial as leaders continue to create policy that shapes healthcare financing. This updated 30,000-foot view of hospital finance is intended to shed some light on the complex system.

By The Center for Health Affairs

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CITE: https://www.r2library.com/Resource/Title/082610254

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What is Tactical Portfolio Management?

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Re-Thinking Strategic Allocation

[By Dr. David Edward Marcinko MBA]

Dr. David E. Marcinko MBAMany successful physician investors, retirement account managers or endowment fund administrators will establish a “strategic” allocation policy that is intended to guide long-term (greater than one-year) investment decisions.

Thinking Long Term?

This strategic allocation reflects the endowment’s thinking regarding the existence of perceived fundamental shifts in the market. Most endowments will also establish a target range or band for each asset class. The day-to-day managers then have the flexibility to make tactical decisions for a given class so long as they stay within the target range.

Terms

The term “tactical” when used in the context of investment strategy refers to the investor or manager’s ability to take advantage of short-term (under one year) market anomalies such as pricing discrepancies between different sectors or across different styles.

Assessment

Historically, tactical decisions with respect to asset allocation were derided as “market timing.” However, market timing implies moving outside of the target ranges whereas tactical decision making simply addresses the opportunistic deployment of funds within the asset class target range.

So, what do you think?

Online MD investor

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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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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Happy NATIONAL DOCTOR’s Day 2022

By Staff Reporters

To all our valued physicians readers and subscribers

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You have always been the shield defending and healing patients in our communities. Now more than ever, you have become a guiding light through uncertainty as we navigate toward a brighter future.

This is our chance to thank you for your hard work and incredible impact!

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THANK YOU

Medical Executive-Post

CERTIFIED MEDICAL PLANNER™

http://www.CertifiedMedicalPlanner.org

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Obtain an ME-P Second Opinion Right Here!

 2nd Opinions

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iMBA, Inc., Consultations and Discussion Board

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Finally … it’s right here!

Link: http://www.medicalbusinessadvisors.com/forum-discussion.asp

Telephonic or electronic advice for medical professionals that is:

  • Objective, affordable, medically focused and personalized
  • Rendered by a prescreened financial consultant or medical management advisor
  • Offered on a pay-as-you-go basis, by phone or secure e-mail transmission.

2nd Opinions

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Typical Topics 

  • Financial Planning
  • Retirement Planning
  • Overhead Assessments
  • Income Distribution Models
  • Academic Funding Analyses
  • Insurance Planning
  • Risk Management
  • Practice Assessments
  • New Venture Business Plans
  • Hospital Based Contract Assessments
  • Practice Income Turnarounds
  • Estate Planning
  • Portfolio Analysis
  • Compensation Plans
  • Cost Accounting Implementation
  • Contract Subsidy Analyses
  • Practice Buy Sell Valuations
  • Investment Policy Statement Analysis
  • Interim Management
  • Contract Compliance Models
  • New Physician Projections
  • Productivity Measurements
  • Revenue Cycle Gap Analyses
  • Payer Rate Evaluations
  • Revenue Cycle Improvements
  • Compensation Benchmarking
  • Strategic Planning Models
  • HIT System Evaluations
  • Staffing Analyses
  • P4P – ACOs – Concierge Medicine
  • Annual Budget Development
  • Ancillary Service Modeling
  • New Practice Development
  • Medical Service Line Extensions
  • Markets, Sales and Advertising
  • Health PR and Medical Practice Crisis Management
  • Investment Management-product evaluation/selection/competitive analysis
    -investment research
    -asset allocation and risk management* Research (products, pensions, planning, risk)
    * Financial Planning (IPS process, solutions, segmentation)
    * New Product Development (pension, longevity insurance, risk management)
    * Management Consulting (effectiveness/efficiency assessment of the investment management process)* Advocacy (regulatory, pensions, new products)
    * Financial Education/Coaching (corporate, groups)

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[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

  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™

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[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

Product DetailsProduct Details

[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

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[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

Product Details

[Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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“Triple Entry Accounting”

What it is – How it works?

[By staff reporters]

The term “Triple Entry Accounting,” was first used by Ian Grigg, financial cryptographer, and described in his paper published in 2005, three years before the emergence of Bitcoin and its underlying Blockchain protocol.

Here is the original historical article on “Triple Entry Accounting” by Grigg:

LINK: https://nakamotoinstitute.org/triple-entry-accounting/

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

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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™

REAL ESTATE Investing for Physicians

SOME GUIDELINES FOR COLLEAGUES

Touring with Marcinko | The Leading Business Education ...

By Dr. David Edward Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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According to Rick Kahler MS CFP® ChFC CCIM [www.KahlerFinancial.com] real estate is one of the largest asset classes in the world. The family home is the largest asset many middle-class Americans own. And, real estate makes up a significant portion of the net worth of many wealth accumulators. Directly owning real estate is not an investment for the faint of heart, the armchair investor, or the uneducated. Most wealth accumulators would do well to leave direct ownership of real estate to the pros and invest in real estate investment trusts (REITs) instead [personal communication].

Still, as we have seen, the lure of investing in a tangible asset like real estate is enticing for high risk tolerant physician-investors who need a sense of control and interaction with their investments. If you are among them, here are a few guidelines that may keep you on a profitable path.

1. Don’t attempt to purchase investment real estate without the help of a commercial real estate specialist who is a fiduciary bound to look out for your best interest. Engage a Certified Commercial Investment Member (CCIM) with years of training and experience in analyzing and acquiring investment real estate. To find a CCIM near you, go to http://www.ccim.com.

2. You will sign a disclosure agreement that will tell you who the Realtor represents. Be sure the Realtor you engage represents you and not the seller, both parties, or neither party.

3. Never trust the income and expense data provided by the seller’s Realtor. While a seller represented by a CCIM will have a greater chance of supplying you with accurate data, most will significantly understate expenses and overstate the capitalization rate. Selling Realtors often understate the average annual cost of repairs and maintenance. I estimate this annual expense at 10%.

4. Another often understated expense is management. Many owners manage their own properties, so the selling broker doesn’t include an estimate for management expenses. They should. Real estate doesn’t manage itself, ever. You will either need to hire professional management or do your own management (always a scary proposition). Even if you do it yourself, you have an opportunity cost of your time, so you must include a management fee in the expenses. Most small residential apartments and single-family homes will pay 10% of their rents to a manager.

5. You must verify all the costs presented to you by the seller’s Realtor. Demand copies of at least the last three and preferably five years of tax returns. Research items like utility bills, property taxes, legal fees, insurance costs and repairs, maintenance costs, replacement reserves, tax preparation and all management fees. As a rule of thumb, expenses will average 40% of rental income on average-aged properties where the tenants pay all utilities except water. Newer properties may have expenses as low as 35%, while older properties can be as high as 50%.

6. By subtracting the vacancy rate and stabilized expenses from the rent, you will find the net operating income. This is the income you will put in your pocket—assuming the property is paid for. By dividing the net operating income by the purchase price, you will find the return you will receive on your investment, called the capitalization or “cap” rate. In Rapid City SD, for example, the cap rate tends to be 4% for single-family homes, 5% to 8% for duplexes to eight-plexes, and 8% to 12% for larger residential and commercial properties.

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

ASSESSMENT: Yes, physician-investors and all of us can build wealth with real estate. You just need to educate yourself, work hard, start conservatively, think long-term, and be prepared for lean years. This is not a quick or easy path to riches.

Your comments are appreciated.

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What is a Medical OBL?

Office Based Laboratories

By Health Capital Consultants, LLC

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DEFINITION: OBLs, also known as office-based endovascular centers, access centers, or office interventional suites, are physician offices wherein a number of services are offered.

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

Similar to ASCs, OBLs can be single specialty or multi-specialty and can have a number of ownership structures. However, unlike ASCs, OBL procedures (because they are located in a physician office) are reimbursed under the Medicare Physician Fee Schedule.

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OBLs are typically operated and utilized by vascular surgeons, interventional radiologists, cardiologists, or other specialists, and services provided include: cardiovascular, endovascular, venous, and non-vascular services; cardiac procedures, such as diagnostic coronary angiograms, coronary stenting, electro physiology services; device implants, including pacemakers, defibrillators, loop recorders, and biventricular pacers; lower extremity endovascular revascularizations, such as chronic total occlusion and complex limb salvage procedures; renal and mesenteric revascularizations; and, subclavian stenting.23 Of these procedures, peripheral vascular intervention, cardiac services, and interventional radiology made up the majority of the OBL market share in 2019.

While slower to materialize than ASCs, OBLs have increased rapidly over the past few years, for reasons similar to ASCs, e.g., opportunities for physician ownership, the “expedient patient experience” and “favorable outpatient procedural reimbursement.”

In 2020, the global OBL market was valued at $9 billion. Similar to ASCs, an increasing focus on outpatient procedures (due to their cost-saving potential)

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What is “Shelf Registration” for Securities?

What is “Shelf Registration” for Securities?

By Dr. David E. Marcinko MBA CMP™

http://www.CertifiedMedicalPlanner.org

A relatively new method of registration under the Act of ’33 is known as shelf registration.

Under this rule, an issuer may register any amount of securities that, at the time the registration statement becomes effective, is reasonably expected to be offered and sold within two years of the initial effective date of the registration.

Once registered, the securities may be sold continuously or periodically within 2 years without any waiting period for a registration to clear issuers generally like shelf registration because of the flexibility it gives them to take advantage of changing market conditions.

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

In addition, the legal, accounting, and printing costs involved in issuance are reduced, since a single registration statement suffices for multiple offerings within the 2 year period. In effect, what the issuer does is register securities that will meet its financing needs for the next 2 years.

It issues what it needs at the current time, and puts the balance on the “shelf” to be taken off the shelf as needed.

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

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

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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™

Invite Dr. Marcinko

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PODCAST: How to be a DEBT FREE Direct Primary Care Physician?

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DEFINITION: The DPC model was created to allow for a singular focus upon the Primary Care Physician-2-Patient relationship. To achieve this, DPC removes the hassles and overhead expenses created by insurance and replaces it with a fixed monthly membership fee. This simplified approach frees the physician from meaningless paperwork and allows them to only see 8-10 patients a day. This level of personalized engagement allows them to develop a meaningful and enduring relationship with each patient.

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

By James Hawkes MD

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Dr. James Hawkes grew up in a large family. His father was a U.S. diplomat, which exposed him to different models of healthcare. In addition to exposure, his grandmother encouraged him to become a doctor. He followed her recommendation but to his surprise, the definition of a good doctor wasn’t about improving patients’ quality of life it was about hierarchies, documentation, administrative requirements, and quality measures. 

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Shortly after saying goodbye to the traditional healthcare model, he launched his own direct care practice. Fast forward to today, he is a 100% debt-free direct care physician. He shares his story of how it’s possible to achieve this goal.

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PODCAST: https://healthcareamericana.com/episode/how-to-become-a-debt-free-direct-care-physician/

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Dr. Dave Marcinko at YOUR Service in 2022

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Book Marcinko for your Next Financial Planning Seminar, Meeting or Medical Business Event 

By Ann Miller RN MHA

Professor and physician executive David Edward Marcinko MBBS DPM MBA MEd BSc CMP® is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; Oglethorpe University, and Atlanta Hospital & Medical Center in GA; and the Aachen City University Hospital, Koln-Germany. He is one of the most innovative global thought leaders in health care business and entrepreneurship today.

Dr. Marcinko is a multi-degreed educator, board certified physician, surgical fellow, hospital medical staff President, Chief Education Officer and philanthropist with more than 400 published papers; 5,150 op-ed pieces and over 125+ international presentations to his credit; including the top 10 biggest pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

Dr. 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 2001. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, management and trade publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News].

As a licensed insurance agent, RIA and SEC registered endowment fund manager, Dr. Marcinko is Founding Dean of the fiduciary focused CERTIFIED MEDICAL PLANNER® chartered designation education program; as well as Chief Editor of the HEALTH DICTIONARY SERIES® Wiki Project. His professional memberships include: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA and HIMSS.

Dr. Marcinko is a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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The IRS, Taxation and Virtual Currency!

New Reporting Warning Issued

By Staff Reporters

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Virtual currency transactions are taxable by law just like transactions in any other property. Taxpayers transacting in virtual currency may have to report those transactions on their tax returns.

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

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All taxpayers must answer a question about virtual currency on their return.

On March 18th, the IRS issued a new alert warning all taxpayers that they must answer a section about virtual currency on their 2021 tax refund this year, even if they did not deal with any digital transactions. According to the agency, there is a question on the top of all versions of Form 1040 that asks, “At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency?”

“All taxpayers filing Form 1040, Form 1040-SR or Form 1040-NR must check one box answering either ‘Yes’ or ‘No’ to the virtual currency question,” the IRS explained. “The question must be answered by all taxpayers, not just taxpayers who engaged in a transaction involving virtual currency in 2021.”

IRS: https://www.irs.gov/businesses/small-businesses-self-employed/virtual-currencies

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EMRs = To Laugh OR Cry?

SAD

[By staff reporters]

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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.

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

Product Details

 

What is the SELLING AWAY of Securities?

Information All Physician Investors Should Know

By Dr. David Edward Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

According to Wikipedia, selling away in the U.S. securities brokerage industry is the inappropriate practice of an investment professional who sells, or solicits the sale of, securities not held or offered by the brokerage firm with which he is associated.

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

An example of the term expressed in a sentence is, “The broker was selling investments away from the firm.” Brokers marketing securities must have obtained the appropriate securities licenses for various types of investments. Brokers in the U.S. may be “associated” with one or more Brokerage firms and must obtain licenses by passing standardized Financial Industry Regulatory Authority exams such as the Series 6 or Series 7 exam.

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In the past I’ve held these as well as a Series 63 and 65 license [SEC].

CFI: https://corporatefinanceinstitute.com/resources/knowledge/trading-investing/selling-away/

YOUR COMMENTS ARE APPRECIATED.

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UPDATE: The Markets, Treasury Yields, Ukraine & the Week Ahead

By Staff Reporters

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  • Markets: US stocks rose for two straight weeks. Investors appear to be putting more emphasis on strong corporate earnings than all the uncertainty around the war in Ukraine and inflation.
  • Treasury: Yields climbed (in anticipation of higher interest rates), giving a lift to financial stocks.
  • Ukraine: Top Russian military officials signaled a change in approach to the war. They spoke about the “complete liberation” of the Donbas region in eastern Ukraine, which means Russia could potentially be pivoting from its initial goal of taking Ukraine’s biggest cities and toppling its government.
  • EARNING REPORTS THIS WEEK:
  • Monday: Earnings from Dave & Buster’s.
  • Tuesday: US consumer confidence; US Job Openings and Labor Turnover (JOLTS); earnings from Micron, Chewy, Lululemon and RH.
  • Wednesday: US ADP jobs report; US GDP for Q4 (third estimate); weekly crude oil inventories; earnings from BioNTech and Paychex.
  • Thursday: End of first quarter; US personal income and spending; US weekly jobless claims: earnings from Walgreens and Blackberry.
  • Friday: US jobs report; US ISM manufacturing.

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What are OTC “PINK” Sheets?

LOW PRICED “PENNY STOCKS?

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

Pink sheets are an over-the-counter (OTC) market that connects broker-dealers electronically. There is no trading floor and the quotations are also all done electronically. Since there is no central trading floor or stock exchange like the New York Stock Exchange (NYSE), the pink sheet-listed companies do not have the same criteria to fulfill as the companies listed on national stock exchanges. Many stocks listed on the pink sheets are low-priced penny stocks that trade for under $5 a share.

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

Pink sheets got their name because the original pink sheets listing the stocks were actually printed and distributed on pink pieces of paper. Trading over-the-counter (OTC) refers to the process of how securities listed on the pink sheets are traded through a broker-dealer network.

MORE: https://en.wikipedia.org/wiki/OTC_Markets_Group

Pink Sheets | Explanation | Examples with Advantages and Disadvantages

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DOJ Recoveries for False Claims Act Cases Doubled in 2021

BY HEALTH CAPITAL CONSULTANTS, LLC.

DEFINITION: The False Claims Act, also called the “Lincoln Law”, is an American federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal Government’s primary litigation tool in combating fraud against the Government. The law includes a provision that allows people who are not affiliated with the government, called “relators” under the law, to file actions on behalf of the government. Persons filing under the Act stand to receive a portion of any recovered damages.

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

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DOJ Recoveries for False Claims Act Cases Doubled in 2021

On February 1, 2022, the U.S. Department of Justice (DOJ) announced their recovery of $5.6 billion in settlements and judgments from civil cases involving fraud and false claims for fiscal year (FY) 2021. Over $5 billion was recouped from the healthcare industry for federal losses alone, and included recoveries from drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

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This figure is more than double the amount of healthcare-related recoveries secured in FY 2020, which totaled $1.8 billion. (Read more…)

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Socially Responsible and ESG Investing!

S.R.I.

[By Rick Kahler CFP®]

The concept of socially responsible investing is far from new; the first SRI fund appeared in 1952. Since then, these funds have used social and ethical screens to exclude companies selling products like tobacco, alcohol, or firearms.

You may not have heard of the next generation of SRI funds, called ESG funds, which means environmental, social and governance funds. Social responsibility is just one-third of the expanded focus of these funds, which also look to include companies that are sensitive to the environment and have more holistic corporate governance.

Updates

In recent years, ESG investing has exploded. According to a July 11, 2018, article in Forbes, The Remarkable Rise of ESG, by Georg Kell, over $20 trillion is invested in ESG funds. This accounts for 25% of all the professionally managed assets in the world. There are currently 275 ESG mutual funds and ETF’s from which to choose.

Yet one facet of investing in ESG funds is widely misunderstood. While ESG investing may help you feel better about yourself, it does not actually impact or hamper the companies you choose not to own.

This may come as a surprise to many ESG investors, who commonly believe that by not owning the shares of an offensive company they are restricting the flow of capital to that company, thereby imperiling its existence. For the most part, that isn’t the case.

The offenders

Listed among the worst offending companies by several ESG organizations are Philip Morris, WalMart, Tyson Foods, Pepsi Corporation, Coca-Cola, and Chevron. No dedicated ESG investors would have these companies in their portfolios. None of these companies would care or be hurt in the least if you didn’t own any of their shares.

Why?

The only time a company benefits from a sale of stock is when the company initially goes public (called an initial public offering, or IPO) or issues additional new shares to raise capital. These are actually fairly rare events.

Most stocks are bought and sold in the “secondary” market through exchanges like the New York Stock Exchange. These platforms facilitate transactions between individuals or institutions wanting to buy or sell shares in a company. The money moves between the buyer and the seller; none of the money goes to the company.

Another way companies receive funding to support their ventures is to borrow money from investors. This is called issuing a bond and is similar to an IPO, only the investor receives a promise from the company to pay them back at some future date and receives interest on the loan in the meantime.

Just like stocks, bonds are only issued by a company once. From then on, buying and selling bonds is done on the open market, and none of the money paid or received goes to the company.

So if you want to punish a company, don’t buy stocks or bonds it issues directly. Otherwise, excluding its shares from your portfolio has no effect on the company’s profits or cash flow.

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Assessment

But if no one bought a company’s shares on the secondary market, wouldn’t that have an impact? Yes, it most certainly would. If the demand for the shares of a company dried up, the company’s stock price would plummet.

The problem is the demand for the shares of these companies isn’t going away as long as they remain profitable. If 25% of investors purchase ESG funds,  that leaves 75% of the market willing to buy these companies. This includes the 20% of stocks owned by passive index funds, which own the entire market.

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

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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™

What is the VIP [Patient] Syndrome

VERY IMPORTANT PERSONS

By Dr. David Edward Marcinko MBA

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VERY IMPORTANT PATIENTS

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DEFINITION: “VIP syndrome” is a term coined in 1964 by the psychiatrist Walter Weintraub to describe an intriguing paradox: Throughout history, the rich and famous, with all their resources and fancy doctors, have often received worse medical treatment, and suffered from worse health outcomes, than the average person. When physicians afford “special privileges” to their powerful patients, from “Mad King” George III to Michael Jackson, they seem to get sicker and even die. While Weintraub, a psychoanalyst, attributed the problem in part to doctors unconsciously resenting their influential patients, it seems doctors simply get starstruck around famous people and high-ranking figures. Despite their medical expertise, these physicians find themselves opting out of basic tests for “privacy” or prescribing dangerous medications for “comfort.”

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

RELATED: https://journal.chestnet.org/article/S0012-3692(16)37268-3/fulltext

MORE: https://www.msn.com/en-us/health/medical/an-easy-treatment-promised-me-a-sharper-jawline%e2%80%94except-for-one-little-catch/ar-AAVpHz9?li=BBnb7Kz\

DKE: https://medicalexecutivepost.com/2018/09/14/what-is-the-dunning-kruger-effect/?preview_id=188020&preview_nonce=b5c7f4a5de&preview=true

INVITATION: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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The TOP 100 Digital Health Companies

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See the source image

There are a zillion digital health companies on the market, each praising their own solution/product as they can. It is up to the market to decide if these are any good. But how would patients, hospital systems, clinics or even investors decide on their added value? With the help of experts.

It is the 4th time we collect The TOP100 Digital Health Companies. A curated list of the best companies of the thousands we encounter while doing our work at The Medical Futurist. Of them, we chose a hundred that represent the following key values: mindset for innovation, truly disruptive technology, viable business model and a clear dedication to digital health.

Take care,
Berci
Bertalan Meskó, MD
The Medical Futurist

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UPDATE: The SAFE Banking Act

By Staff Reporters

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The SAFE Banking Act: Would allow marijuana [pot] shops to convert from cash transactions to digital exchanges potentially reducing the amount of armed robberies.

LINK: https://www.congress.gov/bill/117th-congress/house-bill/1996

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MEDICAL ETHICS: Managing Risk is a Component of Real Health Caring

Demanding High Moral Standards of Self … and Economic HEALTHCARE Organizations

Dr. David Edward Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy. 

Experts Speak

In his book Medicine at the Crossroads, colleague and Emory University professor Melvin Konnor, MD noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He lays significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” 

In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.

Evolution

In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.  While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar. 

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.” 

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.  Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. 

Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise”. 

ASSESSMENT

Health care is indeed grounded in caring. And, managing risk is a component of caring. It arises from a sympathetic response to the suffering of others.

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STOP-LOSS Health Insurance?

What is stop-loss insurance AND how does it work?

By Staff Reporters

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A stop-loss health insurance policy covers claims above a health insurance plan’s retained claims. The claims fund of a self-funded employer will pay claims up to the predetermined deductible for each of the company’s covered employees. The role of the stop-loss is to cover all claims above these deductible levels.

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

According to RoundStone Insurance, aggregate stop-loss insurance is designed to protect an employer who self-funds their employee health plan from higher-than-anticipated payouts for claims. Stop-loss insurance is similar to high-deductible insurance, and the employer remains responsible for claims below the deductible amount.

An individual stop-loss insurance carrier determines the average expected monthly claims per employee / per month PEPM based on the employer’s history. Then, this figure is multiplied by a percentage ranging from 110%-150%. That determined amount is then multiplied by the enrollment on a monthly basis to establish the aggregate deductible.

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The College Degree [Mortality] Advantage

By the NBER

Working Paper 29328), Anne Case and Angus Deaton

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The Persistent Mortality Advantage of a College Degree
In 2019, Americans with a four-year college degree had six years greater life expectancy at age 25 than those without a degree. These educational differences in mortality have been growing in recent decades and are apparent across demographic groups. In Mortality Rates by College Degree before and during COVID-19 (NBER Working Paper 29328), Anne Case and Angus Deaton explore the evolution of these differences during the pandemic.

If every American faced an equal threat of infection and death from COVID-19, then the mortality gap between more and less educated individuals would have narrowed during the pandemic. However, the risks from COVID-19 were plausibly greater for those without a college degree for a variety of reasons. For example, people without college degrees disproportionately work in occupations where working from home to avoid infection is not feasible. They are more likely to use public transportation and to live in crowded housing arrangements, heightening their risk of exposure. Conditional on infection, less educated individuals may experience worse outcomes due to higher average rates of pre-existing conditions and poorer access to health care.

Using provisional mortality data from the National Center for Health Statistics, the researchers determine that a college degree was protective against mortality during the calendar year 2020, which encompassed the first nine months of the pandemic. They express the mortality advantage of a college degree using the ratio of the mortality rate for those without a four-year college degree to the rate for those with a degree. The researchers calculate these ratios for 60 different demographic groups, identified by two genders, five age groups, and six racial/ethnic categories (Hispanic, non-Hispanic White, non-Hispanic Black, Asian, American Indian/Alaskan Native, and those who report two or more races).

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The Bulletin on Health summarizes selected recent NBER Working Papers. It is distributed digitally to economists and other interested persons for informational and discussion purposes. The Bulletin is not copyrighted and may be reproduced freely with attribution of source.

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The Bulletin on Health is edited by Robin McKnight
  Across all demographic groups, the ratios were all above one in 2020, reflecting higher mortality rates for those without college degrees. The ratios were highest for younger age groups: in the 25 to 39 age group, mortality rates for those without college degrees were as much as seven times the rates for those with college degrees. The researchers argue that the association between education and mortality is concentrated among preventable deaths, which are more prevalent causes of death among younger adults. In addition, older Americans are more likely to be retired, so additional risks that less educated workers faced due to occupational differences were less relevant for older age groups.

The overall finding that those without college degrees were at greater risk of death during the pandemic may not seem surprising, given their differential risks of infection, higher rates of pre-existing conditions, and worse access to care. A more unexpected finding is that these differences in mortality risk, as reflected in the mortality ratio, were very similar to the differences in mortality risk in the year prior to the pandemic. The figure, which plots the ratios for each demographic group in 2019 and in 2020, shows that the mortality advantage of a college degree was little changed during the pandemic relative to the prior year.

The figure highlights a few exceptions to this pattern. For Hispanic women aged 25 to 64 and for non-Hispanic American Indian/Alaskan Native women aged 25 to 39, the mortality advantage of a college degree was substantially higher in 2020 than in 2019. But for most demographic groups, the mortality ratios during the pandemic were strikingly similar to those before the pandemic. In fact, for over half of the demographic groups, the ratio was slightly lower in 2020 than in 2019.

The results suggest that the mortality advantage of a college degree during the pandemic was a continuation of pre-existing health differentials between those with and without college degrees. “The mystery,” the researchers conclude, “is not why the [college degree] was protective during the pandemic, but why the effect was proportionately as large before the pandemic.”

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PENSION PLANS: Defined Benefit V. Defined Contribution Types

KNOW THE DIFFERENCE

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Defined Benefit Pension Plan

A defined benefit (DB) pension plan is a type of pension plan in which an employer/sponsor promises a specified pension payment, lump-sum or combination thereof on retirement that is predetermined by a formula based on the employee’s earnings history, tenure of service and age, rather than depending directly on individual investment returns. Traditionally, many governmental and public entities, as well as a large number of corporations, provide defined benefit plans, sometimes as a means of compensating workers in lieu of increased pay.

Defined Contribution Pension Plan

A defined contribution (DC) plan is a type of retirement plan in which the employer, employee or both make contributions on a regular basis. Individual accounts are set up for participants and benefits are based on the amounts credited to these accounts (through employee contributions and, if applicable, employer contributions) plus any investment earnings on the money in the account. In defined contribution plans, future benefits fluctuate on the basis of investment earnings. The most common type of defined contribution plan is a savings and thrift plan. Under this type of plan, the employee contributes a predetermined portion of his or her earnings (usually pretax) to an individual account, all or part of which is matched by the employer.

CITE: Wilipedia

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

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UPDATE: Bitcoin, Retail Sales, ONS and Consumer Confidence

By Staff Reporters

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Bitcoin: Rallied 2% after Russia said it would begin accepting it as payment for oil and natural gas.

Retail Sales: Fell and consumer confidence is at its lowest level in 16 months amid the recent surge in living costs.

Office for National Statistics: Reported an unexpected 0.3% decline in retail sales volumes for February, although some of this weakness reflected a drop in food sales as more people went out to pubs and restaurants.

Consumer Confidence: Continues to deteriorate after GfK reported the worst reading since November 2020 as households face up to 30-year-high levels of inflation, record fuel and food prices and a recent interest rate hike.

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What is an “Inverse” ETF?

WHAT IT IS – HOW IT WORKS

Traditional ETFs: https://medicalexecutivepost.com/2008/01/07/exchange-traded-funds-etfs/

Tax and ETFs: https://medicalexecutivepost.com/2008/01/11/etfs-and-tax-efficiency/

INVERSE DEFINITION:

An inverse exchange-traded fund is an exchange-traded fund, traded on a public stock market, which is designed to perform as the inverse of whatever index or benchmark it is designed to track. These funds work by using short selling, trading derivatives such as futures contracts, and other leveraged investment techniques.

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

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How Inverse ETFs Can Help And Hurt You

READ: https://smartasset.com/investing/inverse-etf

RELATED: https://smartasset.com/investing/what-is-a-leveraged-etf

ASSESSMENT: Your comments and thoughts are appreciated.

THANK YOU

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PODCAST: The Successful Quest Diagnostics Employee Health Plan Cost Reduction Case-Report

By Eric Bricker MD

Their 8 Point Strategy Included: 1) CDHP, 2) Centers-of-Excellence, 3) Narrow Network, 4) Rx Formulary Changes, 5) Spousal Surcharge, 6) COBRA Members to the Exchange, 7) 2nd Opinion Program … AND 8) Moved Health Plan Control from HR to a Chief Medical Officer AND Kept a Short Leash on their ASO Carrier.

CITE: https://www.r2library.com/Resource/Title/082610254

Special Thanks to Dr. Steven Goldberg for Publishing His Company’s Experience in an Academic Journal.

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The Hemline Stock Market Index

What’s Up?

[By staff reporters]

According to Wikipedia, 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.

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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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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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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 A “CLOSED-END” MUTUAL FUND

ON OPEN AND CLOSED MUTUAL FUNDS

By staff reporters

A closed-end fund (CEF) or closed-ended fund is a collective investment model based on issuing a fixed number of shares which are not redeemable from the fund.

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

Unlike open-end funds, new shares in a closed-end fund are not created by managers to meet demand from investors. Instead, the shares can be purchased and sold only in the market, which is the original design of the mutual fund, which predates open-end mutual funds but offers the same actively-managed pooled investments.

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BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS

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

TEXT: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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Primary Care Physician Estimated Career Turn-Over Per Year

By Staff Reporters

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 •  General internal medicine: 4370 (4% of this workforce)
 •  Family medicine: 3624 (3% of this workforce)
 •  General pediatrics: 1320 (2% of this workforce)
 •  Obstetrics/gynecology: 1563 (4% of this workforce)
 •  Geriatrics: 149 (3% of this workforce)
 •  Preventive medicine: 93 (2% of this workforce)

Source: Mayo Clinic Proceedings, “Health Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional Analysis,” February 25, 2022

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Are Target Date Mutual Funds a Good Choice?

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An Easy Answer to Retirement Planning -or- MisStep?

By David Wallace [Search and social media marketer from Anthem, Arizona]

Investing in a target date mutual fund seems like the easy answer to retirement planning.

But, how can a single fund be appropriate for thousands of investors, doctors and medical professionals?

Assessment

Check out the above infographic to see the limitations of target date funds.

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.

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

Product DetailsProduct DetailsProduct Details

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PODCAST: Primary Medical Care: US versus Other Countries

By Eric Bricker MD

The Commonwealth Fund Released a Study in March 2022 Comparing Primary Care in the United States to Other Industrialized Countries.

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ETFs and Tax Efficiency

Join Our Mailing List

A Better Financial Product than Mutual Funds?

[By JD Steinhilber]

Exchange-traded funds are inherently more tax efficient than actively managed mutual funds, which have been rightly criticized for their tax-inefficiency. Tax-efficiency is a critical issue for financial advisors and physician-investors because delaying the taxation of appreciating assets normally enhances after-tax returns over time.

For example, it is estimated that between 1994 and 1999, investors in diversified U.S. stock mutual funds lost, on average, 15% of their annual gains to taxes. The tax inefficiency of mutual funds is the result of portfolio turnover at the fund level caused by two factors: the trading activity of the portfolio manager and the activity of other shareholders in the fund.       

The Mutual Fund Performance / Redemption Problem

Due to fund manager efforts to outperform benchmarks, actively managed mutual funds almost invariably experience more “manager-driven” portfolio turnover than ETFs, where trading is generally driven by change in the composition of the underlying indexes being replicated. Mutual fund portfolio turnover can also be caused by the actions of shareholders in the fund. 

In a mutual fund structure, redemption requests by shareholders can force the fund to sell securities to raise cash. These sales may give rise to gains that, by law, must be distributed and will be taxed to all shareholders in the fund.

Unique Architectural Structure

ETFs, in contrast, are structured in such a way that the actions of one shareholder do not result in tax consequences to another shareholder.  ETFs accomplish this through the innovative architecture in which ETF “units” (which are subdivided into individual ETF shares) are created and redeemed to accommodate the fluctuating demand for the shares of a particular ETF.

ETF units are created and redeemed by institutional investors though non-taxable, “in-kind” transactions, which means that only securities – not cash – change hands in the creation and redemption process. 

An example of this process would be an institution exchanging a portfolio of stocks constituting the S&P 500 index for an S&P 500 ETF “creation unit”. And, once created, the S&P 500 ETF can be subdivided into individual shares that are tradable by investors on the exchange.   

Assessment

As a result of the above – physicians may be insulated from a tax standpoint by the actions of other investors – because taxable transactions don’t take place at the fund level.  Instead, ETF shares are traded between retail investors in transactions on the exchanges, so the tax accounting becomes very similar to that associated with individual stocks.    

Have you used ETFs in your own portfolio, and what is your tax efficiency experience with them; truth or hype? 

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:

Product Details

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

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General Obligation and Revenue Bonds

Understanding GOs and RBs

[By Staff Writers]fp-book2

General obligation bonds are secured by the taxing authority and are therefore considered safer than other municipals. The full faith and credit of the municipality ensures prompt payment of principal and interest.

Further more, most municipal bonds, including city, county, and school district issues, are secured by a pledge of unlimited property taxes (known as ad-valorem taxes), which further secures the bonds. If taxes are not paid, the property may be sold at a tax sale, at which the bondholder has a superior position.

Revenue bonds

Revenue bonds are payable from the earnings of a revenue-generating facility, such as water, sewers, or utility systems, toll bridges, or airports. The risk, however, is that the facility will not generate income sufficient to pay the interest, and therefore the yield is somewhat higher than for a general-obligation bond.

Revenue bonds are supported only by the revenue earned, so if the project does not produce revenues sufficient to pay the interest on the bonds, then the bonds go into default. Therefore, it is important to properly evaluate the municipality’s ability to tax and/or the assumptions used to project the facility’s revenue.

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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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:

LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

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Medicare Customers Say Mental Health Benefits Are Very Important

By Staff Reporters

AN eHEALTH SURVEY

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A eHealth survey of 3,800 Medicare customers aged 65 and older asked “When choosing health coverage, how important are mental health benefits?” The survey found: 
•  38% say mental health benefits are “very important” to them when choosing health insurance.
 •  34% say it’s “somewhat important” to them.
 •  22% say mental health benefits are “not so important” to them.
 •  Only 5% say it’s “not at all important.”
Source: eHealth, “Seniors Speak Out On Mental Health,” March 2022

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Understanding Municipal Bond Underwriting

A Primer for Physician Investors

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

While the underwriting procedures for corporate bonds are almost identical to corporate stock, there are significant differences in the underwriting of municipal securities. Municipal securities – hospitals for example – are exempt from the registration filing requirements or the Securities Act of 1933. A state or local government, in the issuance of municipal securities, is not required to register the offering with the SEC, so there is no filing of a registration statement and there is no prospectus which would otherwise have to be given to investors.

Municipal Underwriting

There are two main methods of financing when it comes to municipal securities. One method is known as negotiated. In the case of a negotiated sale, the municipality looking to borrow money would approach an investment bank and negotiate the terms of the offering directly with the firm. This is really not very different from the equity process.

Competitive Bidding

The other type of municipal underwriting is known as competitive bidding. Under the terms of competitive bidding, an issuer announces that it wishes to borrow money and is looking for syndicates to submit competitive bids. The issue will then be sold to the syndicate which submits the best bid, resulting in the municipality having the lowest net interest cost (lowest expense to the issuer).

If the issue is to be done by a competitive bid, the municipality will use a Notice of Sale to announce that fact. The notice of sale will generally include most or all of the following information.

  • Date, time, and place. This does not mean when the bonds will be sold to the public, but when the issue will be awarded (sold) to the syndicate issuing the bid.
  • Description of the issue and the manner in which the bid is to be made (sealed bid or oral).
  • Type of bond (general obligation, revenue, etc.)
  • Semi-annual interest payment dates and the denominations in which the bonds will be printed.
  • Amount of good faith deposit required, if any.
  • Name of the law firm providing the legal opinion and where to acquire a bid form.
  • The basis upon which the bid will be awarded, generally the lowest net interest cost.

The Bond Attorney

Since municipal securities are not registered with the SEC, the municipality must hire a law firm in order to make sure that they are issuing the securities in compliance with all state, local and federal laws. This is known as the bond attorney, or independent bond counsel. Some functions are included below:

  1. Establishes the exemption from federal income tax by verifying requirements for the exemption.
  2. Determines proper authority for the bond issuance.
  3. Identifies and monitors proper issuance procedures.
  4. Examines the physical bond certificates to make sure that they are proper
  5. Issues the debt and a legal opinion, since municipal bonds are the only securities that require an opinion.
  6. Does not prepare the official statement.

When medical or other investors purchase new issue municipal securities from syndicate or selling group members, there is no prospectus to be delivered to investors, but there is a document which is provided to purchasers very similar in nature to a prospectus. It is known as an Official Statement. The Official Statement contains all of the information an investor needs to make a prudent decision regarding a proposed municipal bond purchase.

Underwriting Syndicate

The formation of a municipal underwriting syndicate is very similar to that for a corporate issue. When there is a negotiated underwriting, an Agreement Among Underwriters (AAU) is used. When the issue is competitive bid, the agreement is known as a Syndicate Letter. In the syndicate letter, the managing underwriter details all of the underwriting agreements among members of the syndicate. Eastern (undivided) and Western (divided) accounts are also used, but there are several different types of orders in a municipal underwriting.

Order Types

The traditional types of orders, in priority order, are:

  • Pre-Sale Order: Made before the syndicate actually offers the bonds. They have first priority over any other order turned in.
  • Syndicate (group net) Order: Made once the offering is under way at the public offering price. The purchase is credited to each syndicate member in proportion to its allotment. An institutional buyer will frequently purchase” group net”, since many of the firms in the syndicate may consider this buyer to be their client and he wishes to please all of them.
  • Designated Order: Sales to medical investors (usually healthcare institutions) at the public offering price where the investor designates which member or members of the syndicate are to be given credit.
  • Member Orders: Purchased by members of the syndicate at the take-down price (spread). The syndicate member keeps the full take-down if the bonds are sold to investors, or earns the take-down less the concession if the sale is made to a member of the selling group. Should the offering be over-subscribed, and the demand for the new bonds exceeds the supply, the first orders to be filled are the pre-sale orders. Those are followed by the syndicate (sometimes called group net) orders, the designated orders, and the last orders filled are the member’s.

Assessment

Finally, be aware that the term bond scale is a listing of coupon rates, maturity dates, and yield or price at which the syndicate is re-offering the bonds to the public. The scale is usually found in the center of a tombstone ad and on the front cover of the official statement. One of the reasons why the word “scale” is used – is that like the scale on a piano – it normally goes up. A regular or positive scale is one in which the yield to maturity is lowest on the near term maturities and highest on the long term maturities. This is also known as a positive yield curve, since the longer the maturity, the higher the yield. In times of very tight money, such as in 1980-81, one might find a bond offering with a negative scale. A negative (sometimes called inverted) scale is just the opposite of a positive one, with, yields on the short term maturities are higher than those on the long term maturities.

http://www.amazon.com/Financial-Planning-Handbook-Physicians-Advisors/dp/0763745790/ref=sr_1_1?ie=UTF8&s=books&qid=1276795609&sr=1-1 

Conclusion

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

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PODCAST: The Healthcare Price versus Quality Disconnect

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What is Risk Adjusted Stock Market Performance?

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Update on Some Interesting and Important Financial Calculations

By Timothy J. McIntosh MBA CFP® MPH

By Dr. David Edward Marcinko MBA CMP™

By Jeffery S. Coons PhD CFA

TMDr. Jeff Coons

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-INTRODUCTION-

Performance measurement, like an annual physical, is an important feedback loop to monitor progress towards the goals of the medical professional’s investment program.  Performance comparisons to market indices and/or peer groups are a useful part of this feedback loop, as long as they are considered in the context of the market environment and with the limitations of market index and manager database construction.

Inherent to performance comparisons is the reality that portfolios taking greater risk will tend to out-perform less risky investments during bullish phases of a market cycle, but are also more likely to under-perform during the bearish phase.  The reason for focusing on performance comparisons over a full market cycle is that the phases biasing results in favor of higher risk approaches can be balanced with less favorable environments for aggressive approaches to lessen/eliminate those biases.

So, as physicians and other investors, can we eliminate the biases of the market environment by adjusting performance for the risk assumed by the portfolio?  While several interesting calculations have been developed to measure risk-adjusted performance, the unfortunate answer is that the biases of the market environment still tend to have an impact even after adjusting returns for various measures of risk.

However, medical professionals and their advisors will have many different risk-adjusted return statistics presented to them, so understanding the Sharpe ratio, Treynor ratio, Jensen’s measure or alpha, Morningstar star ratings, etc. and their limitations should help to improve the decisions made from the performance measurement feedback loop.

[a] The Treynor Ratio

The Treynor ratio measures the excess return achieved over the risk free return per unit of systematic risk as identified by beta to the market portfolio.  In practice, the Treynor ratio is often calculated using the T-Bill return for the risk-free return and the S&P 500 for the market portfolio.

[b] The Sharpe Ratio

The Sharpe ratio, named after CAPM pioneer William F. Sharpe, was originally formulated by substituting the standard deviation of portfolio returns (i.e., systematic plus unsystematic risk) in the place of beta of the Treynor ratio.  Thus, a fully diversified portfolio with no unsystematic risk will have a Sharpe ratio equal to its Treynor ratio, while a less diversified portfolio may have significantly different Sharpe and Treynor ratios.

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8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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[c] The Jensen Alpha Measure

The Jensen measure, named after CAPM research Michael C. Jensen, takes advantage of the CAPM equation discussed in the Portfolio Management section to identify a statistically significant excess return or alpha of a portfolio.  The essential idea is that to investigate the performance of an investment manager you must look not only at the overall return of a portfolio, but also at the risk of that portfolio.

For instance, if there are two mutual funds that both have a 12 percent return, a lucid investor will want the fund that is less risky. Jensen’s gauge is one of the ways to help decide if a portfolio is earning the appropriate return for its level of risk. If the value is positive, then the portfolio is earning excess returns. In other words, a positive value for Jensen’s alpha means a fund manager has “beat the market” with his or her stock picking skills compared with the risk the manager has taken.

[d] Database Ratings

The ratings given to mutual funds by databases, such as Morningstar, and various financial magazines are another attempt to develop risk-adjusted return measures.  These ratings are generally based on a ranking system for funds calculated from return and risk statistics.

A popular example is Morningstar’s star ratings, representing a weighting of three, five and ten year risk/return ratings.  This measure uses a return score from cumulative excess monthly fund returns above T-Bills and a risk score derived from the cumulative monthly return below T-Bills, both of which are normalized by the average for the fund’s asset class.  These scores are then subtracted from each other and funds in the asset class are ranked on the difference.  The top 10 percent receive five stars, the next 22.5 percent get four stars, the subsequent 35 percent receive three stars, the next 22.5 percent receive two stars, and the remaining 10 percent get one star.

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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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Assessment

Unfortunately, these ratings systems tend to have the same problems of consistency and environmental bias seen in both non-risk adjusted comparisons over 3 and 5 year time periods and the other risk-adjusted return measures discussed above.  The bottom line on performance measurement is that the medical professional should not take the easy way out and accept independent comparisons, no matter how sophisticated, at face value.  Returning to our original rules-of-thumb, understanding the limitations of performance statistics is the key to using those statistics to monitor progress towards one’s goals.

This requires an understanding of performance numbers and comparisons in the context of the market environment and the composition/construction of the indices and peer group universes used as benchmarks.

Another important rule-of-thumb is to avoid projecting forward historical average returns, especially when it comes to strong performance in a bull market environment.  Much of an investment or manager’s performance may be environment-driven, and environments can change dramatically.

Channel Surfing

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ABOUT

Timothy J. McIntosh is Chief Investment Officer and founder of SIPCO.  As chairman of the firm’s investment committee, he oversees all aspects of major client accounts and serves as lead portfolio manager for the firm’s equity and bond portfolios. Mr. McIntosh was a Professor of Finance at Eckerd College from 1998 to 2008. He is the author of The Bear Market Survival Guide and the The Sector Strategist.  He is featured in publications like the Wall Street Journal, New York Times, USA Today, Investment Advisor, Fortune, MD News, Tampa Doctor’s Life, and The St. Petersburg Times.  He has been recognized as a Five Star Wealth Manager in Texas Monthly magazine; and continuously named as Medical Economics’ “Best Financial Advisors for Physicians since 2004.  And, he is a contributor to SeekingAlpha.com., a premier website of investment opinion. Mr. McIntosh earned a Bachelor of Science Degree in Economics from Florida State University; Master of Business Administration (M.B.A) degree from the University of Sarasota; Master of Public Health Degree (M.P.H) from the University of South Florida and is a CERTIFIED FINANCIAL PLANNER® practitioner. His previous experience includes employment with Blue Cross/Blue Shield of Florida, Enterprise Leasing Company, and the United States Army Military Intelligence.

Dr. Jeffrey S. Coons is the Co-Director of Research at Manning & Napier Advisors, Inc. with primary responsibilities focusing on the measurement and management of portfolio risk and return relative to client objectives.  This includes providing analysis across every aspect of the investment process, from objectives setting and asset allocation to on-going monitoring of portfolio risk and return.  Dr. Coons is also member of the Investment Policy Group, which establishes and monitors secular investment trends, macroeconomic overviews, and the investment disciplines of the firm. Dr. Coons holds a doctoral degree in economics from Temple University, graduated with distinction from the University of Rochester with a B.A. in Economics, holds the designation of Chartered Financial Analyst, and is one of the employee-owners of Manning and Napier.

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:

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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MENTAL ACCOUNTING: What is it?

By Dr. David E. Marcinko MBA CMP®

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DEFINITION: Mental accounting attempts to describe the process whereby people code, categorize and evaluate economic outcomes. The concept was first named by Richard Thaler. Mental accounting deals with the budgeting and categorization of expenditures. People budget money into mental accounts for expenses or expense categories

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

Mental Accounting is the act of bucketizing investments and then reviewing the performance of the individual buckets separately (e.g. investing at low savings rate while paying high credit card interest rates).

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Mental Accounting • Money is

Examples of mental accounting are: (1) matching costs to benefits (wanting to pay for vacation before taking it and getting paid for work after it was done, even though from perspective of time value of money the opposite should be preferred0, (2) aversion to debt (don’t like long-term debt for short-term benefit), (3) sunk-cost effect (illogically considering non-recoverable costs when making forward-going decisions).

In investing, treating buckets separately and ignoring interaction (correlations) induces people not to sell losers (even though they get tax benefits), prevent them from investing in the stock market because it is too risky in isolation (however much less so when looked at as part of the complete portfolio including other asset classes and labor income and occupied real estate), thus they “do not maximize the return for a given level of risk taken).

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Americans Feel Politicians Lost Touch With Public Health Care Needs

A SURVEY-POLL

By Staff Reporters

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A recent poll of 2,510 American adults by Ipsos found:

 •  87% of Americans feel politicians have lost touch with what the public needs from their health care.
 •  86% of Americans agree that Congress should focus on cracking down on abusive health insurance practices that make it harder for people to get the care they need.
 •  71% of Americans would rather see Congress focus more on reducing the overall costs of health care coverage such as premiums, deductibles, and co-pays.

Source: Ipsos, “Americans frustrated with insurance coverage and costs,” March 1, 2022

CDC: https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html

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Some Common Medical Practice Accounting Embezzlement Schemes

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Understanding How to Avoid Office Embezzlement – Old School

[By Dr. Gary L. Bode CPA, MSA]

Without proper internal accounting controls, a medical practice, clinic or any health entity would never reach peak efficiency or profitability. Internal controls designed and implemented by the practice physician-owner, help prevent bad things from happening.

Embezzlement protection is the classic example. However, internal controls also help ensure good things happen, at least most of the time. A procedural manual or text like: www.BusinessofMedicalPractice.com that teaches physicians how to deal effectively with, and avoid, common schemes is suggested.

Common Schemes

Here is a list of some embezzlement schemes to avoid; however it is imaginative and endless.

  • The physician-owner pocketing cash “off the books”. To the IRS, this is like embezzlement to intentionally defraud it out of tax money.
  • Employee’s pocketing cash from cash transactions.  This is why you see cashiers following protocol that seems to take forever when you’re in the grocery check out line. This is also why you see signs offering a reward if he/she is not offered a receipt. This is partly why security cameras are installed.
  • Bookkeepers writing checks to themselves.  This is easiest to do in flexible software programs like QuickBooks, Peachtree Accounting and financial software [www.Peachtree.com]. It is one of the hardest schemes to detect. The bookkeeper self-writes and cashes the check to their own name; and then the name on the check is changed in the software program to a vendor’s name.  So a real check exists which looks legitimate on checking statements unless a picture of it is available.
  • Employees ordering personal items on practice credit cards.
  • Bookkeepers receiving patient checks and illegally depositing them in an unauthorized, pseudo practice checking account, set up by themselves, in a bank different from yours. They then withdraw funds at will. If this scheme uses only a few patients, who are billed outside of the practice’s accounting software, this is hard to detect.  Executive-management must have a good knowledge of existing patients to catch the ones “missing” from practice records. Monitoring the bookkeeper’s lifestyle might raise suspicion, but this scheme is generally low profile, but protracted. Checking the accounting software “audit trail”, this shows the required original invoice deletions or credit memos in a less sophisticated version of this scheme.
  • Bookkeepers writing payroll checks to non-existent employees. This scheme works well in larger practices and medical clinics with high seasonal turnover of employees, and practices with multiple locations the physician-owner doesn’t visit often.
  • Bookkeepers writing inflated checks to existing employees, vendors or subcontractors. Physician-owners should beware if romantic relationships between the bookkeeper and other practice related parties.
  • Bookkeepers writing checks to false vendors. This is another low profile, protracted scheme that exploits the physician-owner’s indifference to accounts payable.

Assessment

Operating efficiency, safeguarding assets, quality patient care, compliance with existing laws, and accuracy of financial transactions are common goals of internal controls.

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

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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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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

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