VIDEO: What is the “Baltimore Nod”?

Dope Fiends

By Anonymous DEA Agent

DOPE FIEND: A habitual user of a narcotic; slang term.

NOD: To lower and/or raise one’s head slightly and briefly, especially in greeting, assent, or understanding, or to give someone a signal.

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Single Nod

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Group Nod

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Street Nod

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MORE: https://medicalexecutivepost.com/2012/06/01/video-of-the-new-drug-krokodil-aka-crocodile/

Assessment:

An anonymous DEA agent sent us these pictures. The videas are all over YouTube. So, just say “NO” and don’t do drugs.

NOTE: The nod is not to be confused with TD. Tardive dyskinesia is a disorder that results in involuntary, repetitive body movements. This may include grimacing, sticking out the tongue, or smacking the lips. Additionally there may be rapid jerking movements or slow writhing movements. In about 20% of people, decreased functioning results. Tardive dyskinesia occurs in some people as a result of long-term use of neuroleptic medications. These medications are usually used for mental illness, etc.

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PODCAST: Excessive Out of Pocket Healthcare Costs

By Eric Bricker MD

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RELATED: https://medicalexecutivepost.com/2022/08/22/dictionary-health-economics-and-finance-2/

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DICTIONARY: Health Economics and Finance

10,000 TERMS, DEFINITIONS, ABBREVIATIONS AND RESOURCES

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PODCAST: Healthcare Service and Sacrifice [Economics 101]

Understand Diminishing Returns and Opportunity Costs

By Eric Bricker MD

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

Diminishing Returns: https://medicalexecutivepost.com/2010/10/26/higher-spending-on-healthcare-doesnt-always-deliver-quality/

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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4-PODCASTS: When to [Financial] Plan?

The Professional Edge

By Sean G. Todd, Esq., M. Tax, CFP®, CPA

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1-PODCAST: https://professional-edge.captivate.fm/episode/when-to-plan-s1

2-PODCAST: https://professional-edge.captivate.fm/episode/when-to-plan-s2

3PODCAST: https://professional-edge.captivate.fm/episode/when-to-plan-s3

4-PODCAST: https://professional-edge.captivate.fm/episode/when-to-plan-s4

Why do you spend more time planning your vacation than planning for your retirement?

You don’t plan to fail — you just fail to plan …. stop right now and

Take advantage of http://www.emcthebundle.com/ (THE BUNDLE)

Sean G. Todd, Esq., M. Tax, CFP®, CPA

P.S. Your tax, estate and financial plan – done: http://www.emcthebundle.com/ (THE BUNDLE)

COMMENTS APPRECIATED

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

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

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PODCAST: Law Firm Fairmark Partners Suing Large Hospital Systems for Antitrust Violations

Using Court System to Change Healthcare

By Eric Bricker MD

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U.S. Hospitals Feeling the Pain of Physician Burnout

U.S. Hospitals Feeling the Pain of Physician Burnout [REPRINT]

Source: Reuters Health News via MDLinx [11/22/17]

neurotic

Hospitals are just beginning to recognize the toll of burnout on their operations

Experts estimate, for example, that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt, a former Mayo Clinic researcher who became Stanford Medicine’s first chief physician wellness officer in September said Stanford, Harvard Business School, Mayo Clinic, and the American Medical Association (AMA) are working on that. They have put together a comprehensive estimate of the costs of burnout at the organizational and societal level, which has been submitted to a journal for review.

Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.

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 Hospitals can ill afford these added expenses in an era of tight margins, costly nursing shortages, and uncertainty over the fate of the Affordable Care Act, which has put capital projects and payment reform efforts on hold.

Coaching

For a graphic, click here.

http://fingfx.thomsonreuters.com/gfx/rngs/TRAVIS%20HARTMAN/010051RR403/index.html

Sound familiar?

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Graphic-for-2-4-2019-pdf

stress

Conclusion

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The “HEMLINE STOCK INDEX”

Hemline Index

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

By Sen G. TODD; Esq., CPA, CFP, MTax

To make a thorough or dramatic change

  1. Begin by taking the first step
  2. Will you make things change or will you let change happen to you
  3. Define your outcome
  4. If it was easy everyone would be a multi-millionaire – it is if you work with the right professional

Have you honestly considered what YOU get from planning? Your safe and secure retirement is YOUR responsibility. What steps should you take – If your climbing Mt. Everest, you don’t do it alone – you follow your Sherpa to guide you there. Why, they have already done this many times and are there to help you. This is similar to working with Estate Management Counselors – we are your guide – we have already assisted others in making the decisions you face.

Taking advantage of THE BUNDLE

To a prosperous and happy 2021!!

Sean G. Todd, Esq., M. Tax, CFP®, CPA

P.S. Your tax, estate and financial plan – done: THE BUNDLE

LISTEN HERE: https://professional-edge.captivate.fm/episode/transform-s2

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Understanding Medical Cost Accounting

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A Subset of Managerial Accounting

By Dr. David E. Marcinko MBA CMP®

By ME-P Staff Reporters

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Managerial and medical cost accounting is not governed by generally accepted accounting principles (GAAP) as promoted by the Financial Accounting Standards Board (FASB) for CPAs. Rather, a healthcare organization costing expert may be a Certified Cost Accountant (CCA) or Certified Managerial Accountant (CMA) designated by the Cost Accounting Standards Board (CASB), an independent board within the Office of Management and Budget’s (OMB) Office of Federal Procurement Policy (OFPP).

The Cost Accounting Standards Board

CASB consists of five members, including the OFPP Administrator who serves as chairman and four members with experience in government contract cost accounting (two from the federal government, one from industry, and one from the accounting profession). The Board has the exclusive authority to make, promulgate, and amend cost accounting standards and interpretations designed to achieve uniformity and consistency in the cost accounting practices governing the measurement, assignment, and allocation of costs to contracts with the United States.

Codified at 48 CFR

CASB’s regulations are codified at 48 CFR, Chapter 99.  The standards are mandatory for use by all executive agencies and by contractors and subcontractors in estimating, accumulating, and reporting costs in connection with pricing and administration of, and settlement of disputes concerning, all negotiated prime contract and subcontract procurement with the United States in excess of $500,000. The rules and regulations of the CASB appear in the federal acquisition regulations.

North American Industry Classification System (NAICS) codes are used to categorize data for the federal government.  In acquisition they are particularly critical for size standards.  The NAICS codes are revised every five years by the Census Bureau.  As of October 1, 2007, the federal acquisition community began using the 2007 version of the NAICS codes at www.census.gov/epcd/www/naics.html

Cost Accounting Standards

Healthcare organizations and consultants are obligated to comply with the following cost accounting standards (CAS) promulgated by federal agencies:

  • CAS 501 requires consistency in estimating, accumulating, and reporting costs.
  • CAS 502 requires consistency in allocating costs incurred for the same purpose.
  • CAS 505 requires proper treatment of unallowable costs.
  • CAS 506 requires consistency in the periods used for cost accounting.

The requirements of these standards are different from those of traditional financial accounting, which are concerned with providing static historical information to creditors, shareholders, and those outside the public or private healthcare organization.

AssessmentTwo Doctors

Functionally, most healthcare organizations also contain cost centers, which have no revenue budgets or mission to earn revenues for the organization.  Examples include human resources, administration, housekeeping, nursing, and the like.  These are known as responsibility centers with budgeting constraints but no earnings.  Furthermore, shadow cost centers include certain non-cash or cash expenses, such as amortization, depreciation and utilities, and rent. These non-centralized shadow centers are cost allocated for budgeting purposes and must be treated as costs http://www.CertifiedMedicalPlanner.org

MORE:  CASE MODEL EOQ 1

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Activity-Based-Medical-Cost Accounting and Management

A Non-Traditional Accounting System

[Dr. David Marcinko MBA and Staff Writers]CPA

Sooner or later you will want to ascertain and then demonstrate the cost effectiveness of your medical care. By using the process of Activity Based Cost (ABC) management, you will be able to do so.  But, if you’re using a traditional accounting system, you won’t know a thing about your activity costs. Here’s how. 

Traditional Cost Accounting Methods 

In a traditional medical practice cost accounting system, costs are assigned to different procedures and services based on volume.  In others words, office costs are spread over the entire office’s product line and you may not know the true profitability of any single medical activity. So, if the office is doing more “procedures” than general medicine, for example, more indirect office overhead costs will be allocated to the procedural portion of the practice. 

ABC management, on the other hand, determines the actual costs of the resources that each service consumes. Because general medicine requires more human resources than “technical procedures,” ABC management will assign more costs to the general medical portion of the practice. 

Accordingly, most physicians, office managers, and their accountants are surprised that a prior notion of office profitability is different than previously thought. ABC management is just more accurate in measuring medical service profitability than traditional accounting methods. 

Medical Activity Cost Drivers 

Examples of medical activities that are office cost drivers include such items as monitoring vital signs, taking radiographic images, removing dressings or casts, performing laboratory tests or veni-punctures, surgical set-ups or operative procedures; etc.  

However, in the office setting, the most economically important activities are listed as specific CPT codes for each medical specialty.  The most important end result of ABC management is the shift of general overhead costs to low volume services from high volume services. These effects are not symmetrical as there is a bigger dollar effect on the per-unit costs of the low volume service.  

ABC Managerial Accounting Improvements 

ABC management improves office managerial cost accounting systems in three ways: 

  1. It increases the number of cost pools used to accumulate general overhead office costs. Rather than accumulate overhead costs in a single office-wide pool, costs are accumulated by activity, service or procedure.
  2. It changes the base used to assign general overhead costs to services or patients. Rather than assigning costs on the basis of a measure of volume (employee or doctor hours), costs are assigned on the basis of medical services or activities that generated those costs.
  3. It changes the nature of many overhead costs in that those formerly considered indirect, are now traced to specific activities or services. The office service mix may then be adjusted accordingly, for additional profit.   

Methodology 

In order to perform an ABC analysis for your medical office, calculate the cost of delivering a single unit of medical or surgical activity using only the work component of the resource based relative value scale (RBRVS).

Do this by adding up your office’s average variable expenses for the prior 1-3 years.  Now, count the number of work resource based relative value units (RBRVUs) delivered for each CPT code for the same time period, using the latest edition of the Federal Register to obtain the latest list of RVUs by CPT code. Then divide total variable expenses by the total number of work RVUs in order to arrive at the marginal cost of a single unit of service for the time period being evaluated.

For example, if your office had variable expenses of $480,000, and produced 80,000 work RVUs last year, it cost $6, on top of the office’s fixed expenses, to deliver one unit of work product. So, if an HMO plan offers to reimburse you at a rate of $11 per member, per month, and you can expect to reasonably deliver on average of one RVU pm/pm, you’ll earn enough on the contract to cover your marginal costs and some of your fixed and direct expenses. 

CASE MODELs: CVPA 4 and CVPA 3

dhimc-bookAssessment

Remember, this method assumes that you have the excess operating capacity and time slots, available and unused, to see the additional patients of the new plan without adding extra overhead expenses to service the contract.

If not, or if you plan for capitation to become a major portion of your practice, you might want the capitated contract(s) to cover all your office expenses, so be sure to include both the fixed and other direct costs to your variable cost calculations. ABC determines the actual costs of resources rendered for each activity and represents a real measure of practice profitability. Office service mix can then be changed to either maximize revenues or better suit your practice personality.

A Caveat

Suppose however, that a medical service is competitively priced but still shows that the CPT code is unprofitable. For example, the costs of special requests can adversely affect office profits. Yet, special patient requests are one of the biggest reasons that a CPT code or procedure isn’t profitable.

In this case, look closely at activity costs and determine which ones are being performed inefficiently. Improving the efficiency of those kinds of medical services, or referring them out or abandoning them all together, will increase office profitability.

MORE: ABCM

Conclusion

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The “Deeper Dive” Costs of College Debt

Unintended Consequences?

[By Rick Kahler MSFS CFP]  [Dr. David Marcinko MBA]

Not only is a college education a door to higher wages, but providing that education is an important segment of our economy and a huge source of good paying jobs.

In 2017 the average salary for the country’s 624,822 full-time college instructors was $82,240, according to an annual study from the Department of Education’s National Center of Education Statistics.

The old days

In the days before college loans were as easy to get as the common cold, college costs were due in cash. Students and parents had to save money or pay tuition out of their earnings. Many students worked their way through college. Those without savings, the ability or desire for college jobs, or high enough grades for scholarships didn’t go to college.

Since colleges competed for students, market forces controlled the tuition rates. Raising tuition too much resulted in fewer students and smaller revenues. The two forces of supply (college capacity) and demand (the ability to pay tuition) kept college costs in check.

Understandably, borrowing to pay for college tuition was difficult. What sane bank or investor would loan money to an unemployed teenager with no collateral to speak of? If you could find someone willing to make such a risky loan, the interest rate was high.

Politics

Well-intended politicians decided it wasn’t fair that those without the means to pay tuition were denied college educations. Their solution was to require taxpayers to underwrite college loans, sometimes at interest rates lower than those available to the most creditworthy.

With tuition money easy to obtain through low-cost, government backed loans, demand for a college education increased. With the increased demand came higher tuition costs. This easy money is the primary reason that college tuition costs have far outpaced inflation and have gone up twice as fast as medical costs since 1985.

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Consequences

Unfortunately, one consequence of loaning money to those deemed poor risks is that a high percentage of those borrowers are unable to repay the debt.  It should come as no surprise that 10.7% of all student loans are currently 90 days or more in default. Conversely, the composite default rate on mortgages, credit cards, and auto loans is 0.82% as of October 2018.

Today, taxpayers are on the hook for over 92% of the $1.5 trillion in outstanding student loans made to over 44 million borrowers, according to a June 13, 2018, Forbes article by Zack Friedman, “Student Loan Debt Statistics in 2018.” Only home mortgages exceed student loan debt.

And the appetite for loans continues to rise. The average student from the Class of 2016 graduated with over $37,000 of college debt. It isn’t uncommon for a medical student to amass over $200,000 of student loan debt. This year we will add another $120 billion in college debt to the books.

The more college debt that graduates take into the workplace, the less they have to spend for vehicles, rent, and consumer goods. The damage to the credit ratings of the 10.7% who are in default will also hinder their purchasing power for years to come.

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Assessment

If taxpayers ever decide to quit footing the bill, my hunch is that many colleges’ tuition rates will fall as hard as housing prices did in Florida, Arizona, and California in 2009. Lower tuition costs would create a financial hardship for most colleges and the some 4,000,000 people employed in higher education.

Politically, I don’t expect that to happen. Colleges are big business with a lot of money and influence in Congress. Further, a college education is becoming viewed as a right that should be free. In the meantime, savvy students will do whatever they can to minimize their college tuition and graduate debt-free.

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Coaching

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Conclusion

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DOCTORS:

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

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

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PODCAST: Principle-Agent Problems in Employee Health Plans

By Eric Bricker MD

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New Medical Practice Entrepreneurial Business Rules for Young Physicians [circa 2022]

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Go “Out-of-Box” – OR – Go Employee

By Dr. David Edward Marcinko MBA CMP™ www.CertifiedMedicalPlanner.org

There are more than 950,000 physicians in the United States. Yet, the brutal supply and demand, and demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. More so, going forward with the PP-ACA OR, perhaps not so much after the Trump election.

Furthermore, many large health care corporations, hospitals, and clinical and medical practices have not been market responsive to this change. Some physicians with top-down business models did not recognize the changing health care ecosystem or participatory medicine climate. Change is not inherent in the DNA of traditionalists. These entities and practitioners represented a rigid or “used-to-be” mentality, not a flexible or “want-to-be” mindset.

Yet today’s physicians and emerging Health 2.0 initiatives must possess a market nimbleness that cannot be recreated in a command-controlled or collectivist environment. Going forward, it is not difficult to imagine the following rules for the new virtual medical culture, and young physicians of the modern era.

A. Rule 1

Forget about large office suites, surgery centers, fancy equipment, larger hospitals, and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manners, or competitive advantage can outfox a slew of insurance companies, Certified Public Accountants, or the Associate Management Accountant, while still serving patients and making money. It is now a unit-of-one economy where “ME Inc.,” is the standard. Physicians must maneuver for advantages that boost their standing and credibility among patients, peers, and payers.

Examples include patient satisfaction surveys, outcomes research analysis, evidence-based-medicine, direct reimbursement compensation, physician economic credentialing, and true patient-centric medicine. Physicians should realize the power of networking, vertical integration, and the establishment of virtual offices that come together to treat a patient and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not a magnificent office suite or onsite presence.

B. Rule 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus, and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking.” Do traditionalists or collective health care reform advocates react rationally or irrationally?

For example, some health care competition and career thought-leaders, such as Shirley Svorny, PhD, a professor of economics and chair of the Department of Economics at California State University, Northridge, wonder if a medical degree is a barrier—rather than enabler—of affordable health care. An expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

C. Rule 3

Differentiate yourself among your health care peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors must create and innovate, not blindly follow entrenched medical societies into oblivion.

For example, the establishment of virtual medical schools and hospitals, where students, nurses, and doctors learn and practice their art on cyber entities that look and feel like real patients, can be generated electronically through the wonders of virtual reality units.

D. Rule 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of quick change with fast, but informed decision making. Do what you love, disregard what you do not, and let the fates have their way with you.

Assessment

I receive a couple of phone calls each month from young doctors on this topic. I ask them to decide if they are of the philosophical ilk to adhere to the above rules; or become another conformist and go along … to get along? In other words, get fly!

Or, become an employed, or government doctor.  Just remember … the entity that gives you a job, can also take it away.

Sample fly: http://crossoverhealth.com/

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What President Biden’s Student Loan Forgiveness Means for Doctors

By Joe Hannan

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Key Takeaways

President Biden’s student loan forgiveness plan may offer some relief to residents, but many attending physicians will not be eligible.

  • Residents may see $10,000 to $20,000 in debt cancellation, plus a reduction in their monthly payments if they are on an income-driven repayment plan.
  • Clinicians should review the requirements to see if they are eligible. They should also keep tabs on developments with the Public Service Loan Forgiveness (PSLF) program, which could also help eliminate their debt.

Source: Joe Hannan, MD Linx [8/26/22] 

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

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PODCAST: Hospitals Block Guiding Patients

By Eric Bricker MD

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Invite Dr. Marcinko to Mask-Up and Speak at your Next Seminar, Webcast or Event?

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The Choice is Up to You

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

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

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My Fond Farewell to Tuskegee University

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PODCASTS: The “Long Fix” for America’s Healthcare Crisis

By Vivian Lee MD PhD MBA

Politics and Prose

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ERIC BRICKER MD PODCAST: https://www.youtube.com/watch?v=fbXM44YSBfs

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Inflation and Crypto-Currency

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By Staff Reporters

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The inflation-proof nature of cryptocurrency works in the same way as stocks– inflation will cause prices to increase so companies can charge more for their goods which means people are willing to pay.

However, since cryptocurrencies are fairly new and not backed by anything at this point it’s better if they make up a small portion of your portfolio instead of trying to go all in with one coin unless you have enough money lying around where losing some won’t hurt too much.

A lot of corporate investment portfolios have started to include crypto because let’s face it, inflation matters.

***

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Only 7 % of mHealth apps have more than 50,000 monthly active users

Best mHealth user retention concepts
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By Stela Nikolova
Research2Guidance
phone: +49  176 819 26976
email: stela.nikolova@research2guidance.com
www.research2guidance.com

Dear David,

Please find below Research2Guidance’s latest digital health article: “Only 7 % of mHealth apps have more than 50,000 monthly active users – Best mHealth user retention concepts“.

User retention for digital healthcare solutions is still a major issue. Only 7% of mHealth app portfolios count more than 50,000 active users. mHealth publishers know that to become a daily companion, mobile health apps must be individualized, easy to work with and offer real value to their users. Having a good share of active users offers them more business opportunities.

Which user retention concepts work best for mHealth apps?

Thank you for your time.
Conclusion

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The DENTAL Witness Stand

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By Darrell Pruitt DDS

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Today I was on the witness stand in a Dallas County courthouse for 2 hours testifying as an expert witness in an injury case involving a dentist who failed to pay attention to a patient’s safety. The three year old girl was brought into the dental operatory while hugging her mom, face-to-face. The mom and child were in that same position when they were seated in the dental chair – with the child’s legs straddling her mom’s waist, and extending a few inches beyond the back of the chair.

The dentist entered the operatory and reclined the chair by pushing a button on the control module. The hinge mechanism severely pinched the child’s right foot, breaking all 5 metatarsals. She will have problems with her foot the rest of her life.

The lesson, Doc: Never ever recline a dental chair unless all limbs are visibly clear of pinch points.

***
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PODCAST: Inflation Reduction Act [IRA] and Healthcare

THE AGENDA 2022 AND BEYOND!

By Eric Bricker MD

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“Rules-of-Thumb” and Medical Practice Valuation Benchmarks

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Busting another Myth of Medical Practice Appraisal

[By Dr. David Edward Marcinko; MBA, CMP™]

[Publisher-in-Chiefdr-david-marcinko]

For doctors, buying or selling a practice may be the biggest financial transaction of their lives. 

Reasons for appraising practice worth include: succession, retirement and estate planning; partnership disputes and divorce; or as an important tool for organic growth and strategic planning.

However, the transaction is fraught with many pitfalls to avoid and no medical specialty seems immune. 

Valuation Difficulties 

For example, we recall the MD who asked her accountant for the “value” of her practice and was correctly given its lower “book value”, rather than its higher “fair-market-value” as a profitable ongoing-concern. The doctor lost tens-of-thousands-of-dollars in a subsequent attorney-driven sales transaction.

Although her CPA produced correct figures for exactly what was requested, the doctor and attorney did not differentiate between the two terms-of-art.  Later legal mediation determined that neither was responsible for the linguistic error, as both parties acted in good-faith.

Of course, it was the doctor who paid dearly for her mistake in communication and business acumen.  

“Rules-of-Thumb” [aka: benchmark formulas or calculations] 

And so, in the stable distant past, physicians occasionally used “rules of thumb” formulas to value their medical practices. 

“Rules” typically were expressed as benchmark calculations, formulas or multipliers (e.g. “one times revenues” or “five times cash flow”).  

Today, because of the economic volatility in the healthcare industrial complex, “rules of thumb” should not be used to value any medical practice (other than as general internal managerial sanity checks).  

Moreover, they are fraught with legal liability should the deal sour, and such benchmarks general hold little to no weight with the IRS. 

Case example [the tale of two identical medical practices] 

Economically, for example, consider two medical offices, each earning $1 million in gross revenues; both worth $1.5 million (according to a “rule of thumb” that a medical practice is worth 1½ times annual revenues).  Yet, in reality Medical Office #1 is worth twice Medical Office #2.   

How is this possible?   

The answer is because Medical Office #1 is a newer practice in a hot neighborhood that did $500,000 last year, $1 million this year; and projects to do even more next year.  Its property, instruments, HIT and medical equipment is new; aggressive young physician-executive management and medical training is excellent.   

Medical Office #2 is an older practice located in a low-income area, revenues were $2 million a few years ago and have fallen to the current level; the practice has a leaky roof, old equipment and lots of deferred maintenance, etc.  HMO patients abound, with declining reimbursement rates and an older practitioner.  

Assessment 

So, although much more complicated than the above simple example, we can now see how “rule-of-thumbs” can mislead more often than inform. 

Yet, we might also ask why they are still used by some misinformed doctors?  

Simplicity and inertia is the answer, according to Hope Rachel Hetico; RN, MHA a valuation professional and Certified Medical Planner™ from the Institute of Medical Business Advisors Inc, in Atlanta GA www.MedicalBusinessAdvisors.com 

And, the cost of a benchmark “rule-of-thumb” valuation is hard to beat; $0. Keep in mind that in most cases, you will want to ensure the value determination will stand up to IRS scrutiny, so the $0 rule-of-thumb is not really an option  

The Case of Edgar versus Berg 

Legalistically, a landmark legal case in business valuation was the Estate of Edgar A. Berg v. Commissioner (T. C. Memo 1991-279). The Court criticized the CPAs as not being qualified to perform valuations, failing to provide analysis of an appropriate discount rate, and making only general references to justify their “Opinion of Value.”  

In rejecting these experts, the Court accepted the IRS’s expert because he possessed the background, education and training; and developed discounts, and demonstrating how reproducible evidence applied to the assets being examined.  

Assessment 

The Berg decision marked the beginning of the Tax Court leaning toward the side with the most comprehensive appraisal. Previously, it had a tendency to “split the difference.”  

Now, some feel the Berg case launched the business valuation profession.

MORE: https://medicalexecutivepost.com/2017/11/03/traditional-reasons-for-a-medical-practice-valuation/

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

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Invite Dr. Marcinko

On Wall Street’s Suitability, Prudence and Fiduciary Accountability

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Financial Advisor’s are Not Doctors!

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Dr. David E. Marcinko FACFAS MBA CMP™ MBBS

THRIVE-BECOME A CMP™ Physician Focused Fiduciary

http://www.CertifiedMedicalPlanner.org

Financial advisors don’t ascribe to the Hippocratic Oath.  People don’t go to work on “Wall Street” for the same reasons other people become firemen and teachers.  There are no essays where they attempt to come up with a new way to say, “I just want to help people.”

Financial Advisor’s are Not Doctors

Some financial advisors and insurance agents like to compare themselves to CPAs, attorneys and physicians who spend years in training and pass difficult tests to get advanced degrees and certifications. We call these steps: barriers-to-entry. Most agents, financial product representatives and advisors, if they took a test at all, take one that requires little training and even less experience. There are few BTEs in the financial services industry.

For example, most insurance agent licensing tests are thirty minutes in length. The Series #7 exam for stock brokers is about 2 hours; and the formerly exalted CFP® test is about only about six [and now recently abbreviated]. All are multiple-choice [guess] and computerized. An aptitude for psychometric savvy is often as important as real knowledge; and the most rigorous of these examinations can best be compared to a college freshman biology or chemistry test in difficulty.

Yet, financial product salesman, advisors and stock-brokers still use lines such as; “You wouldn’t let just anyone operate on you, would you?” or “I’m like your family physician for your finances.  I might send you to a specialist for a few things, but I’m the one coordinating it all.”  These lines are designed to make us feel good about trusting them with our hard-earned dollars and, more importantly, to think of personal finance and investing as something that “only a professional can do.”

Unfortunately, believing those lines can cost you hundreds of thousands of dollars and years of retirement. 

More: Video on Hedge Fund Manager Michael Burry MD

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Suitability Rule

A National Association of Securities Dealers [NASD] / Financial Industry Regulatory Authority [FINRA] guideline that require stock-brokers, financial product salesman and brokerages to have reasonable grounds for believing a recommendation fits the investment needs of a client. This is a low standard of care for commissioned transactions without relationships; and for those “financial advisors” not interested in engaging clients with advice on a continuous and ongoing basis. It is governed by rules in as much as a Series #7 licensee is a Registered Representative [RR] of a broker-dealer. S/he represents best-interests of the firm; not the client.

And, a year or so ago there we two pieces of legislation for independent broker-dealers-Rule 2111 on suitability guidelines and Rule 408(b)2 on ERISA. These required a change in processes and procedures, as well as mindset change.

Note: ERISA = The Employee Retirement Income Security Act of 1974 (ERISA) codified in part a federal law that established minimum standards for pension plans in private industry and provides for extensive rules on the federal income tax effects of transactions associated with employee benefit plans. ERISA was enacted to protect the interests of employee benefit plan participants and their beneficiaries by:

  • Requiring the disclosure of financial and other information concerning the plan to beneficiaries;
  • Establishing standards of conduct for plan fiduciaries ;
  • Providing for appropriate remedies and access to the federal courts.

ERISA is sometimes used to refer to the full body of laws regulating employee benefit plans, which are found mainly in the Internal Revenue Code and ERISA itself. Responsibility for the interpretation and enforcement of ERISA is divided among the Department Labor, Treasury, IRS and the Pension Benefit Guarantee Corporation.

Yet, there is still room for commissioned based FAs. For example, some smaller physician clients might have limited funds [say under $100,000-$250,000], but still need some counsel, insight or advice.

Or, they may need some investing start up service from time to time; rather than ongoing advice on an annual basis. Thus, for new doctors, a commission based financial advisor may make some sense. 

Prudent Man Rule

This is a federal and state regulation requiring trustees, financial advisors and portfolio managers to make decisions in the manner of a prudent man – that is – with intelligence and discretion. The prudent man rule requires care in the selection of investments but does not limit investment alternatives. This standard of care is a bit higher than mere suitability for one who wants to broaden and deepen client relationships. 

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Prudent Investor Rule

The Uniform Prudent Investor Act (UPIA), adopted in 1992 by the American Law Institute’s Third Restatement of the Law of Trusts, reflects a modern portfolio theory [MPT] and total investment return approach to the exercise of fiduciary investment discretion. This approach allows fiduciary advisors to utilize modern portfolio theory to guide investment decisions and requires risk versus return analysis. Therefore, a fiduciary’s performance is measured on the performance of the entire portfolio, rather than individual investments 

Fiduciary Rule

The legal duty of a fiduciary is to act in the best interests of the client or beneficiary. A fiduciary is governed by regulations and is expected to judge wisely and objectively. This is true for Investment Advisors [IAs] and RIAs; but not necessarily stock-brokers, commission salesmen, agents or even most financial advisors. Doctors, lawyers, CPAs and the clergy are prototypical fiduciaries. 

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More formally, a financial advisor who is a fiduciary is legally bound and authorized to put the client’s interests above his or her own at all times. The Investment Advisors Act of 1940 and the laws of most states contain anti-fraud provisions that require financial advisors to act as fiduciaries in working with their clients. However, following the 2008 financial crisis, there has been substantial debate regarding the fiduciary standard and to which advisors it should apply. In July of 2010, The Dodd-Frank Wall Street Reform and Consumer Protection Act mandated increased consumer protection measures (including enhanced disclosures) and authorized the SEC to extend the fiduciary duty to include brokers rather than only advisors, as prescribed in the 1940 Act. However, as of 2014, the SEC has yet to extend a meaningful fiduciary duty to all brokers and advisors, regardless of their designation.

The Fiduciary Oath: fiduciaryoath_individual

Assessment 

Ultimately, physician focused and holistic “financial lifestyle planning” is about helping some very smart people change their behavior for the better. But, one can’t help doctors choose which opportunities to take advantage of along the way unless there is a sound base of technical knowledge to apply the best skills, tools, and techniques to achieve goals in the first place.

Most of the harms inflicted on consumers by “financial advisors” or “financial planners” occur not due to malice or greed but ignorance; as a result, better consumer protections require not only a fiduciary standard for advice, but a higher standard for competency.

The CFP® practitioner fiduciary should be the minimum standard for financial planning for retail consumers, but there is room for post CFP® studies, certifications and designations; especially those that support real medical niches and deep healthcare specialization like the Certified Medical Planner™ course of study [Michael E. Kitces; MSFS, MTax, CLU, CFP®, personal communication].

Being a financial planner entails Life-Long-Learning [LLL]. One should not be allowed to hold themselves out as an advisor, consultant, or planner unless they are held to a fiduciary standard, period. Corollary – there’s nothing wrong with a suitability standard, but those in sales should be required to hold themselves out as a salesperson, not an advisor.

The real distinction is between advisors and salespeople. And, fiduciary standards can accommodate both fee and commission compensation mechanisms. However; there must be clear standards and a process to which advisors can be held accountable to affirm that a recommendation met the fiduciary obligation despite the compensation involved.

Ultimately, being a fiduciary is about process, not compensation.

More: Deception in the Financial Service Industry

Full Disclosure:

As a medical practitioner, Dr. Marcinko is a fiduciary at all times. He earned Series #7 (general securities), Series #63 (uniform securities state law), and Series #65 (investment advisory) licenses from the National Association of Securities Dealers (NASD-FINRA), and the Securities Exchange Commission [SEC] with a life, health, disability, variable annuity, and property-casualty license from the State of Georgia.

Dr.Marcinko was a licensee of the CERTIFIED FINANCIAL PLANNER™ Board of Standards (Denver) for a decade; now reformed, and holds the Certified Medical Planner™ designation (CMP™). He is CEO of iMBA Inc and the Founding President of: http://www.CertifiedMedicalPlanner.org

More: Enter the CMPs

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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™

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

[Two Newest Books by Marcinko annd the iMBA, Inc Team]

Conclusion

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[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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PODCAST: Statistics in Health Care Finance

By Eric Bricker MD

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Specificity versus Sensitivity: https://medicalexecutivepost.com/2020/03/20/medical-laboratory-sensitivity-versus-specificity/

Correlation versus Causation: https://medicalexecutivepost.com/2021/02/05/correlation-is-not-causation/?preview_id=239347&preview_nonce=a2cdc51424&preview=true

False Positives and Negatives: https://medicalexecutivepost.com/2019/09/14/what-are-false-positive-and-false-negative-tests/

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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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PODCAST: Orthopedic Surgery Payment Changes in Total Knee and Hip Replacements

By Eric Bricker MD

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Physician Owned Hospitals Myths DeBunked

BY HEALTH CAPITAL CONSULTANTS, LLC

Literature Review Debunks Claims Against Physician-Owned Hospitals


Approximately 250 hospitals across the U.S. are completely or partially physician owned. These physician-owned hospitals (POHs) can offer a variety of services, from general care to specialty services, such as cardiovascular or orthopedic care, known as “focused factories.”

Over the past several decades, healthcare providers and policymakers have claimed that POHs have a negative impact on the healthcare industry, suggesting that: (1) POHs “cherry-pick” the most profitable patients; (2) the quality of care provided at POHs is substandard; and, (3) conflicts of interest exist due to the financial incentive for physician owners to refer patients to their POHs. (Read more…) 

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RELATED: 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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Of Doctors, Bull and Bear Markets

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DEM blue

Of Bull and Bear Markets

By Dr. David Edward Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A bull market is generally one of rising stock prices, while a bear market is the opposite. There are usually two bulls for every one bear market over the long term.

More specifically, a bear market is defined as a drop of twenty percent or more in a market index from its high, and can vary in duration and severity. While a bull market has no such threshold requirement to exist, other than they exist between these two periods of sharp decline.

Whither the Bear? 

As a doctor, your action plan in a bear market depends on many variables, with perhaps your age being the most important: 

In your 30s:

  • Pay off debts, school or practice loans.
  • Invest in safe money market mutual funds, cash or CDs.
  • Start retirement plan or 401-K account. 

In your 40s:

  • Increase your pension plan or 401-K contributions.
  • Stay weighted more toward equity investments.
  • Review your goals, risk tolerance and portfolio. 

In your 50s:

  • Position assets for ready cash instruments.
  • Diversify into stock, bonds and cash. 

Retirement:

  • Maintain 3 years of ready cash living expenses.
  • Reduce, but still maintain your exposure to equities.

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Bear + A Falling Stock Chart

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Assessment

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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[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™

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

Front Matter with Foreword by Jason Dyken MD MBA

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PODCAST: Submit a Financial Advisor Prospecting Video to Us [Experts Invited]

Welcome Financial Advisors

An Invitation to Prospect & Promote Your Self

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Healthcare Prospecting with FAs in Mind

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Join your ME-P peers and colleagues. Get free access to on-demand videos and other presentations from leading financial advisors [FAs] and brought to you by www.MedicalExecutivePost.com.

The ME-P is your source for the best online-exclusive content in the financial advisory marketing, and financial planning e-prospecting space, for all healthcare professionals [physicians, podiatrists, osteopaths, dentists, chiropractors, nurses, medical CXOs, etc].

How to Submit a Video

To submit a personal or product presentation video [pod-cast], sponsor a video [pod-cast], or inquire about specific advertising on the ME-P, please contact Ann Miller RN MHA at: 770.448.0769 or MarcinkoAdvisors@msn.com

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Acceptable 5-12 minute video formats include: Flash (in either SWF or FLA), MPEG, MP4, QuickTime or AVI. Submission of a podcast/video does not guarantee publishing on the ME-P website. FA submitted videos are subject to review by the Executive Editor. Company submitted videos are subject to review by the Publisher and Executive Editor.

SAMPLE PODCAST

In this encore podcast, Somnath Basu PhD MBA examines how the recent economic turmoil has changed financial planning clients’ attitudes and expectations.

White Paper: AgeBander

Dr. Basu is a popular ME-P contributor, commentator and “thought-leader”.

Basu Video Link: http://www.youtube.com/watch?v=jzAkB8h5v3Q

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Copyright © 2011 by the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com All rights reserved, USA. Opinions expressed by authors are their own and not necessarily those of iMBA Inc, the editorial staff, or any member of the editorial advisory board.

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TWO SKILLS: Physician Programmers Need to Know

By Joel Comm

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Machine Learning

The global machine learning market was valued at $15.44 billion in 2021, and it is expected to grow to $209 billion by 2029. Machine Learning is a technology that has grown in popularity over the past years, especially driven by the success of companies like Google in the field of AI.

This success is also in big part due to the technology becoming more accessible to the masses. Take OpenAI’s AI image generator, DALL-E, as an example: Since DALL-E Mini went public, it has been given uses ranging from making memes to artwork worth the attention of The New Yorker.

Gone are the days in which machine learning was only accessible to researchers in top-notch institutions. Today, machine learning can be mastered all around the globe in official institutions, online education platforms, and even via comics.

Web3 / Blockchain Development

Whether you are invested in crypto and NFTs or not, the Metaverse is being built, and it promises to turn centralized, corporate-controlled Web2 on its head. The world of computer users–that’s pretty much all of us–has, for years, grown increasingly frustrated by having to operate under the oversight of a few monoliths.

The promise of Web3 is community–not corporation–first.

Innovators in the space like Proof of Learn are developing easily accessible educational platforms where Web2 pros and the tech-interested can learn to code in Web3, in a learn and earn model. The company’s first project is a lore-rich online academy called Metacrafters.io, drawing in gamers and developers, and attracting some serious backing from leading VCs and crypto investors. Fellow industry leaders, such as Solana, Flow, Avalanche, and Polygon Foundations, recently gave $4.5 million in grant funding to support Metacrafters’ mission of upskilling Web2 developers. This grant helps fund their learn and earn protocol, so you get to take courses in a game world and get paid for it.

Metacrafters.io might be one with this learn and earn model teaching coding skills, but it is in line to inspire more of its kind. Look around at the landscape of Web3 education and get cracking, because the Metaverse will be here sooner than expected, and developers will be the major players in it.

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

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PODCAST: Amazon Pharmacy VS. GoodRx Drug Prices

A HEAD-2-HEAD COMPARISON

By Eric Bricker MD

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The NATIONAL Emergency Fund!

How Much?

By Staff Reporters

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Grant Cardone is a self-made millionaire, author and sales training expert. He recommends hitting a lofty savings goal — $100,000 — and then investing any money earned after you hit that amount. “You need to prove to yourself that you can go out and get money,” he wrote in a 2018 post for CNBC. “Saving $100,000 shows that you have an ability to make money and then to keep it. Most people can’t do either of those things. Once you can earn and save, then you can start building wealth.”

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NEF: https://www.aol.com/finance/much-cash-stashed-national-emergency-113034956.html

READ HERE: https://www.msn.com/en-us/money/personalfinance/how-much-should-you-have-in-your-emergency-fund-3-financial-experts-weigh-in/ar-AAZZ8e3?cvid=87320afb8c6649f38290bea7b3da7b7e

PHYSICIANS: https://medicalexecutivepost.com/2007/12/05/emergency-funds/

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DICTIONARY: Health Insurance and Managed Care

Designated a Doody’s CORE TITLE

To keep up with the ever-changing field of health care, we must learn new and re-learn old terminology in order to correctly apply it to practice. By bringing together the most up-to-date abbreviations, acronyms, definitions, and terms in the health care industry, the Dictionary offers a wealth of essential information that will help you understand the ever-changing policies and practices in health insurance and managed care today. For Further Information.

Review

The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion therefore is to ‘read it, refer to it, recommend it, and reap’.”
Michael J. Stahl,PhD, Physician Executive MBA Program, William B. Stokely Distinguished Professor of Business, The University of Tennessee, College of Business Administration

DHIMC: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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HOW: The ME-P Helps Your Financial Advisory Business or Medical Practice Grow?

All about the Medical Executive-Post Business Model

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One of the questions we receive most often from readers of the Medical Executive-Post is how can we “afford” to give away so much content for free. Or stated another way, “how do we get paid for all of this?”

The simple answer is that we know many (or even most) of you will simply take the ideas that we share and implement them yourself. Do-It-YourSelfers can always simply purchase our texts, books and peer reviewed handbooks redacted in more than a thousand, medical, law, business and graduate schools, as well as the Library of Congress, Institute of Health and Library of Congress.

LINK: https://medicalexecutivepost.com/2021/10/22/why-are-certified-medical-planner-textbooks-so-darn-popular/

On the other hand, some of you will realize you need some additional help.

For example:

Maybe as a financial advisor you’re “stuck” in your financial planning business and recognize that some outside assistance is necessary to help you get to the next level of niche specificity thru our Certified Medical Planner™ chartered certification program designation. Helping physicians of all specialty types in a fiduciary focused manner is the proverbial Win-Win for all concerned.

LINK: http://www.CertifiedMedicalPlanner.org

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OR, perhaps you are seeking a glossary of terms and definitions in heath economics, finance, accounting, insurance, managed care, health information technology and security; found in our Health Dictionary Series Wiki Project? Free and print versions are available.

LINK: http://www.HealthDictionarySeries.org

LINK: https://medicalexecutivepost.com/2011/09/17/order-our-three-newest-best-selling-dictionaries/

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OR, as a doctor maybe your medical practice is growing so much you just hit a wall where you don’t have time to do it all for your patients. After all, with only “so much” time available every day and week, it’s vital to delegate or outsource anything that isn’t really core to your practice and management skill set.

LINK: http://www.MedicalBusinessAdvisors.com

OR, maybe you are even starting, buying or selling your medical practice and need our financial and valuation services. Part (1) – Part (2) – Part (3) Financial, estate, investing and retirement planning services are also available.

OR, you may just need a second informed opinion about a topic not listed; there are a myriad of issues to consider in the competitive ecosystem today.

LINK: https://medicalexecutivepost.com/schedule-a-consultation/

Regardless, we may have solutions to help!


So, in the meantime, I hope that the ME-P content continues to be helpful food for thought, and perhaps we’ll have an opportunity to cross paths soon at a future conferences or podcasts. Feel free to invite us to speak at your own seminar/podcast online V-log, as well.

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

With warm regards.

Fraternally.
Ann Miller RN MHA CMP

[Managing Director]

email: MarcinkoAdvisors@msn.com

Phone: 770-448-0769

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PODCAST: Hospital CFOs Found Doctors Drive $1.56 Million / Doctor / Year by Ordering Tests and Performing Procedures!

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By Eric Bricker MD

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AMA ECONOMICS: https://medicalexecutivepost.com/2022/08/01/ama-to-teach-medical-students-about-health-economics/

Health Economics: https://medicalexecutivepost.com/2022/07/31/podcast-history-applied-to-health-economics/

DHEF: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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OUR NEW RADIO SHOW: Listen to Estate Management Consultants

The Professional Edge Radio Show

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By Sean G. Todd Esq., CPA, MTax, CFP™

[Registered Investment Advisor]

Sean G. Todd draws upon the substantial knowledge of tax and financial planning which he gained in his 20+ years of practice.  Sean is a licensed attorney with a Master of Taxation degree.  Sean is also a licensed Certified Financial Planner™ practitioner and a Certified Public Accountant.  He has extensive experience in the areas of Tax, Estate and Financial Planning.  Sean has been an adjunct professor at Oglethorpe University and Emory University in Atlanta.  He is currently teaching Federal Income Tax Planning at The University of Georgia.

Sean earned his Bachelor of Science in Business from Indiana University and his law degree from Ohio Northern College of Law.  In addition, Sean continued his education with a specialization in tax by earning a Master of Taxation degree from The University of Akron.  Sean has been a featured speaker at the National Self Storage Association meeting in Las Vegas, Nevada on several occasions.  He also lectures on topics dealing with estate and financial planning and the new tax laws. 

Clients benefit when working with Sean because of his practical experience. He has completed over 2,000 estate and financial plans for individuals and business owners in the State of Georgia, and clients also benefit from his professional training in investments, finance, accounting, estate planning, taxes and the law.  He has an unmatched ability to coordinate all the moving parts to objectively evaluate and provide effective professional advice to his clients. 

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Tune in Sundays 9-10:00 am EST

Topics include:

  • Tax Strategies
  • IRA Distribution Strategies
  • Retirement Income
  • Estate Planning
  • Asset Protection, and much more!

HISTORICAL REVIEW LISTEN HERE: https://www.emcadvisors.com/radioshow.html

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Editor’s Note: Be sure to visit and subscribe to this ME-P to learn much more from Sean G. Todd. He has deep subject matter expertise of the topics presented aligned with a pragmatic medical perspective from his sister who practices in the Midwest. And, be sure to directly tune into Professor Sean Todd’s own: “The Professional Edge Radio Show” every Sunday at 9-10 am, EST.

Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

THANK YOU

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Coordinated Actions Indicate Growing Scrutiny of Tele-Medicine

By Health Capital Consultants, LLC

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GROWING SCRUTINY OF TELE-MEDICINE

On July 20, 2022, the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) released a Special Fraud Alert on telemedicine. On the same day, the U.S. Department of Justice (DOJ) announced a “nationwide coordinated law enforcement action” against 36 defendants, and the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity announced administrative actions against 52 providers, related to alleged telemedicine arrangements. These coordinated actions indicate a growing scrutiny of telemedicine arrangements by federal government regulators. (Read more...) 

RELATED: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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A Fiduciary Comes with Responsibilities to the Client

By Stephen Kelley, CSA

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As a Registered Investment Adviser (RIA) with a Series #65 securities license, we hold a fiduciary duty to you. This means that we are legally bound to put your interests above those of anyone else, including ourselves.

Now you might reasonably think that anyone offering financial advice or services to clients is required to be a fiduciary. Sadly, if you thought that, you’d be wrong. Some estimates claim that only 15 percent of advisors have a fiduciary duty to their clients. The Paladin Registry puts the number even lower, estimating that just one in 12 (8.3 percent) advisors have a fiduciary responsibility.

For the most part, stockbrokers (also called “Registered Representatives,” “Account Executives,” “Financial Advisors,” or “Wealth Managers”) are not fiduciaries, even though they are allowed to portray themselves as full-service investment advisors. If your stockbroker/registered representative/account executive/financial advisor/wealth manager holds a series seven [#7] securities license, then it’s probable that they aren’t a fiduciary.

This was made amply clear in the movie, “The Wolf of Wall Street,” a biopic about Jordan Belfort, a stockbroker who made his fortune selling junk stocks and bonds to middle-class investors: in other words, by cheating them. Much of it was perfectly legal. The SEC went after Belfort’s company, Stratton Oakmont, for nearly a decade before it was able to shut it down. The point being that even in the face of egregious wrongdoing, theft, fraud and a virtual sea of drugs and blatant hedonism, the securities laws in this country are so loose that it took billions in theft and a decade of suspected and known fraud to step in and stop the abuse. And this movie was based on a true story.

That’s why a fiduciary duty is so important to a client. Being a fiduciary is a legal distinction. A Registered Investment Advisor (RIA) or Investment Advisor Representative (IAR) who holds a Series #65 securities license, subject to the Investment Advisers Act of 1940, is a fiduciary. The legal investment advising standards that govern a non-fiduciary stockbroker and a fiduciary Registered Investment Advisor are very different.

A Registered Investment Advisor is legally required to follow the “trust” standard — the highest known in law — which requires it to place the interests of its clients ahead of its own and fulfill critical fiduciary duties of trust and confidence. Under the fiduciary trust standard, a Registered Investment Advisor must provide its “best advice” to a client. A non-fiduciary stockbroker (like the coveted Series #7 of “The Wolf of Wall Street”) follows only the “suitability” standard, which doesn’t require a stockbroker to place the interests of his clients ahead of its own. Under the non-fiduciary suitability standard, a stockbroker need provide only “suitable advice” to his clients — even if the stockbroker knows that the advice is not the best advice for the client.

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The table below helps summarize which professionals are fiduciaries.

Type of ProfessionalAre They A Fiduciary?
PhysicianYes
LawyerYES/Maybe
CPANo
Trust OfficerYes
Stock BrokerNo
Insurance AgentNo
Registered RepresentativeNo
CFP PractitionerMaybe
Financial PlannerMaybe
Registered Investment AdviserYes
NAFPA-Registered Financial AdvisorYes

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MORE: https://medicalexecutivepost.com/2022/05/21/an-interview-with-bennett-aikin-aif/

RELATED: https://www.kitces.com/blog/the-4-different-types-of-financial-advisor-fiduciaries/

CFPs: https://medicalexecutivepost.com/2016/11/18/why-we-cannot-assume-cfp-equals-fiduciary/

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

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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.

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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™

PODCAST: “Regulatory” Capture in Healthcare

By Eric Bricker MD

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MORE: https://medicalexecutivepost.com/2016/08/12/the-regulatory-capture-of-american-medicine-by-the-drug-and-alcohol-testing-assessment-and-treatment-industry/

BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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UPDATE: The Insulin Price Cap

By Staff Reporters

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Limiting the $35 cap on the price of insulin only to Medicare members is not that consequential, experts said. While the cost of insulin has skyrocketed over the years, many people with private insurance already pay no more than that amount. About a fifth of those who take insulin and have health coverage through large employers pay more than $35 a month for the medication, according to an analysis from the Kaiser Family Foundation. More than a quarter of people with Affordable Care Act policies and nearly one-third of those insured through a small employer pay more than that threshold.

Some private insurers and states are taking action to help Americans afford the drug. UnitedHealthcare will eliminate out-of-pocket costs for insulin for certain policyholders starting next year, while 20 states have placed caps on co-payments. Also, two drug makers are working on inexpensive versions of the insulin medication, while some other manufacturers are offering deep discounts for certain patients. “Bottom line is I don’t think stripping it out will have a major impact on the private sector,” Gerard Anderson, a professor of health policy and management at Johns Hopkins University, said of the insulin cap.

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

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

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The Subjective Theory of Bitcoin from a Physician

By Michel Accad MD

Michel Accad, MD, practices internal medicine and cardiology in San Francisco.

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READ: http://alertandoriented.com/the-subjective-theory-of-bitcoin/

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

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PODCAST: Health Literacy and its Role in Financial Literacy

By Eric Bricker MD

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

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