GAS PRICES: Up Again!

By Staff Reporters

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Gas prices are continuing to rise to start 2023, and experts say prices are “unlikely to turn around any time soon.” And, the current average for a regular gallon of gas $3.50, according to AAA.

While it’s nowhere near the record $5.01 reached in June, its far more than what the average was heading into New Year’s Day and what prices were one year ago.

And, experts say it’s possible the average price reaches $4 later this year.

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PODCASTS: Corporate Practice of Medicine Laws

Private Equity Owning Doctor Practices

LEGALITY?

By Eric Bricker MD

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PODCAST: https://www.youtube.com/watch?v=2epmk4_-kUI

These Laws Were Put Into Place So That Doctors Would Not Put Shareholders Before Patients and So That Corporations Would Not Interfere with Doctor Judgement.

Corporate Practice of Medicine Laws are at the State Level, NOT the Federal Level.

Each State Has Its Own Exceptions Such as 1) Doctors Can Work for Companies That Are Owned by Other Doctors and 2) Doctors Can Work for Hospitals.

Accordingly, Private Equity Firms Have Been on a Physician Practice Buying Binge.

Private Equity Firms Bought 355 Physician Practices from 2013 – 2016.

Two of the Largest Purchases Were KKR’s Purchase of Envision’s 25,000 Doctors for Almost $10 Billion and Blackstone’s Purchase of Team Health’s 20,000 Doctors for $6 Billion.

If Corporate Practice of Medicine Laws Say that Doctors Cannot Work for a Corporation, How are Private Equity Purchases of Physician Practices Legal?

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

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

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HEALTHCARE: Top A.I. Companies to Watch!

By Bertalan Mesko MD PhD

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TOP ARTIFICIAL INTELLIGENCE COMPANIES IN HEALTHCARE TO KEEP AN EYE ON 

More and more companies set the purpose to disrupt healthcare with the help of artificial intelligence. Given how fast these companies come and go, it can prove to be hard to stay up-to-date with the most promising ones.

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

So, I collected the most prominent names currently on the market ranging from start-ups to tech giants to keep an eye on in the future.

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Advertise on the MEDICAL EXECUTIVE-POST: Reap Benefits in 2023?

Join Our Mailing List

Reach Industry Pros, Executives and Decision-Makers with Ease

By Ann Miller RN MHA [Executive-Director]

MarcinkoAdvisors@msn.com

The Medical Executive Post [ME-P] is the premier online community and marketing platform that allows you to profile your company’s product and services to financial advisors, stock brokers, insurance agents, financial planners, accountants, wealth-managers and their highly-targeted healthcare professional clients.

Highlight your company’s news, events, white papers, videos and contact information – all in one place – and update your information 24/7.

And, because we’ll promote your resources to the entire ME-P eco-space, it’s a highly efficient way to fortify your existing marketing programs with the critical decision makers you’re trying to reach.

Why should your company sponsor the ME-P? 

  • Reader loyalty. Not only does the ME-P receive a mind-boggling number of page views and visits each month, its readers are loyal.
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  • Selective advertising. The ME-P is a free read that’s off the radar of the big-ad companies. Your ad here stands out as personal and different.
  • Supporting the ME-P makes a big difference and costs only a fraction of other online publications with far fewer readers.
  • Cost. CPM is ridiculously low compared to other sites.
  • E-mail us for a full packet, but give a look to these results from the ME-P’s annual reader survey:
  • 89% of readers said the ME-P influences their perception of products and companies
  • 34% said that ME-P sponsorship alone give them a higher interest or appreciation for those companies
  • 754% said the ME-P has some, a good bit, or a lot of industry influence

Contact us and I’ll e-mail you a rate card. Your support makes a difference!

 Text Ads

We have great sponsor packages, but maybe you want to run a short-term ad — a position listing, an announcement, or your booth number at an upcoming conference. Or, perhaps your company is between budget cycles and can’t commit to sponsorship yet. We’ve got an answer – ME-P text ads.

Text ads are up to five lines long and are highly cost-effective. You’ll get about 25-35,000 impressions per week, reaching the ME-P’s highly targeted and loyal audience of decision-makers. Think small text ads don’t work? They’ve made two Google kids billionaires!

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So, advertise with the Medical Executive-Post and Reap the Benefits

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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PODCAST: How Doctors are Really Paid?

Learn the Incentives in Physician Compensation

BY ERIC BRICKER MD

RAND and Harvard University Researchers Recently Published a Study in the Journal of the American Medical Association Examining How Doctors are Paid by Hospital System-Owned Practices. The Study Found that only 9% of Primary Care Physician Compensation was Based on Value (Quality and Cost-Effectiveness) and only 5.3% of Specialist Compensation was Based on Value.

The Study Concluded: “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.”

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MORE: https://medicalexecutivepost.com/2020/09/19/what-doctors-must-do-to-file-an-aetna-claim-to-get-paid/?preview_id=237387&preview_nonce=44f9028974&preview=true

RELATED: https://medicalexecutivepost.com/2008/09/12/how-doctors-get-paid/

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

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FAs & CPAs Wanted -BUT- Certified Medical Planners® Needed?

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Career Development, Products and Services for Medical Specificity

“The informed voice of a new generation of fiduciary advisors for healthcare”

SPONSOR: http://www.CertifiedMedicalPlanner.org 

CMP

FINANCIAL ADVISER WANTED: New York’s Belfer family, which gained riches from oil, is racking up quite an investing losing streak. They lost billions in Enron’s collapse and were clients of Bernie Madoff, and now it’s come to light that they were shareholders in FTX.

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CPAs WANTED: Just as tax season kicks off, US firms are facing a national shortage of accountants, forcing them to look overseas for workers to look over your W-2. More than 300k accountants and auditors have quit in the last two years, per the WSJ.

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CMPs NEEDED: The Certified Medical Planner® program was created in response to the frustration felt by doctors in small and mid-sized practices that dealt with top financial, brokerage and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized to few, despite ever changing needs.

Enter the CMPs

Learn why brokerage sales-pitches and/or internet resources will never replace the knowledge and deep advice of a collegial Certified Medical Planner® professional.

Letterhead CMP

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Artificial Intelligence Passes U.S. Medical Licensing Exam

ChatGPT

By Staff Reporters

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Two papers show that large language models, including ChatGPT, can pass the USMLE. The papers highlighted different approaches to using large language models to take the USMLE, which is comprised of three exams: Step 1, Step 2 CK, and Step 3. ChatGPT is an artificial intelligence (AI) search tool that mimics long-form writing based on prompts from human users. It was developed by OpenAI, and became popular after several social media posts showed potential uses for the tool in clinical practice, often with mixed results.

According to Victor Tseng, MD, of Ansible Health in Mountain View, California, and colleagues, the results showed “new and surprising evidence” that this AI tool was up to the challenge. Tseng and team noted that ChatGPT was able to perform at >50% accuracy across all of the exams, and even achieved 60% in most of their analyses. While the USMLE passing threshold does vary between years, the authors said that passing is approximately 60% most years.

Source: Michael DePeau-Wilson, Medpage Today [1/19/23]

RELATED: https://medicalexecutivepost.com/2013/06/21/will-future-doctors-need-a-medical-license/

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AMERICANS: Cash Savings Rate Up!

By Staff Reporters

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Whether we’ve got a recession coming remains the biggest will they or won’t they story, but it looks like more Americans are starting to sock away cash just in case.

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

Data just released by the Department of Commerce puts the savings rate for December at 3.4%—the highest level in seven months and the biggest uptick from the previous month since July 2021 (November’s rate was 2.9%).

EMERGENCY FUND: https://medicalexecutivepost.com/2022/08/20/the-national-emergency-fund/

Could be that everyone’s just saving up for breakfast eggs and Ticketmaster concerts?

MD Emergency Funds: https://medicalexecutivepost.com/2007/12/05/emergency-funds/

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PRIVATE EQUITY: Ownership in Physician Practices

By NIHCM

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Private equity acquisition of physician practices continues to grow nationwide. New research focused on specialists in dermatology, gastroenterology, and ophthalmology shows the impact of the trend.

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

Novel evidence by NIHCM grantee Jane Zhu, MD, and her team, reveals shifts in workforce composition and hiring patterns after private equity firms obtain physician practices. The researchers’ findings are particularly important for policymakers and practices considering selling to private equity firms. Highlights include:

  • A significant yearly increase in the number of advanced practice providers at private equity-acquired practices, specifically nurse practitioners and physician assistants. 
  • In acquired practices, entering clinicians replaced exiting clinicians at a higher rate than at non-private equity-acquired practices.

This work adds to the research team’s previous findings, including the geographic variations in private equity ownership across six medical specialties, and the impact of private equity on health care costs and utilization.

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DAILY UPDATE: Stocks Rise with Economic Data

By Staff Reporters

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Q4’s strong GDP numbers are raising hopes that the Fed could actually pull off the tricky “soft landing”—where it knocks down inflation through interest rate hikes without sending economic growth into reverse. The resilient labor market is cooperating: Despite all the headlines about layoffs, jobless claims fell last week to their lowest point since April 2022.

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

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U.S. stocks ended the day in the green as the markets digested a host of economic and earnings data. The economic calendar came in heavy today, as Q4 GDP growth was higher than expected, jobless claims unexpectedly fell, new home sales rose, and durable goods orders jumped, but dipped when stripping out the volatile component of transportation activity. Several Dow members were in focus, as IBM exceeded expectations, though its cash flow performance garnered some scrutiny on the Street, and Dow Inc. missed quarterly estimates. Fellow Dow component Chevron announced an increased dividend and a new $75.0 billion share repurchase plan, while in other news, Tesla topped quarterly estimates and offered an upbeat outlook.

Treasury yields traded mostly higher, and the U.S. dollar advanced, while crude oil prices increased, and gold moved to the downside.

Asian stocks finished mixed in lighter volume as several markets remained closed for holidays, while markets in Europe were higher for the most part, adding to the region’s strong start to the year.

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AMAZON: Launches “RxPass” Generic Drug Subscription Program

PRIME MEMBERSHIP

By Staff Reporters

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Yesterday, Amazon announced the launch of RxPass: an add-on to Prime memberships that provides subscribers with access to 50 generic prescription drugs for a $5 monthly fee.

RxPass will launch immediately in most states (though not California and Texas, the most populous ones) and include generic drugs that treat common conditions like high blood pressure, anxiety, acid reflux, and hair loss. About 150 million US residents have a prescription for one of the drugs included in RxPass, according to Amazon.

But the service is not available to people on Medicare or Medicaid, and it doesn’t offer insulin.

RxPass is Amazon’s answer to the Mark Cuban Cost Plus Drug Company (which offers significantly more medications—1,100 of them) and is likely part of an effort to attract more users to Amazon Pharmacy. Amazon Pharmacy could use the boost—it launched in 2020 but ranked at the bottom of a list of which Prime perks drew members to the service, a Morgan Stanley survey found last summer.

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PODCAST: Farzad Mostashari MD and “Aledade”Primary Care

By Shahid N Shah

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Our guest on this episode is Dr. Farzad Mostashari. Farzad is the co-founder and CEO of Aledade, a primary care enablement company that partners with independent PCPs to transition to value-based care and, as a result, maintain their independence.

Founded in 2014, Aledade works with 11,000 physicians across 40 states and DC, accounting for 1.7M patients under management in Medicare, Medicare Advantage, Commercial and Medicaid contracts. Farzad previously served as the National Coordinator for Health IT in the Department of Health and Human Services, he completed medical school at the Yale School of Medicine and a Master’s in Population Health from Harvard’s T.H. Chan School of Public Health. Earlier this year, Aledade raised a $123M Series E round of funding led by OMERS Growth Equity.

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In this episode, colleague Shahid N. Shah will discuss with Farzad about (1) his journey to starting Aledade and the role policy expertise and evidence have played in the company’s success (2) why he and the company are betting on independent physicians as the drivers of change in value-based care and (3) how Aledade became the rare profitable health tech company.

-Dr. David Edward Marcinko MBA

PODCAST: https://soundcloud.com/wharton-pulse-podcast/mostashari-aledade

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PODCAST: Medicare Advantage Plan Over Payments

A SYNOPSIS

By Eric Bricker

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PODCAST: Government Overpayments to Medicare Advantage Plans are a major problem.

CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.

Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.

The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.

However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.

When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.

Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.

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IRS TAX FILING: Joint or Separate for Married Couples?

INTUIT

By Staff Reporters

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Married couples have the option to file jointly or separately on their federal income tax returns. The IRS strongly encourages most couples to file joint tax returns by extending several tax breaks to those who file together.

In the vast majority of cases, it’s best for married couples to file jointly, but there may be a few instances when it’s better to submit separate returns.

READ HERE: https://turbotax.intuit.com/tax-tips/marriage/should-you-and-your-spouse-file-taxes-jointly-or-separately/L7gyjnqyM?dclid=CKzxz8Pzy_wCFeMBwQods3cDLQ

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PODCAST: Hospital Money Problems 2023

INFLATION AND COMPETITION

By Eric Bricker MD

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RECESSION INDICATOR: Inverted Yield Curve?

By Staff Reporters

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When economic trouble and/or uncertainty is brewing, it’s not uncommon for the US Treasury yield curve to flatten or even invert. A yield curve inversion, like we’re experiencing now, involves short-term-maturing bonds sporting higher yields than longer-dated Treasury bonds. It’s an indication that investors are worried about the U.S. economic outlook.

For the past 64 years, the Federal Reserve Bank of New York has used the Treasury yield spread between the 10-year bond rate and three-month bond rate to calculate the probability of a U.S. recession occurring within the next 12 months. Over these 64 years, the probability of a recession has topped 25% a dozen times and 40% on eight occasions. 

With the exception of a peak probability of a recession of 41.14% in October 1966, the New York Fed’s recession-forecasting tool hasn’t been wrong if it’s surpassed 40%. In other words, if the New York Fed’s recession probability indicator surpasses 40%, we’ve had a recession within 12 months, without fail, for more than a half-century.

In December 2022, this recession probability tool hit 47.31%. That’s the highest reading since 1981, and a very clear indication that economic activity is expected to slow at some point in 2023.

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PODCAST: Medicare Traditional [A and B] v. Advantage [C] v. Part [D] v. Supplements

By Eric Bricker MD

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

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JANUARY: Cervical Cancer Awareness Month

By Staff Reporters

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Cervical Health Awareness Month

The United States Congress designated January as Cervical Health Awareness Month. More than 14,000 women in the United States are diagnosed with invasive cervical cancer each year, but the disease is preventable with vaccination and appropriate screening.

During January, NCCC and its many local chapters across the country highlight issues related to cervical cancer, HPV disease and the importance of early detection. While NCCC chapters host events throughout the year, January is a month with a special focus as chapters celebrate Cervical Health Awareness Month and work to spread the word in their communities.

NCCC and the American Sexual Health Association (ASHA) also offer a range of resources (listed below) to educate the public and healthcare providers about cervical health, from fact sheets to episodes of ASHA’s Sex+Health podcast.

READ: https://www.nccc-online.org/cervical-health-awareness-month/

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The U.S. Debt Ceiling

By Staff Reporters

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As the US just crashed into the $31.4 trillion debt ceiling as the Treasury Department began taking what it called “extraordinary measures” to prevent the government from defaulting on its debts and sparking an economic crisis.

These measures are a series of deep-cut accounting moves that allow the Treasury to continue making its payments. They include:

  • Suspending reinvestments into government funds for retired federal employees, such as the Civil Service Retirement and Disability Fund.
  • Selling existing investments in those funds to free up more outstanding debt.

And while these measures definitely aren’t ordinary…they probably aren’t so “extra,” either. The Treasury has resorted to them more than 12 times since 1985, including during the last debt-ceiling standoff in 2021.

Still, these steps amount to chugging water after eating a ghost pepper—the pain will return. Treasury Secretary Janet Yellen said her extraordinary measures will last through early June, giving lawmakers about five months to work out a deal to raise the debt ceiling.

NOTE: The US has never defaulted on its debt, but even the threat of it could be disastrous. The country’s first credit downgrade in history came during a debt-ceiling showdown in 2011.

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Alphabet Soup: Financial Designations & Certificates

Join Our Mailing List 

financial-designationsjuly

AUTHOR: Dr. David Edward Marcinko; MBA, CMP™

POSITION: Publisher-in-Chief

dem26

TOPIC: Financial Designations and Certifications [Alphabet Soup of Industry Obfuscation and Self-Promotion, or Real Gravitas – You Decide?]

EXCERPT: “Until recently, most financial advisors were regulated by the NASD, the National Association of Securities Dealers. Now the Financial Industry Regulatory Authority or FINRA is the largest non-governmental regulator for all securities firms doing business in the United States. It is a self-regulatory agency comprised of the nation’s brokerage firms. Upon completion of a required exam the FINRA will issue a variety of licenses. The most common are the Series 6, 7, and 24.

The Series 6 is essentially a license to sell packaged products, namely mutual funds. It is most commonly held by insurance agents and bank representatives. It is considered a very easy test. Holding such a license allows the holder to collect commission income through its member firm.

The Series 7 exam is a bit more difficult and includes issues relating to individual securities such as stocks, bonds and limited partnership interests. The pass rate is lower than the Series 6. The probable culprit is the extensive questioning on margin and options, topics most are unfamiliar with prior to entering the securities business.

The Series 24 covers issues of compliance and supervision and is required of Branch Managers of brokerage firms. All registered representatives (the proper name for a broker) must be supervised by someone with a Series 24, also known as a principal’s license.

Checking the background of a registered representative, a branch manager or a member firm is easily done through NASD and/or FINRA Regulation, Inc. NASDR/FINRA maintains the Central Registration Depository (CRD). The CRD can be checked for a description of a disclosed event by phone or by Internet. One should request information on an advisor’s firm as well as the individual. A reputable advisor at a disreputable firm has its own set of potentially dangerous implications.

Regardless of the above, these tests produce licenses to sell financial products. They are not educational achievements. There is virtually no academic barrier to entry for them. Stock-brokers today – hate the term – and prefer “financial advisor”; yet the term has no real meaning other than as a sales license.

Some are college graduates, and beyond; while some other experts argue that too many are not!”

Hence, the need to “raise the bar to fiduciary accountability with deep knowledge of healthcare modernity.”

For more info: http://www.CertifiedMedicalPlanner.org

READ JULY HERE: financial-designationsjuly

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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HOSPITALS: Financial Management Update

By Staff Reporters

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Hospitals saw a slight financial boost in November 2022, despite continued negative operating margins throughout the year, according to a new Kaufman Hall National Hospital Flash Report, as reported in Healthcare Brew.

Lower expenses and increased outpatient revenue help buoy their performance and increase margins by 12% month over month from October 2022. But Kaufman Hall, a management consulting firm, reported that its year-to-date operating margin index reflected an actual negative figure of -0.2% in November 2022.

The findings underscore the financial challenges hospitals continue to face as they recover from the Covid-19 pandemic.

And, Erik Swanson, senior vice president of data and analytics at Kaufman Hall, wrote that the “November data, while mildly improved compared to October, solidifies what has been a difficult year for hospitals amidst labor shortages, supply chain issues, and rising interest rates.”

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

The monthly report, which is based on data from more than 900 hospitals, partially attributed November’s lowered expenses to a decline in patient volume and slightly shorter lengths of stay. Decreased labor costs, likely due to a drop in a reliance on contract labor, also helped lower expenses, the Kaufman analysis found.

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

Hospitals further saw a 10% increase year over year in outpatient revenue in November 2022, despite inpatient revenue remaining flat, according to the report. Swanson said “[h]ospital leaders should continue to develop their outpatient care capabilities amid ongoing industry uncertainty and transformation.”

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BANKRUPT: Genesis Global Chapter 11

By Staff Reporters

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The bankruptcy of Barry Silbert’s Genesis Global may not have pummeled crypto markets like the implosion of Sam Bankman-Fried’s FTX did, but it features a list of top creditors with similarly large claims topping $3 billion in total.

According to Bloomberg, Genesis’s Chapter 11 filing on Thursday listed seven creditors owed at least $100 million. By far the biggest one is a $766 million claim related to customers of crypto exchange Gemini, who have money stuck with Genesis’s lending unit. FTX-linked entities have 10 claims of more than $100 million, according to a redacted list filed Saturday. 

In all, Genesis owes its top 50 creditors $3.4 billion; for FTX, that figure stands at $3.1 billion. While some of the names of Genesis’ biggest creditors have been redacted in the filing, below is a list of major names.

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


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HEALTHCARE FRAUD: Predatory Senior Medicare Scams

By Staff Reporters

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As you likely know, the US spends much on healthcare ($4.3 trillion in 2021, to be exact). But did you also know that healthcare fraud makes up a not-so-small piece of that pie?

The National Health Care Anti-Fraud Association (NHCAA), a national organization that works to prevent health insurance fraud, conservatively estimates that 3% of the US’s total annual healthcare spend—a hearty $129 billion—is lost to healthcare fraud. Some government agencies estimate that percentage to be as high as 10% (that’s $430 billion), according to the NHCAA.

Overall, Medicare fraud costs the US about $60 billion each year, Nicole Liebau, national resource center director for Senior Medicare Patrol, a government-funded organization designed to help prevent Medicare fraud, told Healthcare Brew, though she added that “the exact figure is impossible to measure.”

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

While Medicare fraud isn’t new, the US saw a rise in one particular tactic during the pandemic: a durable medical equipment (DME) scheme.

How the schemes work.

In a DME scheme, scammers target Medicare patients—often after a procedure or an injury—and cold-call them to offer free equipment, said Jennifer Stewart, senior associate general counsel and senior director of fraud prevention and investigation at Blue Cross Blue Shield of Massachusetts. The scammers offer consumers items like lidocaine, wheelchairs, walkers, or braces.

The scammers have roped in doctors—who are often unaware they’re working with scammers instead of legitimate medical companies—to sign off on prescriptions that are then used to bill Medicare for the equipment, Stewart said. Sometimes patients actually receive the products, and sometimes they don’t.

“It’s really dangerous because [a prescription like lidocaine] could have reactions with other medications. The durable medical equipment isn’t sized for them, and certainly the doctor who treated their injury didn’t prescribe it […] There is a lot of patient harm involved,” Stewart said. Keep reading here.

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“BEAR” it …. So Says Leon Cooperman?

By Staff Reporters

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DEFINITION

A bear market is when a market experiences prolonged price declines. It typically describes a condition in which securities prices fall 20% or more from recent highs amid widespread pessimism and negative investor sentiment.

Bear markets are often associated with declines in an overall market or index like the S&P 500, but individual securities or commodities can also be considered to be in a bear market if they experience a decline of 20% or more over a sustained period of time—typically two months or more. Bear markets also may accompany general economic downturns such as a recession. Bear markets may be contrasted with upward-trending bull markets.

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

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So, If you are feeling optimistic the new year will usher in a change in stock market dynamics and shift sentiment from bear to bull-forget about it!? Leon Cooperman has some bad news for you.

The billionaire investor has been a fully-fledged bear for a while now and 2023 has done little to change his stance. “Anybody looking for a new bull market any time soon is looking the wrong way,” Cooperman said.

In fact, Cooperman thinks there’s only a 5% chance the S&P 500 sees out 2023 above the 4,400 mark (up 13% from current levels), believing the stock market is far likelier to head back down from here.

Cooperman evidently knows a thing or two about investing in bear markets, and if we’re to heed his advice, it’s best to look for ‘safe havens’ to shield from further incoming volatility. OR- Maybe not!

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REAL ESTATE Investing for Physicians

SOME GUIDELINES FOR COLLEAGUES

Touring with Marcinko | The Leading Business Education ...

By Dr. David Edward Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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

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

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

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

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

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

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

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

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

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

Your comments are appreciated.

Thank You.

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

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PODCAST: “Sage Transparency” on Hospital Prices

EMPLOYER SPONSORED HEALTH INSURANCE PLANS

By Eric Bricker MD

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CRYPTO-CURRENCY: Worth Since 2020?

By Staff Reporters

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Winners Since March 2020:

Here’s how much $100 in each of the following cryptocurrencies and stocks back at the bottom of the U.S. market in March 2020 would be worth today:

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

  • Bitcoin (CRYPTO: BTC): $405.67
  • Ethereum (CRYPTO: ETH): $1,268.90
  • Dogecoin (CRYPTO: DOGE): $4,731.19

DHIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security-ebook/dp/B005F84GF2/ref=sr_1_3?crid=2SQPPJMMUV55D&keywords=david+marcinko&qid=1674073311&sprefix=david+marcinko%2Caps%2C115&sr=8-3

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ABOUT: “Turn-it-In”

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Turnitin (stylized as turnitin) is an Internet-based plagiarism detection service run by the American company Turnitin, LLC, a subsidiary of Advance Publications.

LINK: http://www.TurnItIn.com

Founded in 1998, it sells its licenses to universities and high schools who then use the software as a service (SaaS) website to check submitted documents against its database and the content of other websites with the aim of identifying plagiarism. Results can identify similarities with existing sources and can also be used in formative assessment to help students learn to avoid plagiarism and improve their writing.

Students may be required to submit work to Turnitin as a requirement of taking a certain course or class. The software has been a source of controversy, with some students refusing to submit, arguing that requiring submission implies a presumption of guilt. Some critics have alleged that use of this proprietary software violates educational privacy as well as international intellectual-property laws, and exploits students’ works for commercial purposes by permanently storing them in Turnitin’s privately held database.

ChatGPT: https://medicalexecutivepost.com/2023/01/17/chatgpt-a-microsoft-start-up-venture/

Turnitin, LLC also runs the informational website plagiarism.org and offers a similar plagiarism-detection service for newspaper editors and book and magazine publishers called iThenticate. Other tools included with the Turnitin suite are GradeMark (online grading and corrective feedback) and PeerMark (student peer-review service).

NOTE: According to Wikipedia, in March 2019, Advance Publications acquired private Turnitin, LLC for US$1.75 billion.

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PODCAST: Employee Engagement and Health Plans

By Eric Bricker MD

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

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DAILY UPDATE: Cathie Wood, META and Index Futures

By Staff Reporters

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Cathie Wood and Ark’s flagship exchange-traded fund Ark Innovation ETF (NYSE: ARKK) bought 168,989 shares of Tesla on Friday, valued at $20.68 million at the session’s closing price. The stock ended Friday’s session down 0.94% at $122.40, according to Benzinga Pro data. At one point in the session, the loss was as much as 6.4%. For the week, the stock gained 8.26%.

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

Investing $1,000 in META Stock: Shares of Meta Platforms traded at $332.46 on June 4, 2021. A $1,000 investment could have purchased 3 shares of META stock. The $1,000 investment would be worth $410.94 today, based on a current price of $136.98 for Meta Platforms. This represents a loss of 58.9% in 19 months.

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European equities and US stock-index futures fell amid signs central banks will turn more hawkish and as investors focused on earnings reports from Wall Street banks.

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ChatGPT: A Microsoft Start-Up Venture!

By Staff Reporters

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Microsoft is reportedly preparing for its largest startup investment in history: a $10 billion stake in OpenAI that could value the research lab at $29 billion. OpenAI is the creator of potentially groundbreaking AI tools like ChatGPT, the multitalented chatbot that can code in Python and help high schoolers cheat on English essays.

MSFT has already invested $1 billion in OpenAI, but thinks an even tighter relationship would help it better compete with Big Tech rivals like Google (which reportedly declared a “code red” over ChatGPT’s threat to its search dominance).

But Microsoft’s AI ambitions go beyond just integrating ChatGPT know-how into its own search engine, Bing. The company wants to use OpenAI’s tools in its Office suite—and it’s already experimenting with algorithms to help users craft emails in Outlook.

OpenAI was founded in 2015 as a mission-based AI research organization by a roster from Silicon Valley’s A-list, including Elon Musk. Its stated goal is to develop safe AI for the benefit of humanity. But OpenAI has plenty of critics who have called it out for ethical concerns, a lack of transparency, and abandoning its mission for profits.

According to MorningBrew, a slew of buzzy AI product releases in 2022 has startup investors forgetting they ever heard the word “metaverse.” Languishing in the prolonged crypto winter and facing an uncertain economic environment, many venture capitalists see the field as the next big thing to shovel money into their coffers.

MORE :https://www.kevinmd.com/2023/01/revolutionizing-medicine-how-chatgpt-is-changing-the-way-we-think-about-health-care.html

RELATED: https://medicalexecutivepost.com/2023/01/18/about-turn-it-in/

UPDATE: Bill Gates just hinted that he may be working on Open AI’s large language chatbot ChatGPT in collaboration with Microsoft if the reported $10 billion investment in the start-up goes through. Gates also admitted that he’s still involved with the company’s research and product plans, and said he’s watching the developments in ChatGPT “very closely.”

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CRYPTO-CURRENCY: Trades 24/7/365

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The US stock and bond markets are closed today for MLK Day, so we’ll have to wait 24 more hours to see if this year-opening rally will continue for a third week.

But crypto currency trades 24/7, and the same hopeful inflation news that’s been lifting stocks has also given life to beaten-down cryptocurrencies. Bitcoin gained for the 11th straight day on Saturday, topping $20,000 for the first time in more than two months.

So, here are some ways in which the non-stop crypto market affects institutions — banks and exchanges, in particular.

The stock market takes a break every day, and every weekend. That gives all the players in the market — individual investors and institutions — a chance to assess and reposition their assets for their next moves. But since crypto trades all the time, there are stretches during the 24-hour day when banks and exchanges are effectively closed, and money isn’t being moved around as quickly or efficiently as it would during business hours.

This can cause lags — if a crypto trader is trying to deposit money into their crypto exchange account to execute a trade at, say, 2 am ET on a Sunday night, that money won’t actually move until the next day. That has the potential to cause some friction in the markets.

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

In short, there’s a mismatch between the standard business hours of many institutions and the 24-hour nature of the crypto markets, which may have an effect on the markets.

MORE: https://www.newsnow.co.uk/h/Business+&+Finance/Cryptocurrencies

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MEDICARE SUPPLEMENT INSURANCE: Part G

What is it and How Does it Work?

By Staff Reporters

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Did you know that Medicare Plan G is the most popular Medicare Supplement with Baby Boomer clients? Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F, which is no longer available for people new to Medicare on or after January 1st, 2020. Plan G offers great value for beneficiaries willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your Medicare Part A hospital deductible, co-pays, and coinsurance. It also covers the 20% that Medicare Part B doesn’t cover. Doctors and other healthcare providers must accept a Medigap Plan G if they accept Original Medicare. Plan G policies can be used across the U.S. since they do not have network limitations, and the premium costs can be very reasonable for the coverage you receive.

As you can see below, Supplement Plan G covers almost everything that F does, except for the Part B deductible.

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Medicare Plan G, also called Medigap Plan G, is an increasingly popular Supplement

Reasons:

First, Plan G covers each of the gaps in Medicare except for the annual Part B deductible. This deductible is only $226 in 2023. In fact, if you have a Plan F that has been in place for years, it can probably help you on premiums by looking at Plan G. When you shop for benefits, you can often find a Supplement Plan G that saves quite a bit in premiums over Plan F, usually substantially more than the $226 deductible that you’ll pay out.

Second, it has great coverage. For hospital stays, it covers all your hospital expenses. Most importantly, it pays the hospital deductible, which is over $1,600 in 2023. It also covers the expensive daily co-pays that you might encounter for a hospital stay that runs longer than 60 days. It provides an additional 365 days in the hospital after your Medicare benefits run out, and it covers your skilled nursing facility co-insurance, too.

What Other Medical Services Does Plan G Cover?

Medicare Supplement Plan G covers your percentage of any medical benefit that Original Medicare covers, except for the outpatient deductible. So, it helps to pay for inpatient hospital costs, such as the first three pints of blood, skilled nursing facility care, and hospice care. It also covers outpatient medical services such as doctor visits, lab work, diabetes supplies, cancer treatment, durable medical equipment, x-rays, ambulance, surgeries and much more. This means Plan G covers the coverage gaps with Original Medicare and all Plan G products must provide you with the exact same coverage.

Medicare pays first, then Plan G pays the remaining amount after you pay the once annual deductible. In addition, Plan G Medicare Supplements offer up to $50,000 in foreign travel emergency benefits (up to plan limits).

Related Article: Medicare Costs for 2023

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

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Why Physicians DO NOT Get Rich?

SOME REASONS WHY DOCTORS DON’T GET RICH

“Physicians have a significantly low propensity to accumulate substantial wealth.”

Thomas Stanley – Author “The Millionaire Next Door”

[New York Times]

How come doctors fail to get rich? Re-read the above!

By Dr. David Edward Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

The Institute of Medical Business Advisors Inc identified several reasons based on observations working with medical professional and physician clients over the years.

A late start

By the time doctors finish medical school and residency they’re typically in their middle or late thirties. Many have families to feed, and substantial student loans to pay off. It will be years before they can even start accumulating wealth. Consider that physicians typically enter careers at later ages, often with larger debts from training. Some specialties may not lead a case until 10 years of practice, and many specialties have limited longevity. Peak earning years may also be shorter for health care providers than other professionals. Financial survival skills are paramount for converting the limited earnings time period to personal financial security.

Challenging socio-political environment

It is increasingly challenging to practice medicine. With the Medicare Trust Fund slated to go bust in 2019, the Center for Medicare and Medicare Service (CMS) is increasingly resorting to cutting physician reimbursements and implementing capitation and bundled value based medical payments models. The medical reimbursement effects of the PP-ACA are not yet fully discerned; but appear to continue the decline in compensation. And to illustrate this potential governmental control, in what other industry can participants debate the simple question, “who is the customer?”

Lifestyle expectations

Society expects a doctor to live like a doctor, dress like a doctor, and drive like a doctor. Meeting social expectations can be quite expensive.

Time and energy

A doctor can’t be just a doctor any more. S/he also has to deal with ever increasing regulatory mandates, paperwork requirements by state and federal agencies and capricious insurance companies. It is estimated that for every hour spent on patient care, and additional half-hour is spent on paperwork. To-date, the use of electronic medical records has exacerbated; not ameliorated this problem. The demand on their time is mind-boggling. A typical doctor works a ten- to twelve-hour day. After work and family, they simply don’t have time and energy left to do comprehensive financial planning.

Financially naïve

Doctors are smart. They’re highly trained in their area of expertise. But, that doesn’t translate into understanding about finance or economics. Because they are smart, it’s easy for them to think they can easily master and execute concepts of personal financial planning, as well. Often, they don’t.

Lack of trust and delegation

Many doctors don’t trust financial advisors working for major Wall Street banks. They have the good instinct to realize that their interests are not aligned. Not knowing there are independent advisors out there who observe a strict fiduciary standard, they tend to do everything by themselves.

In fact, Paul Larson CFP®, President-CEO of the firm LARSON Financial Group LLC, noted a disquieting trend among physician client in his firm [personal communication]. Almost 90% of them fail to take care of their own family finances in a comprehensive manner; while only 10% are succeeding.  The strategies in this chapter and book are common to their success.

Too Trusting

Another aspect of naivety, many physicians do not realize that the financial advisory industry lacks the same discipline and regulation that the average physician operates in. A primary care doctor would never even attempt a complicated surgery on a patient, but is trained to refer such patients to a specialist in the field with the proper training and experience. Financial Advisors often come from a sales background and are trained to keep a client in house even if the advisor is lacking in expertise. Also, many physicians are not trained to discern a qualified financial advisor from a sales person dressed up like a financial advisor. It is illegal to call yourself a physician in the United States unless you have the credentials to back it up; yet, anyone in the US can legally call themselves a financial advisor or a financial planner.

Your thoughts are appreciated.

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

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Medical School Ethics VERSUS Business School Ethics

Is Business Finally Embracing Medical Values?

[By Render S. Davis MHA CHE]

[By David Edward Marcinko MBA]

dr-david-marcinko

In the evolutionary shifts in models for medical care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.

While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other business parties to the health care delivery system to raise their ethical bar.

Tit-for-Tat

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

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face-off

[Medicine versus Business]

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Assessment

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.

Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

About the Author

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

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

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MORGAN STANLEY: S&P 500 May Drop Another 22% in 2023?

By Staff Reporters

Many investors were happy to wave goodbye to 2022, Wall Street’s worst year since 2008. The S&P finished down 19.4%, while the tech centered NASDAQ shed 33.1%. The blue-chip focused Dow Jones did better, losing just 8.8% across the year. Unfortunately, a number of senior investment bankers predict 2023 could bring more stock market woes. Most recently, in fact, Morgan Stanley Chief U.S. Equity Strategist & Chief Investment Officer, Michael Wilson, said he thought the S&P 500 could drop by another 22% in 2023.

Wilson wrote in a note this week that next year’s losses could be more significant than many are expecting. According to Bloomberg, Wilson thinks a peak in inflation would be “very negative for profitability.” He added, “The consensus could be right directionally, but wrong in terms of magnitude.”

Some analysts think that when inflation peaks, the Federal Reserve will ease up on its aggressive rate hikes and the stock market will recover. But Wilson argues this is only part of the picture. He thinks falling prices would have a knock-on effect on company profits, and the subsequent drop in margins would outweigh any benefit from a change in the Fed’s stance.

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

Wilson also alerted clients to the risk that companies would be caught “off guard” by a combination of falling demand and a catch up in supply. Supply chain issues, caused by a mix of COVID-19 lock downs, labor shortages, and other factors, have contributed to price increases and had a negative impact on production. If the supply chain starts to recover at the same time as recession-induced drops in consumption levels, he thinks the stock market could fall further.

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

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DAILY UPDATE: Elon Musk Wins but SPACS Do Not

By Staff Reporters

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A judge just ruled that a group of laid-off Twitter employees suing the business over their severance compensation, have to pursue their claims individually rather than as part of a class action, according to a Bloomberg report. About 500 of the roughly 3,700 Twitter employees Elon Musk laid off since taking control of the company last year have already filed individual arbitration claims, according to Shannon Liss-Riordan, the lawyer who filed those claims on the workers’ behalf.

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SPAC SEEKING SPAC: Money-losing companies that recently went public via SPAC are combining with other SPACs to secure more funding and stay afloat. The ultimate goal is one giant SPAC?

DEFINITION: https://medicalexecutivepost.com/2022/06/13/spac-v-direct-listing-v-ipo/

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

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

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COMMENTS APPRECIATED

Thank You

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