The Physician as CEO

Anthem is Now Elevance Health

By Jakob Emerson, beckerspayer.com

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The company formerly known as Anthem commemorated its official rebranding to Elevance Health on June 28th by ringing the opening bell at the New York Stock Exchange and beginning to trade under the new ticker symbol “ELV”. The former Anthem website now reflects the name change, which is a combination of the words elevate and advance to represent the company’s commitment to “elevating the importance of whole health and advancing health beyond healthcare for consumers.”

When it first announced the rebrand in March, the payer said Blue Cross Blue Shield health plan names would not change, though it planned to narrow the number of brands under its umbrella. The company owns BCBS plans in 14 states. On June 15, the company launched two new subsidiaries under the Elevance name: Carelon and Wellpoint.

Carelon, a healthcare services brand, will consolidate the company’s existing portfolio of capabilities and services businesses under a single name. The Wellpoint health plan brand will unify the company’s Medicare, Medicaid, and commercial health plans in select markets.

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Value v. Growth Fund Managers

Understanding Investment Styles

By Dr. David Edward Marcinko; MBA, CMPbiz-book1

A mutual or hedge fund manager’s investment style is defined by the means or strategies used to accomplish the fund’s stated objective. Most managers have a strategy they believe to be the key to maximizing risk-adjusted investment returns. For example, two equity managers may seek growth of capital or capital appreciation over the long term. The strategies they use to achieve that goal can be vastly different, however, as evidenced by their choice of securities.

Style Characteristics

Astute physician-investors are aware that there are four, main manager style characteristics: value vs. growth, top-down vs. bottom-up—which can be refined further by additional approaches. Certain statistics and information reveal a manager’s style. An investor may prefer one style or one combination over another

Approaches Vary

Style approaches can be used in tactical asset allocation. Research has shown that one style tends to outperform the other during certain periods. If investors believe they can identify when one style will outperform the other, they could overweight the favored approach. More and more fund complexes are now offering funds in each style; especially for large healthcare entities and other institutions.

Value vs. Growth

Manager autonomy and style is an important consideration.

  1. Value managers focus on a company’s assets or net worth and attempt to place a value on such assets: if their valuation is greater than the market’s valuation, the security is a candidate for ownership. Benjamin Graham, the father of value investing, believed this approach to selecting securities would eventually be recognized by the market, rewarding patient, long-term investors. In today’s service economy, value managers also attempt to value the intangible assets of a company, such as franchise value or human capital. Value managers tend to be contrarians—they buy out-of-favor stocks or stocks not widely followed or recommended by analysts. Value managers also look at the breakup value of a company (what the individual parts could be sold for). They buy cheap stocks: stocks with low P/E ratios or low price-to-book value relative to the market, and stocks of established companies that pay dividends.
  2. Growth managers look at corporate earnings and focus on improving or accelerating earnings. They look at the trend of an industry or market sector (for example, environmental technology) to see if there is future sales-growth potential. They may lean toward companies that are dominant in the industry or have a product or service that will dramatically improve their market share. Growth managers typically own stocks with higher P/E ratios than the market average; these stocks may not be out of favor, but they may have been overlooked by market analysts. Growth stocks usually are not high-income-paying stocks.

Assessment

Prior to the recent financial meltdown, growth and momentum investing was the norm. Now it is value investing. What about the future for the physician-investor?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

IMHO @TeamCigna Should Treat their Dentists Better!

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By Darrell Pruitt DDS

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“How Is The Market Feeling About Cigna?” Spoiler – According to Benzinga insights, the market is not optimistic about Cigna’s future. Neither am I. But then, I’m only their clients’ dentist.

Link: https://www.benzinga.com/short-sellers/22/06/27888029/how-is-the-market-feeling-about-cigna

Tomorrow is my last day as a Cigna Preferred Provider .. Never Again!

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Investment Adviser v. Mutual Fund Manager

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“What’s the difference … and why pay fees to both?”

By Rick Kahler MS CFP® http://www.KahlerFinancial.com

Rick Kahler MS CFPQuestions – from doctors – like these remind me that the workings of the financial services industry which I tend to take for granted but can be confusing to people outside the field.

The following analogy may help to explain.

Orchestra Analogy

Think of an orchestra. The investment adviser is the equivalent of the director/conductor and the money managers are the instrumentalists. Each one is a specialist who plays a particular type of instrument, and it takes a variety of these specialists to make up the orchestra.

Specialists

The broad specialties are the types of instruments, such as strings, brass, winds, and percussion. These are the equivalent of fund managers who specialize in asset classes like equities, bonds, real estate, commodities, and absolute returns.

Sub-Specialists

Within each specialty are a variety of subspecialists. Winds, for example, include clarinets, oboes, and saxophones—which are further divided into alto, soprano, tenor, and bass. The brass section has French horns, trumpets, and trombones. The divisions and sub-divisions go on and on. Similarly, within the various asset classes are a great many mutual fund managers who specialize in narrower subcategories.

Conductor

The task of the orchestra conductor-director is to pick, not just the best musicians, but the best mix of musicians. A group with only trumpets or every subspecialty of percussion, no matter how skilled, isn’t an orchestra. Before auditioning a single musician, the director’s first task is to clarify the purpose of the ensemble being created. A different mix of instruments will be required for a symphony, a marching band, an intimate chamber group, or a dance band. It all depends on what the audience wants.

The conductor-director needs to weigh the various musicians’ abilities against their cost and their specific specialties against the needs of the orchestra. When the right mix of players has been chosen, the director needs to pick the appropriate music, assemble the group, and rehearse. The director’s talent, experience, and leadership skills all serve to help the right players produce the right sound for their audiences.

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It takes similar coordination and skill to put together the right mix of asset classes and mutual fund managers to produce the best results for various clients, especially since there are some 17,000 mutual funds to choose from.

Fees

Just as both the orchestra director and the musicians are paid based on their skills and their work, both mutual fund managers and investment advisers are paid based on the assets they manage. Mutual fund managers earn 0.05% to 3.0%. Financial advisers earn 0.30% to 3.0%. An informed consumer could pay as low as 0.35% while an uninformed consumer could pay up to 6% a year, which would eat up most of the investment returns.

One essential responsibility for an adviser, then, is to choose mutual fund managers whose fees are low.

However, the cost of the mutual fund manager isn’t the be-all and end-all. One must also weigh performance, just as an orchestra director might pay more to get an outstanding musician who would add significant value to the performances.

Example:

For example, my firm’s overall average fee for mutual fund managers is 0.5%. We could get that as low as 0.1%, which might be impressive at first glance.

However, we would give up 0.25% to 1.00% of net return in some areas, resulting in poorer outcomes for the clients.

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Assessment

Skilled direction of an orchestra is obviously more art than science. Skilled coordination of mutual fund managers is the same. Both require knowledge, integrity, and commitment to the quality of the final product.

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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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

UPDATE: The Markets, SS COLAS, EY, and Monkey-Pox?

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Markets: Stocks sagged for the second straight day, with technology chip stocks taking some of the biggest blows. A new consumer report showed that Americans are not confident in the economy, but are confident that inflation will be remain for the next year.

A Social Security official earlier this month said he expects a COLA bump of about 8%, based on the current inflationary trends. But if inflation continues at its current pace — the cost of goods and services in May accelerated to 8.6% — seniors could receive a COLA hike of 10.8% in early 2023, according to a new analysis from the non-partisan Committee for a Responsible Federal Budget. If inflation grinds to a halt over the final months of 2022, seniors would receive a COLA increase of 7.3%, the group predicted. 

Ernst and Young (EY), one of the world’s largest auditing firms, has agreed to pay a $100 million SEC fine after admitting hundreds of its accountants have cheated on their ethics exams between 2017 and 2021.

US health officials ramped up their fight against the Monkeypox outbreak, expanding the group eligible to get vaccines and deploying more doses and testing capabilities.

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PODCAST: Healthcare I.T. Interoperability Rankings

By Eric Bricker MD

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PODCAST: https://www.youtube.com/watch?v=yQSY957s_GY

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On Business Entrepreneurial Ownership

No Self-Indulgent Path to Success

repeat

No Self-Indulgent Path to Success

By Rick Kahler CFP® 

http://www.MedicalExecutivePost.com

“Most of my friends assume that business owners spend their money and time on cocaine and hookers.”

This jaw-dropping quote came from a young man I was talking with recently about money, investing, and running a business. I was shocked; this was a money script I had never heard.I asked if he was serious. He was. I asked if any of the friends with this belief were raised by a parent who owned a business. He thought for a moment and said, “No, not one.”

This conversation reminded me of a government employee who once told me, “Any person who succeeds in business had to do so illegally by embracing corruption and dishonesty.” He, too, was serious.

I was dumbfounded by both of these encounters. My experience of being raised by parents who owned a small business, and then going into business for myself, was quite different from these perceptions.

My father started his own business when I was four years old. I witnessed him working long hours. I remember the times when business was so bad he would have to borrow money to pay the bills and keep the doors open. Later in life I learned his business rarely made a profit and was just able to pay his salary.

He never shared with his employees how tight money was. When I went to work for him as a teenager, I remember listening to the talk around the water cooler. They all assumed he made far more money than what I knew was true.

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In the years since, I have discovered many misperceptions about people who own real estate, are in business, or who have accumulated wealth.

The first misperception is that someone who owns real estate or a business has actually accumulated wealth. My 40 years of experience in financial planning has taught me that many, if not most, business owners would make more money working for someone else. And real estate owners accumulate wealth slowly. Most of them, myself included, struggle through some lean years with short or even negative cash flow until they finally pay off their mortgages.

Certainly, real estate or business owners who  persevere over the long term can become wealthy. Being wealthy, according to various studies, is defined as having a minimum net worth of somewhere between five million and twenty million dollars.

About 80% of millionaires own their own businesses. They put in long hours, often in careers they love enough so that work becomes play. The average business owner puts in about 70 hours a week. They are five times more likely than non-business owners to be “always available” via e-mail, four times more likely to work nights, and three times more likely to be in the office or store on weekends.

This is the way one successful business owner described it: “Our company will celebrate its 50th anniversary next year. Probably the first 30 years were spent working 70-100 hour weeks at below minimum wage and dumping every extra penny back into the business. I would say it’s only been the last 10 years that we have begun to reap the financial rewards that we spent 40 years striving to attain, still working 60-70 hour weeks. I acknowledge our work habits may in part be a result of being stubborn Norwegians that don’t think anyone else can do things right, but most successful small business owners I know have pretty much dedicated their life to become successful.”

Assessment

This focus and work ethic are what it takes to succeed at business ownership. It’s not a mindset that includes blowing money and time on cocaine and hookers.

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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Business Plan for Creatives … and Doctors!

CMP logo

A Detailed Plan for Medical Professionals

By Dr. David Edward Marcinko MBA CMP

http://www.CertifiedMedicalPlanner.org

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MBA Business Plan CAPSTONE Outline

PODCAST Transcript: Podcast

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:

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

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

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ENTREPRENEURIAL MANAGEMENT EFFICIENCY: “Slowly I Turned … Step by Step … Inch by Inch”

By Staff Writers

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Venture capitalists who are in a rut should stop talking about how hard it is to raise a $100 million fund. Instead, raise a $5 million fund.

Rather, they should stop trying to invest $5 million at a time (with an 18-month window before going public). A better strategy is to start doing smaller investments with longer time horizons.

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

Just like chili, low and slow is the way to maximum flavor.

READ: https://tinyurl.com/2ewwvz2c

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U.S. Supreme Court Sides with Doctors Challenging Opioid Convictions

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By Nate Raymond

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(Reuters) – The U.S. Supreme Court just made it harder for prosecutors to win convictions of doctors accused of running “pill mills” and excessively prescribing opioids and other addictive drugs by requiring the government to prove that defendants knew their prescriptions had no legitimate medical purpose.

READ FULL STORY: https://www.msn.com/en-us/news/us/u-s-supreme-court-sides-with-doctors-challenging-opioid-convictions/ar-AAYUg31?cvid=c26cb4159770466e984575227031e724

Related: https://medicalexecutivepost.com/2012/02/26/medical-uses-of-abused-drugs/

FAKE Rx: https://medicalexecutivepost.com/2022/05/10/fake-prescription-drug-rx-example/

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REPORT: Digital Health Technology

By Staff Reporters and MCOL

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Digital Health Tech Report – 5 Key Findings

 •  48% of hospitals don’t have a strong digital health strategy.
 •  90% believe a strong digital health strategy is critical to improving outcomes, increasing productivity, and enhancing clinician satisfaction.
 •  55% receive more than 11 vendor calls and emails from digital health solution vendors per week.
 •  95% say it’s challenging to narrow down the list of digital health solutions to evaluate.
 •  25% are “very confident” that, after selecting a new digital health solution, it’s truly the best one for their unique needs.

Source: Panda Health, April 2022

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HEALTH TECH: Technology Giants?

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Dr. Bertalan Meskó, MD PhD

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The Medical Futurist

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  • Google in healthcare: The search giant has repeatedly successfully transferred its in-depth knowledge of algorithms in the field of medicine, particularly since it acquired DeepMind.
  • Apple in healthcare: Apple will keep on working on expanding the health features of its devices, Apple Watch and iPhones included.
  • Microsoft in healthcare: Microsoft’s cloud solutions provide integrated capabilities that make it easier to improve the healthcare experience.
  • Amazon in healthcare: Amazon will make further use of its vast knowledge of online shopping trends and behavior and will keep on providing what people need, from medicine to wearables.
  • IBM in healthcare: IBM has a lot to offer in federated learning, blockchain, and quantum computing
  • Nvidia in healthcare: NVIDIA seems incredibly focused on its approach to healthcare. We can expect NVIDIA to be a leader in the use of artificial intelligence in healthcare
  • Facebook in healthcare: The Metaverse developed by Facebook/Meta has incredible potential to revolutionize healthcare.

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UPDATE: Market Predictions and the Global Economy?

By Staff Reporters

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  • Predictions: The stock market could surge 7% this week as quarter-end re-balancing leads to a buying spree in equities, according to JPMorgan. The bank expects re-balancing trades to favor equities after a year-to-date decline of nearly 20%. “Next week’s re-balance is important since equity markets were down significantly over the past month, quarter and six-month time periods.”
  • Markets: With the S&P having plunged nearly 18% this year, expect W. Buffett to preach the value of value stocks (aka steady, non-flashy public companies). By one measure, they’re on track to beat growth stocks by the widest margin in more than two decades, according to the WSJ.
  • Global economy: Russia defaulted on its foreign-currency sovereign debt for the first time since the Bolshevik Revolution in 1918 after failing to pay bondholders $100 million worth of interest by the end of a 30-day grace period. The default marks the beginning of a complex legal journey for bondholders, but it’s not expected to have any major consequences for the Russian economy, which has already been battered by Western sanctions.

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

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The Next Big [Investment] Thing?

Or, NOT!

By Rick Kahler CFP®

How do you spot the investment opportunity that will become the next Apple, Facebook, or Microsoft? Certainly they are out there. Someone is going to discover them and be set for life, so why shouldn’t it be you?

Here’s why it shouldn’t

As with all Registered Investment Advisors, the amount of money I manage for clients is publicly disclosed information that anyone with an Internet connection can find.

Because of that, I am seen as the gatekeeper of a source of funding for every under funded business opportunity that is sure to become the next Apple. I get to see a lot of proposals. Many have promise at first glance. But the promise usually fades the more I dig into the proposal, ask questions, and do the math.

After hours and hours of investigation, every few years I see that one proposal that looks really good. One that calls to me to invest, that really has the promise of being a winner. When all the stars and the planets align, I know I now have a 90% chance of not making a dime on the venture.

That’s why I have learned to save my time and my money when I am approached with “the next big thing.” I just don’t have time to investigate every project and cull hundreds of opportunities down to the one that has a 10% chance of succeeding. I see it as looking for the proverbial needle in the haystack. Certainly, there’s a needle in there somewhere. But examining every piece of hay in order to find it has a significant monetary cost.

To succeed, I would need a lot of time, even more money, and exponentially more intuition and intellect. Not to mention a fair amount of luck. The probability that I will go bankrupt before I ever find the needle is staggering.

Most of the “next big things” are discovered by driven entrepreneurs who bank everything they have on an idea and find the financing to shoestring it together. It usually isn’t the armchair investor who cashes in.

My experience

Over my 40 years of real estate and investment experience, I have seen people lose millions investing in lumber mills, emu farms, highly leveraged real estate, futures contracts, day trading, restaurants, multi-level-marketing companies, rare earth minerals, Iraqi currency, and the newest ones—marijuana farms and crypto-currencies.

As a result, for my money and the money of my clients, I’ll play the odds for success by saying “no” to every opportunity that comes across my desk. I don’t take the time to investigate them. I don’t read the offering circulars. I don’t attend presentations. The answer is “no” to the great odds of losing my money and “yes” to the staggering odds of keeping money growing conservatively for me and for my clients.

What do I say “yes” to? I say yes to investing in mutual funds that own or loan money to 12,000 successful companies around the globe and thousands of real estate properties. I say yes to well-diversified portfolios. I say yes to proven investment strategies with 25-year track records. I say yes to having enough cash reserves to fund two to five years of retirement income.

Boring

I know, it’s not very sexy, is it? In fact, the way I invest my money and the money of those who have entrusted their investments to me is downright boring.

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

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Assessment

So here is my hot tip when it comes to finding investment opportunities to secure your future: forget about the “next big thing.” Instead, stay with the “next boring thing.” The odds are overwhelming that this will make you a long-term winner.

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.

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Ransomware Simplified?

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By Darrell K. Pruitt DDS

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“We’re now truly in the era of ransomware as pure extortion without the encryption –
Why screw around with cryptography and keys when just stealing the info is good enough”

Jessica Lyons Hardcastle

{The Register, June 25, 2022]

READ: https://www.theregister.com/2022/06/25/ransomware_gangs_extortion_feature/

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What is Techno SCAM-BAITING?

BY ANONYMOUS

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Scam-Baiting Behind the Scenes

The most basic form of scambaiting sets out to waste a scammer’s time. At a minimum, scambaiters attempt to make scammers answer countless questions or perform pointless and random tasks. By keeping a scammer busy, scambaiters claim they’re preventing the scammer from defrauding a real victim.

Scambaiting may also be conducted with a specific purpose in mind. Sometimes scambaiters attempt to obtain an offender’s bank account information, for instance, which they then report to a financial institution. But there are other, less benevolent motives in the scambaiting community.

Thousands of scambaiters are organised on the 419eater forum, which describes itself as the “largest scambaiting community on earth”, with over 1.7 million forum threads. The forum was first established in 2003 to tackle the growing issue of 419 emails – a scam that promises people huge sums of cash in return for a small upfront fee.

419eater provides a particularly interesting case study because members are incentivised and rewarded for their scambaits through a unique system of icons, regarded as trophies, that they can obtain in their profile’s signature lines.

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Romance Scam : Find Out How We Uncovered This Chinese Scam

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MORE: https://www.theguardian.com/technology/2021/oct/03/who-scams-the-scammers-meet-the-amateur-scambaiters-taking-on-the-crooks?utm_source=pocket-newtab

Healthcare: https://www.scamwatch.gov.au/types-of-scams/buying-or-selling/health-medical-products

Medical Insurance: https://www.reddit.com/r/scambait/comments/jsgffx/just_got_a_scam_call_to_sign_me_up_for_bogus/

YOUR COMMENTS ARE APPRECIATED.

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SUPREME COURT: Rules Against HHS Drug Pricing [340-B] Program

By Health Capital Consultants, LLC

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U.S. Supreme Court Rules Against HHS in 340B Case

On June 15, 2022, the U.S. Supreme Court released its decision regarding the cuts made by the Department of Health and Human Services (HHS) to the 340B Drug Pricing Program, finding that HHS acted outside its statutory authority in changing reimbursement rates for one group of hospitals without first surveying them on their costs.

The 340B Drug Pricing Program allows hospitals and clinics that treat low-income, medically underserved patients to purchase certain “specified covered outpatient drugs” at discounted prices. (Read more…)

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Medical School Ethics VERSUS Business School Ethics

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Is Business Finally Embracing Medical Values?

[By Render S. Davis MHA CHE]

[By David Edward Marcinko MBA]

dr-david-marcinko

In the evolutionary shifts in models for medical 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 business parties to the health care delivery system to raise their ethical bar.

Tit-for-Tat

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.”

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[Medicine versus Business]

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Assessment

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.”

About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

More:

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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Put and Call OPTIONS RATIO?

By Staff Reporters

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Options are contracts that give investors the right to buy or sell stocks, indexes or other financial securities at an agreed upon price and date. Puts are the option to sell while calls are the option to buy.

Specifically – A Call Option gives the buyer the right, but not the obligation to buy the underlying security at the exercise price, at or within a specified time. A Put Option gives the buyer the right, but not the obligation to sell the underlying security at the exercise price, at or within a specified time.

Ratio – When the ratio of puts to calls is rising, it is usually a sign investors are growing more nervous. A ratio above 1 is considered bearish. The Fear & Greed Index uses a bearish options ratio as a signal for Fear.

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

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What is Stock Price STRENGTH

By Staff Reporters

A few big stocks can skew returns for the market. It’s important to also know how many stocks are doing well versus those that are struggling. This shows the number of stocks on the NYSE at 52-week highs compared to those at 52-week lows.

When there are many more highs than lows, that’s a bullish sign and signals Greed.

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

Now; Relative Price Strength (RPS) compares the price trend of a stock to the market.

An RPS > 1 indicates that the stock outperformed the market, an RPS < 1 indicates that the stock underperformed the market, and an RPS = 1 indicates that the stock performed on par with the market.

RPS can be misleading as it uses historical data and does not take into account risk.

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Mutual Fund Terms and Definitions for Physicians

A “Need-to-Know” Glossary for all Medical Professionals

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[ME-P Staff Writers] 

ADV: A two-part form filed by investment advisors who register with the Securities and Exchange Commission (SEC), as required under the Investment Advisers Act. ADV Part II information must be provided to potential investors and made available to current investors.

Alpha: A measure of the amount of a portfolio’s expected return that is not related to the portfolio’s sensitivity to market volatility. A benchmark that uses beta as a measure of risk, a benchmark and a risk free rate of return (usually T-bills) to compare actual performance with expected performance.

For example, a fund with a beta of .80 in a market that rises 10% is expected to rise 8%.

If the risk-free return is 3%, the alpha would be –.6%, calculated as follows: (Fund return – Risk-free return) – (Beta x Excess return) = Alpha   (8% – 3%) – [.8 × (10% – 3%)] = (–) .6%   

Note: A positive alpha indicates out-performance while a negative alpha means underperformance. 

Asset allocation: Strategic asset allocation refers to the long-term targets for allocation of a percentage of a portfolio among different asset classes. In contrast, tactical asset allocation refers to short-term targets.

Average maturity: The average weighted maturity of the bonds in a portfolio providing an indication of interest rate risk.

Benchmark: An index, managed portfolio, or fund used to compare performance characteristics with the targeted portfolio or fund.

Beta: A statistically computed measure of the portfolio’s relationship to changes in market value. If, compared to the S&P 500, a fund has a beta of .80; it is expected to underperform a rising market by 20% and outperform a falling market by 20%. 

Bond: Publicly traded debt instruments that are issued by governments and corporations. The issuer agrees to pay a fixed amount of interest over a specified time period and to repay the principal at maturity.

Closed-end mutual fund: An investment company that registers shares in accordance with SEC regulations and is traded in securities markets at prices determined by investments. 

Diversification: Buying a number of different investment vehicles to protect against default of a single vehicle, thereby reducing the risk of the portfolio.

Duration: A more technical calculation of interest rate risk exposure that uses the present value of expected cash flows to be returned to the bond holder over the term of the bond. 

Fundamental analysis: An analysis of a company’s stock that focuses on the economic environment, the industry the company is in, and the company’s financial situation and operating results.

Mutual fund: A regulated investment company that manages a portfolio of securities for its shareholders.

Net asset value (NAV): The value of fund assets fewer liabilities divided by outstanding shares. 

Open-end mutual fund: An investment company that invests money in accordance with specific objectives on behalf of investors. Fund assets expand or contract based on investment performance, new investments and redemptions.

Portfolio manager: The person(s) who is/are responsible for managing the portfolio in accordance with the objectives dictated by an investor or a fund’s prospectus.

Prospectus: A disclosure document filed with the SEC and made available to prospective and current investors. The prospectus covers sales charges, expenses, investment objectives and restrictions, management fees, financial highlights, and other information. 

R-squared (R2): Relationship of a fund or portfolio’s performance to a benchmark index.

For example, a fund R-squared of .5 means only 50% of its return is explained by the index. Other factors are responsible for the balance of performance. 

SEC yield: A standardized calculation of yield over a 30-day period, sometimes quoted as the “30-day yield.” It takes into account yield-to-maturity rather than current dividends. 

Standard deviation: A statistic that looks at a series of returns and expresses the average deviation from the mean return.

Statement of additional information: A disclosure document filed with the SEC that supplements the prospectus. It is made available to investors upon request. 

Technical analysis: An analysis that focuses on trends in financial markets generally.

For example, a technical analyst may view an entire industry’s group of stocks to be declining. Although the analyst may be correct about the group of stocks as a whole, there may be exceptions represented by specific, individual companies.

Total return: The combination of investment return from income, such as dividends and interest, and appreciation or depreciation in the value of the investment (Income returns plus capital return.) 

Turnover: Under SEC rules, a figure computed that indicates how often securities in the portfolio are bought and sold. For example, if turnover is 100% over a one-year period, the securities (on average) were replaced once. 

12b-1 fee: The maximum annual fee payable from fund assets for distribution and sales costs as allowed by the SEC. 

MORE: Glossary Terms Ap 3

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MARK CUBAN’s: “Cost Plus Drugs”. com

By Staff Reporters

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Mark Cuban: The billionaire owner of the Dallas Mavericks just launched an online pharmacy for generic drugs that looks to cut out middlemen and combat pharmaceutical industry price gouging by offering steep discounts.

Set up as CostPlusDrugs.com with 100 generic drugs to treat conditions like diabetes and asthma. Cost Plus will not accept health insurance but claims its prices will still be lower than what people would typically pay at a pharmacy.

“All drugs are priced at cost plus 15%!” Cuban tweeted.

READ: https://medicalexecutivepost.com/2022/01/23/podcast-the-mark-cuban-cost-plus-drug-co-mccpdc/

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The Market Technicians

Technical Analysis – Defined

[By Julia O’Neal; MA, CPA with Staff writers]

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Technical market analysis focuses on the historical price and volume changes that occur as a stock trades, and it attempts to predict the stock’s future behavior based on prior patterns.

Technical analysis is not concerned with the financials of a company; it assumes that fundamental factors are already reflected in the market behavior of a stock and that the history of that behavior gives a strong clue to the future. The focus on price and volume in technical analysis could also be considered a study of supply and demand. 

Technical analysis applies technical market theories to stock market data on stock prices, indexes, and trading. Technicians identify market trends and try to predict future movements.  

Theoretically, technical and fundamental analysis exist in opposition to each other, but in reality, most fundamental analysts sneak a look at the charts from time to time and technical analysts pay attention to some fundamentals. 

Both schools of thought are based on the possibility of predicting the future using the past. Market psychology, which does not always follow rhyme or reason, can prove both types of analysis wrong.

Technical analysis involves discovering patterns that repeat themselves. Patterns can exist for an individual stock or for an index, and stocks can be compared to their respective indexes. 

Stocks (and indexes) are said to trade in a range. When prices go above this range, they often encounter selling pressure. This is called an area of resistance, and stocks are characterized as “overbought.” 

Conversely, a decline below a level of support will instigate buying, because the stock seems cheap or “oversold.” 

When a breakout occurs above a resistance level – or below a support level – technical analysts predict the stock will stay on the new course.  

Methods for taking advantage of anticipated upward trends include buying stop orders or call options at a level slightly above the resistance level.  To profit from downward trends, physician investors would enter a sell-stop order, sell short, or purchase put options at a price slightly below the support level.  

  • Accumulation areas occur when medical buyers are accumulating stock and the support level is moving up.  
  • Distribution areas occur when physician selling is occurring and the stock is considered weak.  
  • A sideways movement (the stock continues to be bought and sold at the same price for some time) is called an area of consolidation. 

Technical analysis

Other technical patterns:

A head and shoulders pattern may be either above (“head and shoulders top”) or below (“head and shoulders bottom”) a constant trend line. This theory assumes that after a top there will be a reverse; after a bottom, there will be a move back to a top.  

Rising bottoms and ascending tops/falling bottoms and descending tops.  A rising trend in the low prices of a security shows higher and higher support levels. Combined with ascending tops, this would be a bullish indicator. The reverse would be bearish. 

Double top and double bottom show resistance and support levels.  A double bottom shows the stock could break below support levels and reach new lows; a stock with a double top pattern might be expected to move on to a new high.

Assessment

What kind of physician investor are you; fundamental or technical?

Conclusion

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SURVEY: Primary Care Doctor Trust or NOT?

By Staff Reporters

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75% Trust Their Primary Care Physicians

 •  Primary care physicians: 75%
 •  Specialty care physicians: 66%
 •  Pharmacies: 59%
 •  Hospitals and clinics: 58%
 •  Health insurance company: 51%
 •  Government: 24%

Source: Health Sparq, “2022 Annual Consumer Sentiment Benchmark Report,” January 2022

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Behavioral Finance for Doctors?

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On the Psychology of Investing [Book Review]

By Peter Benedek, PhD CFA

Founder: www.RetirementAction.com

Some of the pioneers of behavioral finance are Drs. Kahneman, Twersky and Thaler. This short introduction to the subject is based on John Nofsinger’s little book entitled “Psychology of Investing” an excellent quick read for all medical professionals or anyone who is interested in learning more about behavioral finance.

Rational Decisions?

Much of modern finance is built on the assumption that investors “make rational decisions” and “are unbiased in their predictions about the future”, however this is not always the case.

Cognitive errors come from (1) prospect theory (people feel good/bad about gain/loss of $500, but not twice as good/bad about a gain/loss of $1,000; they feel worse about a $500 loss than feel good about a $500 gain); (2) mental accounting (meaning that people tend to create separate buckets which they examine individually), (3) Self-deception (e.g. overconfidence), (4) heuristic simplification (shortcuts) and (4) mood can affect ability to reach a logical conclusion.

John Nofsinger’s Book

The following are some of the major chapter headings in Nofsinger’s book, and represent some of the key behavioral finance concepts.

Overconfidence leads to: (1) excessive trading (which in turn results in lower returns due to costs incurred), (2) underestimation of risk (portfolios of decreasing risk were found for single men, married men, married women, and single women), (3) illusion of knowledge (you can get a lot more data nowadays on the internet) and (4) illusion of control (on-line trading).

Pride and Regret leads to: (1) disposition effect (not only selling winners and holding on to the losers, but selling winners too soon- confirming how smart I was, and losers to late- not admitting a bad call, even though selling losers increases one’s wealth due to the tax benefits), (2) reference points (the point from where one measures gains or losses is not necessarily the purchase price, but may perhaps be the most recent 52 week high and it is most likely changing continuously- clearly such a reference point will affect investor’s judgment by perhaps holding on to “loser” too long when in fact it was a winner.)

Considering the Past in decisions about the future, when future outcomes are independent of the past lead to a whole slew of more bad decisions, such as: (1) house money effect (willing to increase the level of risk taken after recent winnings- i.e. playing with house’s money), (2) risk aversion or snake-bite effect (becoming more risk averse after losing money), (3) trying to break-even (at times people will increase their willing to take higher risk to try to recover their losses- e.g. double or nothing), (4) endowment or status quo effect (often people are only prepared to sell something they own for more than they would be willing to buy it- i.e. for investments people tend to do nothing, just hold on to investments they already have) (5) memory and decision making ( decisions are affected by how long ago did the pain/pleasure occur or what was the sequence of pain and pleasure), (6) cognitive dissonance (people avoid important decisions or ignore negative information because of pain associated with circumstances).

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).

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).

In building portfolios, assets included should not be chosen on basis of risk and return only, but also correlation; even otherwise well educated individuals make the mistake of assuming that adding a risky asset to a portfolio will increase the overall risk, when in fact the opposite will occur depending on the correlation of the asset to be added with the portfolio (i.e. people misjudge or disregard interactions between buckets, which are key determinants of risk).

This can lead to: (1) building behavioral portfolios (i.e. safety, income, get rich, etc type sub-portfolios, resulting in goal diversification rather than asset diversification), (2) naïve diversification (when aiming for 50:50 stock:bond allocation implementing this as 50:50 in both tax-deferred (401(k)/RRSP) accounts and taxable accounts, rather than placing the bonds in the tax-deferred and stocks in taxable accounts respectively for tax advantages), (3) naïve diversification in retirement accounts (if five investment options are offered then investing 1/5th in each, thus getting an inappropriate level of diversification or no diversification depending on the available choices; or being too heavily invested in one’s employer’s stock).

Representativeness may lead investors to confusing a good company with a good investment (good company may already be overpriced in the market; extrapolating past returns or momentum investing), and familiarity to over-investment in one’s own employer (perhaps inappropriate as when stock tanks one’s job may also be at risk) or industry or country thus not having a properly diversified portfolio.

Emotions can affect investment decisions: mood/feelings/optimism will affect decision to buy or sell risky or conservative assets, even though the mood resulted from matters unrelated to investment. Social interactions such as friends/coworkers/clubs and the media (e.g. CNBC) can lead to herding effects like over (under) valuation.

Financial Strategies

Nofsinger finishes with a final chapter which includes strategies for:

(i) beating the biases: (1) Understand the biases, (2) define your investment objectives, (3) have quantitative investment criteria, i.e. understand why you are buying a specific investor (or even better invest in a passive fashion), (4) diversify among asset classes and within asset classes (and don’t over invest in your employer’s stock), and (5) control your investment environment (check on stock monthly, trade only monthly and review progress toward goals annually).

(ii) using biases for the good: (1) set new employee defaults for retirement plans to being enrolled, (2) get employees to commit some percent of future raises to automatically go toward retirement (save-more-tomorrow).

Assessment

Buy the book (you can get used copies at through Amazon for under $10). As indicated it is a quick read and occasionally you may even want to re-read it to insure you avoid the biases or use them for the good. Also, the book has long list of references for those inclined to delve into the subject more deeply.

You might even ask “How does all this Behavioral Finance coexist with Efficient Market theory?” and that’s a great question that I’ll leave for another time.

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Medical Endowment Fund Manager Selection

Are External Financial Consultants Necessary?

[By Dr. David E. Marcinko MBA CMP]

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John English, of the Ford Foundation, once observed that:

[T]he thing that is most interesting to me is that every one of the managers is able to give me a chart that shows me he was in the first quartile or the first decile. I have never had a prospective manager come in and say, ‘We’re in the fourth quartile or bottom decile’.

According to Wayne Firebaugh CPA, CFP® CMP™ most medical endowment funds today, even those with internal investment staff, rely heavily upon consultants and external managers.

In fact, the 2006 Commonfund Benchmarks Healthcare Study revealed that 85% of all surveyed institutions relied upon consultants with an even greater percentage of larger endowments relying upon consultants.  The common reasons given by endowments for such reliance are augmenting staff and oddly enough, cost containment.  In essence, the endowment staff’s job becomes one of managing the managers.

Manager Selection 

Even those endowments that use consultants to assist in selecting outside managers remain involved in the selection and monitoring process.  Interestingly, performance should generally not be the overriding criterion for selecting a manager.  Selecting a manager could be viewed as a two-step process in which the endowment first establishes its initial allocation and determines what classes will require an external manager.  The second part of the process is to select a manager that due diligence has indicated to have two primary characteristics: integrity and a repeatable and sustainable systematic process.  These characteristics are interrelated, as a manager who embodies integrity will also strive to follow the established investment selection process.

Of Medical-Managers

In medicine, obtaining the best care often means consulting a specialist.  As a manager of managers, the average endowment should seek specialist managers within a given asset class. Just as physicians and healthcare institutions gain additional insight and skill in their area of specialty, investment managers may be able to gain informational or system advantages within a given concentrated area of investments.

Assessment

Since most plan managers are seeking positive alpha by actively managing certain asset classes, many successful endowments will use a greater number of external managers in the concentrated segments than they will in the larger, more efficient markets.

Conclusion

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HEDGE FUNDS: History in Brief

ABOUT | DAVID EDWARD MARCINKO

BY DR. DAVID E. MARCINKO MBA CMP®

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The investment profession has come a long way since the door-to-door stock salesmen of the 1920s sold a willing public on worthless stock certificates. The stock market crash of 1929 and ensuing Great Depression of the 1930s forever changed the way investment operations are run. A bewildering array of laws and regulations sprung up, all geared to protecting the individual investor from fraud. These laws also set out specific guidelines on what types of investment can be marketed to the general public – and allowed for the creation of a set of investment products specifically not marketed to the general public. These early-mid 20th century lawmakers specifically exempted from the definition of “general public,” for all practical purposes, those investors that meet certain minimum net worth guidelines.

The lawmakers decided that wealth brings the sophistication required to evaluate, either independently or together with wise counsel, investment options that fall outside the mainstream. Not surprisingly, an investment industry catering to such wealthy individuals, such as doctors and healthcare professionals, and qualifying institutions has sprung up.

EARLY DAYS

The original hedge fund was an investment partnership started by A.W. Jones in 1949. A financial writer prior to starting his investment management career, Mr. Jones is widely credited as being the prototypical hedge fund manager. His style of investment in fact gave the hedge fund its name – although Mr. Jones himself called his fund a “hedged fund.” Mr. Jones attempted to “hedge,” or protect, his investment partnership against market swings by selling short overvalued securities while at the same time buying undervalued securities. Leverage was an integral part of the strategy. Other managers followed in Mr. Jones’ footsteps, and the hedge fund industry was born.

In those early days, the hedge fund industry was defined by the types of investment operations undertaken – selling short securities, making liberal use of leverage, engaging in arbitrage and otherwise attempting to limit one’s exposure to market swings. Today, the hedge fund industry is defined more by the structure of the investment fund and the type of manager compensation employed.

The changing definition is largely a sign of the times. In 1949, the United States was in a unique state. With the memory of Great Depression still massively influencing common wisdom on stocks, the post-war euphoria sparked an interest in the securities markets not seen in several decades. Perhaps it is not so surprising that at such a time a particularly reflective financial writer such as A.W. Jones would start an investment operation featuring most prominently the protection against market swings rather than participation in them. 

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Apart from a few significant hiccups – 1972-73, 1987 and 2006-07 being most prominent – the U.S. stock markets have been on quite a roll for quite a long time now. So today, hedge funds come in all flavors – many not hedged at all. Instead, the concept of a private investment fund structured as a partnership, with performance incentive compensation for the manager, has come to dominate the mindscape when hedge funds are discussed. Hence, we now have a term in “hedge fund” that is not always accurate in its description of the underlying activity. In fact, several recent events have contributed to an even more distorted general understanding of hedge funds.

During 1998, the high profile Long Term Capital Management crisis and the spectacular currency losses experienced by the George Soros organization both contributed to a drastic reversal of fortune in the court of public opinion for hedge funds. Most hedge fund managers, who spend much of their time attempting to limit risk in one way or another, were appalled at the manner with which the press used the highest profile cases to vilify the industry as dangerous risk-takers. At one point during late 1998, hedge funds were even blamed in the lay press for the currency collapses of several developing nations; whether this was even possible got short thrift in the press.

Needless to say, more than a few managers have decided they did not much appreciate being painted with the same “hedge fund” brush. Alternative investment fund, private investment fund, and several other terms have been promoted but inadequately adopted. As the memory of 1998 and 2007 fades, “hedge fund” may once again become a term embraced by all private investment managers.

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ASSESSMENT: Physicians, and all investors, should be aware, however, that several different terms defining the same basic structure might be used. Investors should therefore become familiar with the structure of such funds, independent of the label. The Securities Exchange Commission calls such funds “privately offered investment companies” and the Internal Revenue Service calls them “securities partnerships.”

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Money Management and Portfolio Performance

Money Management and Portfolio Performance

By Jeffrey S. Coons; PhD, CFA

By Christopher J. Cummings; CFA, CFP™

Evaluating portfolio performance is a vital and often contentious topic in monitoring progress towards a physician’s investment goals.   

Introduction 

A typical portfolio’s objective may be to preserve the purchasing power of its assets by achieving returns above inflation – or to have total returns adequate to satisfy an annual spending need without eroding original capital, etc.  Whatever the absolute goal for the doctor; performance numbers need to be evaluated based on an understanding of the market environment over the period being measured.

One way to put a portfolio’s a time-weighted return in the context of the overall market environment is to compare the performance to relevant alternative investment vehicles.   This can be done through comparisons to either market indices, which are board baskets of investable securities, or peer groups, which are collections of returns from managers or funds investing in a similar universe of securities with similar objectives as the portfolio.

By evaluating the performance of alternatives that were available over the period, the physician investor and/or his/her advisor are able to gain insight to the general investment environment over the time period.

The Indices 

Market indices are frequently used to gain perspective on the market environment and to evaluate how well the portfolio performed relative to that environment. 

Market indices are typically segmented into different asset classes.

Common stock market indices include the following:

· Dow Jones Industrial Average – a price-weighted index of 30 large U.S. corporations.

· Standard & Poor’s (S&P) 500 Index – a capitalization-weighted index of 500 large U.S. corporations.

· Value Line Index – an equally-weighted index of 1700 large U.S. corporations.

· Russell 2000 – a capitalization-weighted index of smaller capitalization U.S. companies.

· Wilshire 5000 – a cap weighted index of the 5000 largest U.S. corporations.

· Morgan Stanley Europe Australia, Far East (EAFE) Index – a capitalization-weighted index of the stocks traded in developed economies. 

Common bond market indices include the following:

· Lehman Brothers Government Credit Index – an index of investment grade domestic bonds excluding mortgages.

· Lehman Brothers Aggregate Index – the LBGCI plus investment grade mortgages.

· Solomon Brothers Bond Index – similar in construction to the LBAI.

· Merrill Lynch High Yield Index – an index of below investment grade bonds.

· JP Morgan Global Government Bond – an index of domestic and foreign government-issued fixed income securities.

Assessment

The selection of an appropriate market index depends on the goals of the portfolio and the universe of securities from which the portfolio was selected. 

Just as a portfolio with a short-time horizon and a primary goal of capital preservation should not be expected to perform in line with the S&P 500, a portfolio with a long-term horizon and a primary goal of capital growth should not be evaluated versus Treasury Bills.

Conclusion 

While the Dow Jones Industrial Average and S&P 500 are often quoted in the newspapers, there are clearly broader market indices available to describe the overall performance of the U.S. stock market.

Likewise, indices like the S&P 500 and Wilshire 5000 are capitalization-weighted, so their returns are generally dominated by the largest 50 of their 500 – 5000 stocks.

Fortunately, capitalization-bias does not typically affect long-term performance comparisons, but there may be periods of time in which large cap stocks out-or under-perform mid-to-small cap stocks, thus creating a bias when cap-weighted indices are used versus what is usually non-cap weighted strategies of managers or mutual funds.

Finally, the fixed income indices tend to have a bias towards intermediate-term securities versus longer-term bonds.  Therefore, a physician investor with a long-term time horizon, and therefore potentially a higher allocation to long bonds, should keep this bias in mind when evaluating performance.

How do you evaluate your portfolio?

Do you evaluate it on a risk-adjusted basis?

***

Schulze School of Entrepreneurship

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State Economy Engine

Since launching a two-year commercial course in 1895, the University of St. Thomas has placed an emphasis on helping the state of Minnesota create entrepreneurial endeavors that contribute to the state’s thriving, diverse economy.

Opus College of Business

More than 150 years later, the university’s Opus College of Business continues that tradition, as this interactive graphic shows.

engine

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SURVEY: Medical Imaging A.I. Adoption?

By MCOL

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Medical Imaging A.I. Adoption Survey [3 Takeaways]

 •  When it comes to specific activities, 88% of respondents trust or are neutral about AI’s role in making appointments.
 •  Only 19% of respondents believed they received care supported by AI, while 24% did not know, and 58% believed they had not.
 •  60% think that AI will perform over half of radiology services in five years, with that number increasing to 75% of respondents in the next 20 years.

Source: Intelerad via HIT Consultant, “Patient Trust Not a Barrier to AI Medical Imaging Adoption,” May 31, 2022

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UPDATE: The Markets!

By Staff Reporters

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CELEBRATE JUNETEENTH

  • The Markets: Can an extra day of rest change the market’s fortune?
  • As the Fed has escalated its fight against inflation, the S&P has fallen for 10 weeks out of the last 11. And not even American blue-chip firms have been spared from the carnage.
  • The Dow Jones Industrial Average closed below 30,000 for the first time since January 2021.

COMMENTS APPRECIATED

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INTERVIEW: A Healthcare Financing Solution for Entrepreneurs?

Former: CEO and Founder
Superior Consultant Company, Inc.
[SUPC-NASD]

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

Today for your consideration – How to fix the healthcare financing methods in the United States?

I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.

This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .

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

Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.

Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.

Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.

Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:

1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.

3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).

4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.

5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.

6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.

7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.

Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.

Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.

I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.

So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.

Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.

Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.

No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow.  If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.

For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.

Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately

One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.

Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.

So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:

1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.

2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis.  Eliminate all the other tax-funded plans in favor of this new one.

3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.

4. Open Medicare Part D (prescription drugs) to every US citizen. Today.

YOUR THOUGHTS ARE APPRECIATED.

Thank You

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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HEALTHCARE: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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Managing for Endowment Fund Portfolio Alpha

Understanding Non-Systematic Return on Investment

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www.CertifiedMedicalPlanner.org

DEM 2013

[By Dr. David Edward Marcinko MBA]

According to Wayne Firebaugh CPA, CFP®, CMP™ alpha measures non-systematic return on investment [ROI], or the return that cannot be attributed to the market.

It shows the difference between a fund’s actual return and its expected performance given the level of systematic (or market) risk (as measured by beta).

Example

For example, a fund with a beta of 1.2 in a market that returns 10% would be expected to earn 12%. If, in fact, the fund earns a return of 14%, it then has an alpha of 2 which would suggest that the manager has added value. Conversely, a return below that expected given the fund’s beta would suggest that the manager diminished value.

In a truly efficient market, no manager should be able to consistently generate positive alpha. In such a market, the endowment manager would likely employ a passive strategy that seeks to replicate index returns. Although there is substantial evidence of efficient domestic markets, there is also evidence to suggest that certain managers do repeat their positive alpha performance.

In fact, a 2002 study by Roger Ibbotson and Amita Patel found that “the phenomenon of persistence does exist in domestic equity funds.” The same study suggested that 65% of mutual funds with the highest style-adjusted alpha repeated with positive alpha performances in the following year.

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More Research

Additional research suggests that active management can add value and achieve positive alpha in concentrated portfolios.

A pre 2008 crash study of actively managed mutual funds found that “on average, higher industry concentration improves the performance of the funds. The most concentrated funds generate, after adjusting for risk … the highest performance. They yield an average abnormal return [alpha] of 2.56% per year before deducting expenses and 1.12% per year after deducting expenses.”

FutureMetrics

FutureMetrics, a pension plan consulting firm, calculated that in 2006 the median pension fund achieved record alpha of 3.7% compared to a 60/40 benchmark portfolio, the best since the firm began calculating return data in 1988. Over longer periods of time, an endowment manager’s ability to achieve positive alpha for their entire portfolio is more hotly debated.  Dimensional Fund Advisors, a mutual fund firm specializing in a unique form of passive management, compiled FutureMetrics data on 192 pension funds for the period of 1988 through 2005.

Their research showed that over this period of time approximately 75% of the pension funds underperformed the 60/40 benchmark. The end result is that many endowments will use a combination of active and passive management approaches with respect to some portion of the domestic equity segment of their allocation.

Assessment

One approach is known as the “core and satellite” method in which a “core” investment into a passive index is used to capture the broader market’s performance while concentrated satellite positions are taken in an attempt to “capture” alpha. Since other asset classes such as private equity, foreign equity, and real assets are often viewed to be less efficient, the endowment manager will typically use active management to obtain positive alpha from these segments.

Notes:

  • Ibbotson, R.G. and Patel, A.K. Do Winners Repeat with Style? Summary of Findings – Ibbotson & Associates, Chicago (February 2002).
  • Kacperczyk, M.T., Sialm, C., and Lu Zheng. On Industry Concentration of Actively Managed Equity Mutual Funds. University of Michigan Business School. (November 2002).
  • 2007 Annual US Corporate Pension Plan Best and Worst Investment Performance Report.  FutureMetrics, April 20, 2007.

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:

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: Health Tech Faves & Investment Trends from Entrepreneurs

START-UPS AND INNOVATIONS

Health tech investment raced ahead in 2020. Join innovation insiders for a discussion on new health technologies, health-care’s digital transformation timeline, and what to expect for mid- to long-term health tech investment.

Health Care Technology Today | Canadian Physiotherapy ...

PODCAST: https://www.healthsharetv.com/content/golive-webinar-health-tech-faves-investment-trends-innovation-insiders

Your thoughts are appreciated.

THANK YOU

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HEALTHCARE MERGERS & ACQUISITIONS: 2021 in Review

By Staff Reporters

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Healthcare Partnerships – 5 Takeaways

 •  This year had the largest percentage of announced “mega merger” transactions in the last six years at 16.3% and, in more than one out of every 10 transactions, the smaller partner had a credit rating of A- or higher in 2021.
 •  Since 2011, average smaller partner size by annual revenue has increased at a compound annual growth rate (CAGR) of approximately 8.0%.
 •  Transactions involving a not-for-profit partner represented 87% of announced transactions.
 •  Transactions involving rural or urban/rural sellers increased to 31% of announced transactions.

Source: KaufmanHall, January 10, 2022

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

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Professor VERSUS Entrepreneur

Teaching / Educating

Bill Hennessey, M.D.

Bill Hennessey, M.D.

As a teacher educating is your job. It’s what you enjoy. There’s a fairly lax time schedule and resources are already built in the equation. Little accountability because the ultimate burden and measure of success is placed on the student to pass a test. If they don’t do well, it’s the student not directly the teacher who pays the price.

Now, I work with first year students who don’t know what a red blood cell looks like (biconcave disc, you thought I forgot, didn’t you) all the way to a chief resident who can probably do some surgeries better than me. It’s my job to take that first year student and turn them into a chief resident.

As an entrepreneur with limited resources, time, and energy, you don’t have the luxury to continuously teach, develop, and convince. You need people who simply get it especially in strategic positions. You don’t have the luxury of time or resources. You also are directly accountable if they don’t understand because you have a burn rate that probably just got worse. So how much “oxygen” do you allocate when trying to build your team?

Different story for Apple, Boeing and others that can create academies and educational tracks to teach and develop internally.

ASSESSMENT: Your thoughts are appreciated.

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Employee Engagement for Startups and Entrepreneurs

3 Business Start-up Blunders

Jonathan Mase | Jonathan A. Mase's WordPress Blog

Operating as a startup company will present many challenges, but you should take heart in knowing that many of today’s biggest companies were once in your position. If you wish for your startup company to succeed, then employee engagement will be a crucial factor. Keep reading to learn more about the importance of employee engagement for startups. It should allow you to figure out the right path forward to find the success you desire.

It Makes Employees Loyal

When employees are engaged in the work they are doing, they will be more likely to be loyal to your company. Having loyal employees will benefit you in several different ways, but one of the most important ones is that they will work harder. When employees are engaged in the work that they’re doing, then that means that they truly care about it. They’re going to take things seriously, and you will…

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The Real Economic Business Cycle?

REALLY?

By Dr. David Edward Marcinko MBA

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The business cycle is also known as the economic cycle and reflects the expansion or contraction in economic activity. Understanding the business cycle and the indicators used to determine its phases may influence investment or economic business decisions and financial or medical planning expectations. 

Although often depicted as the regular rising and falling of an episodic curve, the business cycle is very irregular in terms of amplitude and duration. Moreover, many elements move together during the cycle and individual elements seldom carry enough momentum to cause the cycle to move.  

However, elements may have a domino effect on one another, and this is ultimately drives the cycle, too.  We can also have a large positive cycle, coincident with a smaller but still negative cycle, as may be seen in the current healthcare climate of today. 

  1. First Phase: Trough to Recovery (service and production driven)

Scenario: A depressed GNP leads to declining industrial production and capacity utilization. Decreased workloads result in improved labor productivity and reduced labor (unit) costs until actual producer (wholesale) prices decline. 

  1. Second Phase: Recovery to Expansion (patient and consumer driven)

Scenario: CPI declines (due to reduced wholesale prices) and consumer real income rises, improving consumer sentiment and actual demand for consumer goods. 

  1. Third Phase: Expansion to Peak (service and production driven)

Scenario: GNP raises leading to increased industrial production and capacity utilization. But, labor productivity declines and unit labor costs and producer (wholesale) prices rise. 

  1. Fourth Phase: Peak to Contraction (patient and consumer driven)

Scenario: CPI rises making consumer real income and sentiment erode until consumer demand, and ultimately purchases, shrink dramatically.  Recessions may occur and economists have an alphabet used to describe them.  

For example, with a “V” graph shape, the drop and recovery is quick. For a “U” shaped graph, the economy moves up more sluggishly from the bottom. A “W” is what you would expect: repeated recoveries and declines. An “L” shaped recession describes a prolonged dry economic spell or even depression.

And now, the REAL Cycle?

MORE: https://etonomics.com/2021/11/09/real-business-cycle-theory/

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COMMENTS APPRECIATED

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JUNK-BOND Demand

By Staff Reporters

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Junk bonds carry a higher risk of default compared to other bonds. Bond yields – or the return you get on investing in a bond – dip when prices go up. If investors crave junk bonds, the yields drop. Likewise, yields rise when people are selling.

So a smaller difference (or spread) between yields for junk bonds and safer government bonds is a sign investors are taking on more risk. A wider spread shows more caution. The Fear & Greed Index uses junk bond demand as a signal for Greed.

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

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COMMENTS APPRECIATED

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