BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Good Evening
We’re not sure anyone’s administered a Halloween costume contest for almost 1million ME-P readers, but we’re going to give it a shot.
Subscribe, Like and Comment Reply to this post with a pic of your Halloween costume (PG-13 rated or less), and we’ll choose a winner[s] to shout out in a future ME-P.
In traditional finance transaction data is guarded by exchanges, brokers, banks and regulators. It’s not accessible to everyone and big players pay a fortune for it.
But, in crypto, Transaction Data is public and on-chain – but it’s not usable by everyone. So, manually making sense of raw blockchain data is practically impossible. The data needs to be processed and analyzed to be made useful. That’s what sophisticated blockchain analytics tools are doing.
The combination of on-chain data and transaction analysis is something that hasn’t been before – in crypto or traditional finance. Getting access to transaction data and tools for searching and analyzing it will unlock a goldmine of potential insight.
People who have been on the inside of projects and see how the sausage is made know that the explanations for price movements are often simple and based on key players buying and selling. When the biggest holders are dumping the price is likely to go down. When a major new buyer takes a position prices are likely to go up.
That’s insight traditional Technical Analysis cannot provide, because it’s limited to looking at price movements. Transaction data, instead, is the underlying activity that generates prices in crypto.
Also known as the internet bubble or the information technology bubble, the dotcom bubble was the unprecedented rise in equity valuations of internet-based tech companies during the bull market of the late 1990s.
Thanks mainly to speculation and substantial funding for these new internet start-ups, investments in dot-coms (named as such for the .com online top-level domain [TLD] used by such companies) boosted the NASDAQ Composite Index (COMP) from 751 in January 1995 to a peak of 5,048.62 on March 10, 2000. But the bubble eventually burst in March 2000, with many companies failing to even come close to fulfilling their promise. As such, the NASDAQ fell by more than 75 percent between March 2000 and October 2002, thus wiping out more than $5 trillion in market value.
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Some financial and economic analysts are beginning to compare this year’s tech rout (which has cost the NASDAQ $8 trillion in value so far) with the bursting of the dot-com bubble in 2000–2002, when the NASDAQ lost the equivalent of $8.6 trillion in today’s dollars. The industrial-focused Dow, on the other hand, is on track for its best October in history.
The FOMC is likely a lock to hike interest rates by a large75 basis points on Wednesday for the fourth straight meeting. Evidence that its inflation-fighting campaign is working could come on Friday, with the October jobs report.
Financial planning as a concept has been around for a long time, but not as we know it today. When Loren Dunton set up the Society for Financial Counseling Ethics in 1969, or when the first graduating class of the College of Financial Planning graduated in 1973, financial planning was very different. It was centered around selling limited partnerships, which came to end with the Tax Reform Act of 1986.
However, financial planning re-emerged — all thanks to Richard Averitt III. The certified financial planner gave new meaning to financial planning, this time with a focus on who the client is and what their needs are. This approach was purely methodological in nature.
Soon after, financial planning picked up again. According to the Certified Financial Planner (C.F.P.) Board of Standards in Denver, today, there are more than 94,000 C.F.P.s worldwide, including over 48,000 in the U.S. Additionally, there are also organizations that have been set up for C.F.P.s, such as the Financial Planning Association (FPA), which has approximately 22,000 members.
Financial planning, as we know it now, includes investing, tax planning, retirement planning, and basically other ways to get your finances in order and create mindful budgets to ensure a safe and secure future. Getting a step ahead of your spending and finances is beneficial in the long run and Financial Planning Month in October is the perfect time to do that.
DEFINITION: A a 30-year Treasury bond that protects you against inflation. It pays both a fixed interest rate and a rate that changes twice a year with inflation.
Interest is compounded semiannually, meaning every 6 months a new interest rate is applied to a new principal value that equals the prior principal plus the interest earned in the last 6 months. The bond’s value grows because it earns interest and because the principal value gets bigger.
You can buy $10,000 worth from the Treasury and another $5,000 using your tax refund. You can cash them in after 12 months, but if you do so in less than 5 years, you lose the last 3 months of interest.
Taxes on I Bonds?
You must pay federal income tax but no state and local taxes on I bonds. You can either report each year’s earnings or wait to report all the earnings when you cash the bond.
If you use the money for qualified higher education expenses, you may not owe tax on the earnings.
Current Interest Rates
The current the record high 9.62% interest rate on I bonds issued through October will drop Nov. 1st, 2022 to 6.48%.
One way to classify joints is by range of motion. Immovable joints include the sutures of the skull, the articulations between teeth and the mandible, and the joint located between the first pair of ribs and the sternum. Some joints have slight movement; an example is the distal joint between the tibia and fibula. Joints that allow a lot of motion (think of the shoulder, wrist, hip, and ankle) are located in the upper and lower limbs.
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KNEE: No bones about it
The $19.6b joint-replacement industry uses outdated methods, leading to 100,000 surgeries failing annually.Monogram aims to fix it with precision surgical robots + personalized implants.
Essentially, the HALLOWEEN INDICATOR is a market-timing strategy. It argues that, by buying into the stock market after Halloween and selling at the end of April, investors would generate a better annual return on their portfolio than if they had remained invested throughout the year. Sell in May and go away is an investment strategy for stocks based on a theory that the period from November to April inclusive has significantly stronger stock market growth on average than the other months
The practice of abandoning stocks beginning in May of each year is widely thought to have its origins in the United Kingdom. The privileged class would leave London and head to their country estates for the summer months, where they would largely ignore their investment portfolios. To this day, many stock market watchers have postulated that the corresponding impact of summer vacations on market liquidity and investors’ risk aversion is at least partly responsible for the difference in seasonal returns.
In what is considered to be a seminal piece of research on the subject, “The Halloween Indicator, ‘Sell in May and Go Away’: Another Puzzle,” authors Sven Bouman and Ben Jacobsen were among the first to document a strong seasonal effect in global stock markets. In 36 of the 37 developed and emerging markets they studied between 1973 and 1998, the authors found returns in the November through April period to be, on average, significantly higher than those in the May through October period, even after taking transaction costs into account. What puzzled the authors was the fact that, while the anomaly was widely known and seemed to offer considerable economic rewards, it had not been arbitraged away.
More recently, Jacobsen partnered with Cherry Zhang on a follow up study, titled, “The Halloween Indicator: Everywhere and All the Time,” and extended the research to 108 stock markets using all historical data available. The result was a sample of 55,425 monthly observations (including more than 300 years of UK data), which helped to rebut any criticisms of data mining and sample selection bias. The results were compelling, as the November through April “winter” period delivered returns that were, on average, 4.52% higher than the “summer” returns. The Halloween effect was evident in 81 out of 108 countries. The size of the Halloween effect varied across geographies. It was found to be stronger in developed and emerging markets than in frontier markets.
The future of healthcare will be defined by nurses. Giving them a platform where they can be seen, heard, and valued for what they contribute each and every day is healthcare innovation.
connectRN is an empowered community of nurses, helping them access the flexible work opportunities they want. Nurses use connectRN to find work, access resources, and get much-needed peer support. And healthcare facilities can get the staff they need to provide high-quality patient care.
From in-app shift scheduling to same-day pay to 24/7 support, connectRN offers nurses a modern, seamless, and stress-free experience. After all, thriving clinicians provide the best care.
U.S. Financial Planning Month is observed nationwide during October.
With the holiday season coming up (aka hefty gifting expenses) and the new year just around the corner, Financial Planning Month is a great opportunity to get your finances and budgets in order before life gets too busy.
Elon Musk, the richest person on the planet, is the CEO of the world’s most valuable automaker TESLA, heads up a $125 billion aerospace giant, and as of yesterday, is the owner of a social media company Twitter.
According to multiple reports, Musk closed the $44 billion deal last night, less than 24 hours before today’s 5pm ET deadline. He began his reign as “Chief Twit” by firing at least four executives, including CEO Parag Agrawal (who was reportedly escorted out of Twitter’s SF headquarters). Later today, Musk is expected to address anxious employees, who might be worried they’ll face the same fate as their former leader. Historically:
Musk acquired a large stake in Twitter and later signed a deal to buy all of it.
Then he tried to back out, citing bot issues, but Twitter sued him to enforce the agreement.
Musk blinked weeks ahead of a trial, and said he would buy Twitter.
Now What?
So begins Musk’s attempt to, in his words, “help humanity” by trying to turn Twitter into a “common digital town square.”
We know that Musk has ultra-ambitious goals for the company: 5x Twitter’s revenue by 2028, supercharge the subscriptions business, and turn Twitter into a super app called “X.” But murkier is the path he intends to take to get there, and he’s already sending mixed signals about his intentions. And what about doctors and the healthcare industrial complex? Will it remain the same or change?
History
Back in early 2014 the first list of the “Top 100 Twitter Accounts For Healthcare Professionals To Follow” was born. Then, the biggest social media-related question to hurdle wasn’t, “Who should I be following on social media?” but rather, “Should I even be on social media at all?”
Many years later, it’s safe to say that social media has firmly established itself in the healthcare industry. By finding healthcare Twitter accounts that are related to your specialty, you can have access to the best information and always remain within the loop.
But, with the Elon Musk takeover of Twitter, the medicine and healthcare accounts available may change, remain static or grow, and finding the most valuable medical accounts to follow has become more challenging than ever.
Today
Today, the question truly is, “Who should I be following?” Thankfully, you have been covered since 2020.
The New York Stock Exchange will suspend Twitter shares today as Elon Musk closes in on a takeover. Musk just bought the social media company for $44 billion after trying to walk away from the deal.
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Stocks Ended Mixed in Volatile Day Full of Reports
U.S. stocks finished mixed in a choppy trading session, as a host of earnings and economic news were released. The markets digested a second-straight 75 basis point rate hike by the European Central Bank (ECB).
Shares of Meta Platforms tumbled after missing earnings estimates and forecasting much higher-than-expected capital expenditures, while Dow members Caterpillar, McDonald’s, Honeywell, and Merck all rallied after beating earnings expectations.
The economic calendar is full as Q3 GDP growth came in stronger than expected, and weekly initial jobless claims were lower than anticipated, but durable goods orders missed forecasts. Treasury yields fell following the data, and the U.S. dollar rebounded from a recent drop amid the ECB rate hike.
Crude oil prices were higher, and gold dipped. Asia diverged as the markets remained choppy, while Europe ended higher following the ECB’s monetary policy decision and amid the flood of earnings reports.
EDITOR’S NOTE: In this interview with investment website @GuruFocus, my colleague Vitaliy shares the full gamut of how he invests, where and why. He touches on the role of being eclectic when investing, how to invest abroad, and how value investors should think about macro-economics and finance, among many other important topics. Enjoy this fun and wide-ranging interview! It is very timely with the S&P 500, DJIA and NASDAQ just posting their 4th straight day of gains while Facebook rattled investors by posting a rare profit decline, driven by the company’s heavy spending on its vision for a so-called Metaverse and simultaneously confronting advertising challenges on its existing services.
As Published in the Annals of Internal Medicine by an All-Star Cast of Researchers:
1) Limitations of Information 2) Inertia/Status Quo Bias 3) Choice Overload 4) Immediacy 5) Loss Aversion 6) Relative Social Ranking 7) Threshold Effect 8) Limits of Willpower 9) Mental Accounting
Plunging tech stocks are dragging the markets down and snapping a brief winning streak. Up next for the economy: The third-quarter GDP report.
America’s internet giants are slumping hard in this era of higher interest rates, lower advertising budgets, and widespread economic uncertainty
For example, Meta recently became the latest Big Tech company to post rough financial results for the prior quarter. It recorded its second straight quarter of declining revenue and provided a gloomy outlook for Q4. Perhaps Meta shouldn’t even be considered “Big Tech” anymore. Since its share price peaked in September 2021, the company lost nearly two-thirds of its value…before diving another ~20% in after-hours trading yesterday.
What went wrong? Younger people are fleeing Facebook, and investors aren’t confident CEO Mark Zuckerberg can reinvent the company as a metaverse platform. “Meta has drifted into the land of excess—too many people, too many ideas, too little urgency,” a prominent shareholder wrote this week in a scathing letter. Meta’s metaverse unit, Reality Labs, has lost $9.4 billion so far this year.
While Meta may be the poster child for Big Tech’s struggles, it’s not the only company that needs a checkup
Google parent Alphabet posted its slowest revenue growth since 2013 (outside of one early pandemic quarter), and YouTube ad sales actually fell in Q3. It’s “a tough time in the ad market,” CEO Sundar Pichai acknowledged. Alphabet shares had their worst day since March 2020.
And Microsoft also had its worst day since March 2020 after giving a disappointing forecast. Its push to dominate the metaverse is also faltering, per the WSJ.
Big view
Tech giants scored record profits during COVID, when interest rates were near zero, stimulus checks were flowing, and everyone was stuck inside with only the internet to entertain themselves. No anymore!
U.S. equities closed out a volatile session mixed as the markets digested a host of quarterly results with earnings season kicking into high gear. Information Technology and Communications Services sectors were the biggest laggards in the wake of disappointing reports from Google’s parent Alphabet, as well as Dow member Microsoft.
Meanwhile, Dow component Boeing was lower despite optimism about its free-cash flow performance, but Dow member Visa rallied following its results.
Housing data dominated the economic front today, with mortgage applications falling for a fifth-straight week, and new home sales dropping amid the spike in interest rates in September.
Treasury yields were lower and the U.S. dollar tumbled to alleviate some uneasiness in the markets, while a smaller-than-expected rate hike out of Canada appeared to also soothe some nerves.
Crude oil prices were sharply higher, and gold traded to the upside.
Asia finished higher though choppiness remained, while Europe saw widespread gains amid cautious trading ahead of tomorrow’s monetary policy decision from the European Central Bank.
Hospitals this year are seeing more red than black as growing financial challenges, like spiked labor costs and inflation on medical supplies, puts them on pace to have the worst financial performance into the pandemic thus far.
More than half of hospitals (53% of more than 900 sampled) are projected to have negative margins by the end of the year, compared to 39% in 2019, according to a September report from management consulting firm Kaufman Hall, on behalf of AHA. The firm put the median operating margin for hospitals at about -1%, which could mean service cuts, and for more vulnerable hospitals, including rural ones, closing their doors.
But why is the financial outlook so bleak for hospitals? A few factors are conspiring:
Labor costs: The top reasons hospitals are struggling financially in 2022 are “labor, labor, and labor,” said Kevin Holloran, senior director at Fitch Ratings. The healthcare labor shortage doesn’t just extend to nurses, but across the board.
Rising supply prices: Blame inflation. AHA reported that the “costs for energy, resins, cotton, and most metals surged in excess of 30%” between fall 2020 and early 2022.
Sicker patients, longer stays: Intensive care units across the country were overwhelmed with Covid-19 patients at the outset of the pandemic, but more recently hospitals have been caring for sicker non-Covid patients, said Aaron Wesolowski, AHA’s vice president for policy research and analytics
October is National Financial Planning Month—an ideal time to plan your financial future. The end of the year is approaching and a new one will soon begin, so this is the right time to think about what you have done in 2022 and what you could do in 2023. You might want to do something new; you may want to do some things differently.
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GREAT NEWS: But what about financial planning specificity for physicians, nurses and all medical professionals?
Fear of money: An abnormal and persistent fear of money. Sufferers experience undue anxiety even though they realize their fear is irrational. They worry that they might mismanage money or that money might live up to its reputation as “the root of all evil.” Perhaps they remember well the ill fortune that befell the mythical King Midas. His wish that everything he touched be turned to gold was fulfilled, and even his food was transformed into gold.
The fear of money is termed chrometophobia or chrematophobia, from the Greek “chrimata” (money) and “phobos” (fear). The “chrome” in “chrometophobia” may also be related to the Greek word “chroma” (color) because of the brilliant colors of ancient coins — for example, gold, silver, bronze and copper.
One quarter of U.S. physicians, advanced practice providers, and nurses are considering switching careers and one third are considering switching employers, according to newly released results from a survey conducted by Bain & Company. Below are some key takeaways from the survey and brief, which was released October 11th and can be found in full here.
1. Of the 25 percent of clinicians who are thinking about exiting healthcare entirely, 89 percent cite burnout as the main driver.
2. The top three things clinicians care about most in their profession are compensation, quality of patient care, and workload, according to the survey. Of those three, they are least satisfied with compensation (59 percent expressed satisfaction) and workload (60 percent). Eighty percent said they are satisfied with the quality of patient care.
3. Burnout shows up throughout clinicians’ days, with 63 percent saying they feel worn out at the end of the workday, 51 percent saying they feel they don’t have time and energy for family and friends during leisure time, and 38 percent feeling exhausted in the morning at the thought of another workday.
The personal savings of Americans have plunged this year, hitting $629 billion in the second quarter of 2022, according to the Federal Reserve Bank of St. Louis. That’s down from $1.98 trillion in the second quarter of 2021, and $4.85 trillion in the second quarter of 2020, boosted by COVID-related government cash. But it’s also down from $1.41 trillion in the second quarter of 2019, before the pandemic.
In fact, the personal saving rate — meaning personal saving as a percentage of disposable income, or the share of income left after paying taxes and spending money — fell to 3.5% in August, according to the Bureau of Economic Analysis. It’s quite a U-turn: The personal saving rate recently peaked at 26.3% in March 2021 and 33.8% in April 2020. But the drop in the personal saving rate isn’t all pandemic-related: In January 2020, before the coronavirus pandemic, it was 9.1%.
But, what about doctors and other medical professionals?
Stocks are hot and posted their third straight day of gains on hope that the FOMC might end its rate hikes at some point in the future. But that streak could end today.
Alphabet shares took a tumble in late trading after the company revealed its fifth consecutive quarter of slower revenue growth. Cracks are emerging in some of its core properties: Google search and YouTube. YouTube revenue declined for the first time since Google started reporting the division’s earnings separately.
Alphabet’s total quarterly revenue growth drastically declined from 41% to 6%.
The growth rate of Microsoft’s search and news advertising business has been shrinking each quarter of the past year, coinciding with the general downward trajectory of the entire online advertising market.
Stocks Extend Rally as U.S. Dollar and Bond Yields Cool Off
U.S. stocks traded higher as Treasury yields and the U.S. dollar pulled back, while investors digested a host of corporate results.
Earnings reports painted a mixed picture, as Dow member Coca-Cola beat earnings estimates and raised its guidance, while Dow member 3M also announced a positive earnings surprise, but lowered its full-year outlook. Additionally, General Electric missed earnings expectations and lowered guidance, and General Motors topped profit projections. In economic news, home prices declined more than expected in August, consumer confidence decreased, and regional manufacturing fell more than fore-casted.
Crude oil and gold prices gained ground.
Markets in Asia finished mixed as economic uncertainty continued to weigh on conviction, while European stocks finished mostly higher following economic reports and the political situation in the U.K.
Ben Wood, chief analyst at European CCS Insights predicts that Apple will enter the US health insurance market in partnership with a major insurer in 2024 – Forbes reported.
The company already collects heaps of health data, such as blood pressure, blood oxygen levels, ECG readings and body temperature from the Watch, and through phone apps that help people regulate their medication or manage chronic conditions like diabetes.
I hope you find the report useful!
Best regards, Bertalan Meskó, MD The Medical Futurist
With Meta’s share price down more than 60% this year, investors are losing patience with Mark Zuckerberg’s big bet on the metaverse.
Altimeter Capital CEO Brad Gerstner, whose firm has more than 2 million shares in the company, wrote an open letter yesterday urging Meta to cut headcount expenses by 20% and keep metaverse spending under $5 billion per year to become a “more productive, and more focused company.”
We’ll see how Meta feels about its own mojo when it reports earnings tomorrow.
U.S. stocks ended the day higher, adding to last week’s rally, which was the biggest advance since June. The three major stock averages climbed for the second straight trading day, but this rally will face a big test in the upcoming earnings season. Left out in the cold were Chinese tech stocks like Alibaba, which plunged as markets reacted (rather negatively) to China’s President Xi Jinping securing an unprecedented third term and packing the country’s leadership with loyalists.
Treasury yields were mixed, as longer-term rates reversed to the upside and seemingly weighed on growth sectors.
The markets awaited this week’s flood of earnings reports amid a day light in equity news, headlined by Tesla’s decision to cut prices for some of its vehicles in China. Political developments out of China and the U.K. were also in focus, along with a flood of Manufacturing and Services PMIs in the U.S. and abroad, which mostly showed a slowdown in activity.
The U.S. dollar was unchanged, while crude oil and gold prices edged lower.
Asian stocks finished mixed with mainland Chinese and Hong Kong equities tumbling, while Europe ended higher despite some
Dental coverage under Medicare could soon start expanding for seniors under a new proposal from the U.S. Centers for Medicare and Medicaid Services (CMS). Still, the proposed rules would not provide full coverage for regular dental care, which has been explicitly excluded from Medicare since the program’s founding in 1965.
“Traditional Medicare doesn’t cover routine preventive dental services, such as exams, cleanings, X-rays, nor more expensive services such as fillings, crowns or dentures,” said Meredith Freed, a Medicare expert with the Kaiser Family Foundation.
However, the new proposal would effectively open the door to Medicare potentially covering a wider array of dental services if medical science can demonstrate that oral health substantially improves the
Leveraged ETFs have received tremendous media attention and are proving to be extremely popular with both individual and institutional investors. There are hundreds of leveraged ETFs, covering virtually every asset class and industry sector. The majority are double-leveraged, but there’s a sizeable group of triple-leveraged ETFs.
For professional investors, leveraged ETFs are useful in statistical arbitrage, short-term tactical strategies, and for use as short-term hedges without the need to roll futures. For individual investors, leveraged ETFs are alluring because of the potential for higher returns.
Now, some physicians and Uninformed investors might assume that the leverage returns are generated on a continuous basis, so that if an underlying index is up 5% for a month, the double-leveraged ETF will be up 10% for the same month; if the index is up 10% for 6 months, the ETF will be up 20%, and so forth. That is absolutely not the case. The leverage is determined on a daily basis and the returns for any other period usually will not be double or triple the underlying index.
In order for the leveraged funds to achieve appropriate levels of assets so they can provide their implied leverage, they have to rebalance daily. In the case of an ETF providing long 2-times leveraged exposure, they would typically attain exposure to a notional set of assets equal to 2 times their NAV.
Example: An example would be an ETF that takes in 100 units in assets that does a swap with a counterparty to provide exposure to 200 units in performing assets. The rebalancing activity of these funds will almost always be in the same direction as the market.
In essence, a leveraged ETF is essentially marked to market every night. It starts with a clean slate the next day, almost as if the previous day had not existed. This process produces daily leverage results. However, over time, the compounding of this reset can potentially vary the performance of the fund versus its underlying benchmark. This can result in either greater or lesser degrees of final leverage over individual holding periods.
A jumbo loan, also known as a jumbo mortgage, is a type of financing that exceeds the limits set by the Federal Housing Finance Agency (FHFA). Unlike conventional mortgages, a jumbo loan is not eligible to be purchased, guaranteed, or securitized by Fannie Mae or Freddie Mac. Designed to finance luxury properties and homes in highly competitive local real estate markets, jumbo mortgages come with unique underwriting requirements and tax implications. These kinds of mortgages have gained traction as the housing market continues to recover following the Great Recession.
The value of a jumbo mortgage varies by state—and even county. The FHFA sets the conforming loan limit size for different areas on an annual basis. The limit for 2022 was set at $647,200 for most of the country. This was an increase of $98,950 from the 2021 limit of $548,250. For counties that have higher home values, the baseline limit is set at $970,800, or 150% of $647,200.1
The FHFA has a different set of provisions for areas outside of the continental United States for loan limit calculations. As a result, the baseline limit for a jumbo loan in Alaska, Guam, Hawaii, and the U.S. Virgin Islands as of 2022 is also $970,800. That amount may actually be even higher in counties that have higher home values.
Happy Diwali! Hindus, Sikhs, Jains, and Buddhists around the world will celebrate India’s “festival of lights” today. In a sign of growing recognition of the festival, New York City announced last week that Diwali will become an official school holiday.
Earnings: If earnings season were a music festival, the headliners are about to come onstage. Corporate titans Amazon, Microsoft, Apple, Alphabet, and Meta are among the ~150 S&P companies that will give financial updates this week.
Economic data: The US economy shrank during the first two quarters of the year. We’ll find out whether it grew again in Q3 when fresh GDP numbers drop on Thursday (it’s expected to have). Plus, the Fed’s preferred measure of inflation will be released on Friday.
As a new physician investor, it’s important to know the distinctions between like measurements because the market allows firms to advertise their numbers in ways not otherwise regulated. Often companies will publicize their numbers using either GAAP or non-GAAP measures. GAAP, or generally accepted accounting principles, outlines rules and conventions for reporting financial information. It is a means to standardize financial statements and ensure consistency in reporting.
When a company publicizes its earnings and includes non-GAAP figures, it means it wants to provide investors with an arguably more accurate depiction of the company’s health (for instance, by removing one-time items to smooth out earnings). However, the further a company deviates from GAAP standards, the more room is allocated for some creative accounting and manipulation.
When looking at a company that is publishing non-GAAP numbers, new physician investors should be wary of these pro forma statements, because they may differ greatly from what GAAP deems acceptable.
GAAP is set forth in 10 primary principles, as follows:
Principle of consistency: This principle ensures that consistent standards are followed in financial reporting from period to period.
Principle of permanent methods: Closely related to the previous principle is that of consistent procedures and practices being applied in accounting and financial reporting to allow comparison.
Principle of non-compensation: This principle states that all aspects of an organization’s performance, whether positive or negative, are to be reported. In other words, it should not compensate (offset) a debt with an asset.
Principle of prudence: All reporting of financial data is to be factual, reasonable, and not speculative.
Principle of regularity: This principle means that all accountants are to consistently abide by the GAAP.
Principle of sincerity: Accountants should perform and report with basic honesty and accuracy.
Principle of good faith: Similar to the previous principle, this principle asserts that anyone involved in financial reporting is expected to be acting honestly and in good faith.
Principle of materiality: All financial reporting should clearly disclose the organization’s genuine financial position.
Principle of continuity: This principle states that all asset valuations in financial reporting are based on the assumption that the business or other entity will continue to operate going forward.
Principle of periodicity: This principle refers to entities abiding by commonly accepted financial reporting periods, such as quarterly or annually.
Financial ratio analysis typically involves the calculation of ratios that are financial and operational measures representative of the financial status of a clinic or medical practice enterprise. These ratios are evaluated in terms of their relative comparison to generally established industry norms, which may be expressed as positive or negative trends for that industry sector. The ratios selected may function as several different measures of operating performance or financial condition of the subject entity.
Common types of financial indicators that are measured by ratio analysis include:
Liquidity. Liquidity ratios measure the ability of an organization to meet cash obligations as they become due, i.e., to support operational goals. Ratios above the industry mean generally indicate that the organization is in an advantageous position to better support immediate goals. The current ratio, which quantifies the relationship between assets and liabilities, is an indicator of an organization’s ability to meet short-term obligations. Managers use this measure to determine how quickly assets are converted into cash.
Activity. Activity ratios, also called efficiency ratios, indicate how efficiently the organization utilizes its resources or assets, including cash, accounts receivable, salaries, inventory, property, plant, and equipment. Lower ratios may indicate an inefficient use of those assets.
Leverage.Leverage ratios, measured as the ratio of long-term debt to net fixed assets, are used to illustrate the proportion of funds, or capital, provided by shareholders (owners) and creditors to aid analysts in assessing the appropriateness of an organization’s current level of debt. When this ratio falls equal to or below the industry norm, the organization is typically not considered to be at significant risk.
Profitability. Indicates the overall net effect of managerial efficiency of the enterprise. To determine the profitability of the enterprise for benchmarking purposes, the analyst should first review and make adjustments to the owner(s) compensation, if appropriate. Adjustments for the market value of the “replacement cost” of the professional services provided by the owner are particularly important in the valuation of professional medical practices for the purpose of arriving at an ”economic level” of profit.
The selection of financial ratios for analysis and comparison to the organization’s performance requires careful attention to the homogeneity of data. Benchmarking of intra-organizational data (i.e., internal benchmarking) typically proves to be less variable across several different measurement periods.
However, the use of data from external facilities for comparison may introduce variation in measurement methodology and procedure. In the latter case, use of a standard chart of accounts for the organization or recasting the organization’s data to a standard format can effectively facilitate an appropriate comparison of the organization’s operating performance and financial status data to survey results.
The death cross is a technical chart pattern indicating the potential for a major sell-off. The death cross appears on a chart when a stock’s short-term moving average crosses below its long-term moving average. Typically, the most common moving averages used in this pattern are the 50-day and 200-day moving averages.
For months, traders, academics, and other analysts have fretted that the $23.7 trillion Treasury market might be the source of the next financial crisis. Then last week, U.S. Treasury Secretary Janet Yellen acknowledged concerns about a potential breakdown in the trading of government debt and expressed worry about “a loss of adequate liquidity in the market.” Now, strategists at BofA Securities have identified a list of reasons why U.S. government bonds are exposed to the risk of “large scale forced selling or an external surprise” at a time when the bond market is in need of a reliable group of big buyers.
“We believe the UST market is fragile and potentially one shock away from functioning challenges” arising from either “large scale forced selling or an external surprise,” said BofA strategists Mark Cabana, Ralph Axel and Adarsh Sinha. “A UST breakdown is not our base case, but it is a building tail risk.”
With any organizational change, getting support from physicians, practice administrators, and clinical and office staff isn’t easy. The transition to a population health-based strategy is no different.
Find out how to educate and coach your staff to implement your population health program successfully — based on the real-world experience of Verlin Janzen MD, medical director at Hutchinson Clinic. Dr. Janzen has dedicated his career to implementing a population-health based strategy. To achieve his goals at Hutchinson Clinic, he had to overcome a major challenge—lack of buy-in from his colleagues.
A Bloomberg economic model forecast a 100% chance of a US recession within 12 months
Jeff Bezos warned companies to “batten down the hatches” in response to Goldman Sachs’s CEO saying there’s a good chance we’ll have a recession.
Elon Musk guesstimated that we’re going to be in a recession “probably until spring of ’24.”
Gwyneth Paltrow said, “The economy sucks.”
BUT, Bank of America CEO Brian Moynihan (the one with the epic vocabulary) said that while analysts are warning of recession and slower spending, “We just don’t see [that] here at Bank of America.” Transaction volumes for its customers jumped 10% in September and the first half of October over a year earlier.
And, American Express’s CEO said, “We’re not seeing any changes in consumer spending” and predicted a strong holiday quarter for retail and travel.
United Airlines’s CEO is “so optimistic about 2023.”
Many business leaders are forecasting an economic downturn. But the execs who run travel and credit card companies say that shoppers aren’t pulling back spending at all.
It’s like Americans are watching the forecast call for thunderstorms but, seeing that it’s still sunny outside, are heading out to the waves to surf anyway.
Big picture: Recession fears are rising as the Fed raises interest rates to tame inflation that’s soaring at 40-year highs. While the definition of a recession is pretty broad, a slowdown in consumer spending would certainly be an indicator of one: It accounts for about 70% of the US economy.
Diwali, Deepavali or Dipavali is the Hindu festival of lights, which is celebrated every autumn in the northern hemisphere.
One of the most popular festivals of Hinduism, Diwali symbolises the spiritual “victory of light over darkness, good over evil and knowledge over ignorance”.
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During the celebration, temples, homes, shops and office buildings are brightly illuminated. The preparations, and rituals, for the festival typically last five days, with the climax occurring on the third day coinciding with the darkest night of the Hindu Lunisolar month Kartika.
In the Gregorian calendar, the festival generally falls between mid-October and mid-November.
The IRS just said that the maximum contribution that an individual can make in 2023 to a 401(k), 403(b) and most 457 plans will be $22,500. That’s up from $20,500 this year.
People aged 50 and over, which have the option to make additional “catch-up” contributions to 401(k) and similar plans, will be able to contribute up to $7,500 next year, up from $6,500 this year. That’s means a 401(k) saver who is 50 or older can contribute a maximum of $30,000 to their retirement plan in 2023.
The IRS also raised the 2023 annual contribution limits on individual retirement arrangements, or IRAs, to $6,500, up from $6,000 this year. The IRA “catch-up” contribution limit remains at $1,000, as it’s not subject to an annual cost of living adjustment, the IRS said.
Annually observed on the third Friday-Saturday in October, as part of National Breast Cancer Awareness Month, October 22nd. is National Mammography Day. This day serves as a reminder to all women that the best defense is early detection.
What to Do
Perform regular monthly self-examinations.
Make sure you get your regular physician checkups.
Make your mammography appointment today!
History
President Bill Clinton proclaimed the first National Mammography Day in 1993.
Don’t forget male breast cancer
Male breast neoplasm is a relatively rare cancer in men that originates from the breast. As it presents a similar pathology as female breast cancer, assessment and treatment relies on experiences and guidelines that have been developed in female patients. The optimal treatment is currently not known.
Incidence
According to Wikipedia, about one percent of breast cancer develops in males. It is estimated that about 2,140 new cases are diagnosed annually in the United States (US) and about 300 in the United Kingdom (UK). The number of annual deaths in the US is about 450. In a study from India, eight out of 1,200 (0.7%) male cancer diagnoses in a pathology review represented breast cancer. Incidences of male breast cancer have been increasing which raise the probability of other family members developing the disease. The relative risk of breast cancer for a female with an affected brother is approximately 30% higher than for a female with an affected sister. The tumor can occur over a wide age range, but typically appears in men in their sixties and seventies. Known risk factors include radiation exposure, exposure to female hormones (estrogen), and genetic factors.
High estrogen exposure may occur by medications, obesity, or liver disease, and genetic links include a high prevalence of female breast cancer in close relatives. Chronic alcoholism has been linked to male breast cancer. The highest risk for male breast cancer is carried by men with Klinefelter syndrome. Male BRCA mutation carriers are thought to be at higher risk for breast cancer as well, with roughly 10% of male breast cancer cases carrying BRCA2 mutations, and BRCA1 mutation being in the minority.
Conclusion
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As reported on this ME-P and elsewhere, I was recently in Philadelphia for a number of reasons and had the opportunity to stop by Drexel University to get some information on their nursing program. There, I learned that it is one of the nation’s top nursing schools.
In fact, Drexel University is ranked one of “America’s BEST Colleges 2011” by U.S.News & World Report. I also learned the following about breast cancer:
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Assessment
Understanding the facts about breast cancer is of vital importance, because it may save your life or the life of someone you love.
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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Stocks Ended Noticeably Higher Amid Wall Street Journal Report
U.S. equities rose sharply in a choppy trading session as investors sifted through a host of earnings releases, and reassessed the outlook for future Fed rate hikes. This follows the release of a Wall Street Journal (WSJ) report that said some Fed officials are concerned about over-tightening monetary policy. Investors also eyed events overseas, particularly the abrupt resignation of U.K. Prime Minister Liz Truss, as today’s domestic economic calendar was void of any major releases. Q3 earnings season continued in earnest, as Dow member American Express eclipsed analysts’ expectations but an increase in reserves for potential defaults seemed to hamper conviction.
Fellow Dow component Verizon Communications beat forecasts, Tenet Healthcare’s disappointing guidance overshadowed its earnings beat, and social media company Snap was able to post an adjusted profit, but warned of lower ad revenues in the future. Pfizer was among the standout companies after revealing plans to start charging more for Covid vaccines.
Treasury yields were mixed in the wake of the Wall Street Journal reporting, while the Fed is likely to go for another big rate hike in November, it’ll probably start slowing down thereafter.
The U.S. dollar dropped amid a rally in the British pound and the Euro, while crude oil and gold prices increased.
Stocks in Europe ended the day mostly lower, with the political chaos surrounding the U.K. in focus, while markets in Asia were mixed, as economic uncertainty continues to weigh on sentiment.
Insider transactions shouldn’t be used primarily to make an investing decision, however an insider transaction can be an important factor in the investing decision.
In legal terms, an “insider” refers to any shareholder who owns at least 10% of a company. This can include executives in the c-suite and large hedge funds. These insiders are required to let the public know of their transactions via a Form 4 filing, which must be filed within two business days of the transaction.
Mark Zuckerberg, CEO at Facebook (NASDAQ:FB), just made a large buy and sell of company shares on November 3, according to a new SEC filing. A Form 4 filing from the U.S. Securities and Exchange Commission states that Mark Zuckerberg exercised options to purchase 62,300 Facebook shares for $0 on November 3. They then sold their shares on the same day in the open market. They sold at prices ranging from $324.04 to $332.02 to raise a total of $25,463,482 from the stock sale.
Zuckerberg still owns a total of 232,400 shares of Facebook worth, $78,226,142.
By 2030, the WHO projects that 15 million healthcare workers will be missing globally.
Introducing Florence, the “world’s most extensive freely accessible AI health worker” is one way of tackling this issue. Florence is knowledgeable in key health topics, including mental health, nutrition and tobacco cessation, and provides information on COVID-19 vaccines. So, have a chat with her.
DEFINITION: OBLs, also known as office-based endovascular centers, access centers, or office interventional suites, are physician offices wherein a number of services are offered.
Similar to ASCs, OBLs can be single specialty or multi-specialty and can have a number of ownership structures. However, unlike ASCs, OBL procedures (because they are located in a physician office) are reimbursed under the Medicare Physician Fee Schedule.
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OBLs are typically operated and utilized by vascular surgeons, interventional radiologists, cardiologists, or other specialists, and services provided include: cardiovascular, endovascular, venous, and non-vascular services; cardiac procedures, such as diagnostic coronary angiograms, coronary stenting, electro physiology services; device implants, including pacemakers, defibrillators, loop recorders, and biventricular pacers; lower extremity endovascular revascularizations, such as chronic total occlusion and complex limb salvage procedures; renal and mesenteric revascularizations; and, subclavian stenting.23 Of these procedures, peripheral vascular intervention, cardiac services, and interventional radiology made up the majority of the OBL market share in 2019.
While slower to materialize than ASCs, OBLs have increased rapidly over the past few years, for reasons similar to ASCs, e.g., opportunities for physician ownership, the “expedient patient experience” and “favorable outpatient procedural reimbursement.”
In 2020, the global OBL market was valued at $9 billion. Similar to ASCs, an increasing focus on outpatient procedures (due to their cost-saving potential)
I. DEFINITION: A poison pill is a defense tactic utilized by a target company to prevent or discourage hostile takeover attempts. Poison pills allow existing shareholders the right to purchase additional shares at a discount, effectively diluting the ownership interest of a new, hostile party.
II. DEFINITION: A hostile takeover refers to the acquisition of one company by another corporation against the wishes of the former. The company being acquired in a hostile takeover is called the target company while the one executing the takeover is called the acquirer. In a hostile takeover, the acquirer goes directly to the company’s shareholders or fights to replace management to get the acquisition approved. Approval of a hostile takeover is generally completed through either a tender offer or a proxy fight.
According to the Washington Post, Elon Musk told potential investors for his Twitter purchase that he would thin the company’s 7,500-person workforce by 75%, leaving less than 2,000 employees to protect against security threats and solve the bot problem.
But even if the deal didn’t go through, Twitter was probably headed for layoffs. Current management said they needed to cut payroll by nearly $800 million by the end of 2023. Musk’s acquisition of Twitter is expected to close by next week.
DEFINITION: “VIP syndrome” is a term coined in 1964 by the psychiatrist Walter Weintraub to describe an intriguing paradox: Throughout history, the rich and famous, with all their resources and fancy doctors, have often received worse medical treatment, and suffered from worse health outcomes, than the average person. When physicians afford “special privileges” to their powerful patients, from “Mad King” George III to Michael Jackson, they seem to get sicker and even die. While Weintraub, a psychoanalyst, attributed the problem in part to doctors unconsciously resenting their influential patients, it seems doctors simply get starstruck around famous people and high-ranking figures. Despite their medical expertise, these physicians find themselves opting out of basic tests for “privacy” or prescribing dangerous medications for “comfort.”
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